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National AIDS Control Organisation ’s voice against AIDS Ministry of Health & Family Welfare, 6th & 9th Floors, Chandralok Building, 36, Janpath, New - 110001 www.naco.gov.in VERSION 1.0 GOI/NACO/SIM/DEP/011214 Published with support of the Centers for Disease Control and Prevention under Cooperative Agreement No. 3U2GPS001955 implemented by FHI 360 District HIV/AIDS Epidemiological Profiles developed through Data Triangulation

FACT SHEETS

National AIDS Control Organisation

India’s voice against AIDS Ministry of Health & Family Welfare, Government of India 6th & 9th Floors, Chandralok Building, 36, Janpath, New Delhi - 110001 www.naco.gov.in

December 2014

Dr. Ashok Kumar, M.D. F.I.S.C.D & F.I.P.H.A Dy. Director General Tele : 91-11-23731956 Fax : 91-11-23731746 E-mail : [email protected] FOREWORD The national response to HIV/AIDS in India over the last decade has yielded encouraging outcomes in terms of prevention and control of HIV. However, in recent years, while declining HIV trends are evident at the national level as well as in most of the States, some low prevalence and vulnerable States have shown rising trends, warranting focused prevention efforts in specific areas. The National AIDS Control Programme (NACP) is strongly evidence-based and evidence-driven. Based on evidence from ‘Triangulation of Data’ from multiple sources and giving due weightage to vulnerability, the organizational structure of NACP has been decentralized to identified districts for priority attention. The programme has been successful in creating a robust database on HIV/AIDS through the HIV Sentinel Surveillance system, monthly programme reporting data and various research studies. However, the district level focus of the programme demands consolidated information that helps better understand HIV/AIDS scenario in each district, to enable effective targeting of prevention and treatment interventions to the vulnerable population groups and geographic areas. Information collected and analysed during the extensive data triangulation exercise conducted during 2009-10 and 2010-11 and updated data from recent years has been the basis for this technical document on District HIV Epidemiological Profiling. For each district it consists of a brief narrative report on the district background, the HIV/ AIDS epidemic profile of the district based on the updated information compiled from all the available sources, and key recommendations based on the identified information gaps and areas for programme interventions. I strongly feel that this document will be highly useful for programme managers at district, State and national levels. The major outcomes of this exercise were systematic compilation of the available data for a district at one place, identification of information gaps for effective strategic planning at district level, and development of a framework for re-prioritisation of districts under the programme. The other key achievements were institutional strengthening, capacity building of programme staff in data analysis and data use, and involvement and ownership of staff of service delivery units in the entire process. We congratulate the efforts made by the National Technical Team, the State AIDS Control Societies, and the State Coordinating agencies and all the district level personnel involved in the process. The technical & financial support provided by our partner agencies UNAIDS, USAID, BMGF and PHFI for this exercise is gratefully acknowledged. Special thanks to the officers from CDC, FHI 360, WHO, UNAIDS & JSI for their efforts in finalizing the individual factsheets. The efforts of the Officers of Data Analysis & Dissemination Unit at NACO for planning, coordinating & successfully completing this process and bringing out this valuable document, are appreciated.

(Dr. Ashok Kumar) iii Acknowledgement

Under the project ‘District Epidemiological Profiling’ using Data Tringulation, the National AIDS Control Organisation had undertaken a systematic compilation and analysis of all the available data for 539 districts of the country from multiple sources, including surveillance data and programme data, to derive meaningful inferences. This document is an outcome of the Data Triangulation excercise and provides the district-wise HIV epidemic summary and programme response. This enormous task would not have been possible without the involvement and ownership of district level programme managers and staff of service delivery units. The contributions of the District AIDS Prevention and Control Unit teams (Programme Managers, M&E Officers), ICTC Supervisors, Counselors, Targeted Intervention staff, ART Research Officers, NRHM District Programme Officers and others who were actively involved in the entire process, are highly appreciated. The collaborative effort of the State Coordinating Agencies and the State AIDS Control Societies (SACS) involved in identifying programme questions, performing quality checks and data validation, preparation of data tables and compiling data for development of district profile reports, is sincerely acknowledged. The efforts of Deputy Director (M&E), State Epidemiologists and M&E Officers of SACS who implemented this exercise under the guidance and leadership of the Project Directors and Additional Project Directors are also appreciated. The efforts made by the National Technical Team members who developed guidelines and tools for undertaking this project, and the teams involved in finalizing the database for each district and in preparing the district factsheets, are highly commendable. The technical & financial support provided by our partner agencies UNAIDS, USAID, BMGF and PHFI for this exercise is gratefully acknowledged. Special thanks to the officers from CDC, FHI 360, WHO, UNAIDS & JSI for their sincere efforts in finalizing the individual district database and factsheets. Role of Officers of Data Analysis & Dissemination Unit at NACO are deeply appreciated for planning, coordinating & successfully completing this process and bringing out this valuable document.

iv Contents

Foreword ...... iii Acknowledgement ...... iv Contents ...... v Acronyms ...... vi Glossary ...... vii

Introduction ...... 1 16. ...... 40

Methodology ...... 2 17. ...... 42

Specific Notes on Fact sheets ...... 6 18. ...... 44

District Map of Maharashtra ...... 9 19. ...... 46

1. ...... 10 20. Nandurbar ...... 48

2. ...... 12 21. ...... 50

3. ...... 14 22. Osmanabad ...... 52

4. ...... 16 23. ...... 54

5. ...... 18 24. ...... 56

6. ...... 20 25. Raigarh ...... 58

7. Buldana ...... 22 26. ...... 60

8. ...... 24 27. ...... 62

9. ...... 26 28. ...... 64

10. ...... 28 29. Sindhudurg ...... 66

11. ...... 30 30. ...... 68

12. ...... 32 31. ...... 70

13. Jalgao ...... 34 32. ...... 72

14. Jalna ...... 36 33. ...... 74

15. ...... 38 34. ...... 76

v Acronyms Glossary

AIDS Acquired Immune Deficiency Syndrome 1. ART Centre: Free first line and second line Anti-Retroviral Treatment (ART) is provided to clinically eligible PLHIV ANC Antenatal Clinic at designated centres across the country. As soon as the persons are detected to be HIV positive at ICTC, they are ART Anti-Retroviral Therapy referred to the ART centre for pre-ART registration. At the time of registration, all the baseline investigations are done including CD4 count. If these persons are clinically eligible for treatment, they are started on first line ART. BSS Behavioral Surveillance Survey Otherwise, PLHIV are followed up every six months for CD4 count. The number of PLHIV on ART mentioned in the CCC Community Care Centre document refers to those on first line ART at NACO-supported ART centres. Another 30,000 PLHIV are estimated CMIS Computerised Management Information System to be receiving ART in the private sector. DEP District Epidemiological Profile 2. Blood Safety: Under the Blood Safety programme, Blood Banks across the country are supported by NACO and DIC Drop-in-Centre voluntary blood donation is strongly promoted to ensure that every blood unit collected is screened and is free DLHS District Level Health Survey from HIV and other infections. DLN District Level Network for HIV positive people 3. Community Care Centres (CCC): CCC have been set up in the non-government sector with the objective of FSW Female Sex Workers providing PLHIV with psychosocial support, counseling for drug adherence and nutrition, treatment of opportunistic HIV Human Immunodeficiency Virus infections, home-based care, referral and outreach services for follow up, besides tracing patients lost to follow up HRG High Risk Group and those missing anti-retroviral drugs as per schedule. HSS HIV Sentinel Surveillance 4. Condom Promotion: The condom promotion strategy under NACP focuses on two aspects: ensuring availability IBBA Integrated Biological and Behavioral Assessment of and creating demand for condoms. There are two channels of condom supply by the Government, namely IBBS Integrated Biological and Behavioral Survey free and socially marketed. Under the programme, free condoms are distributed to High Risk Groups through TI ICTC Integrated Counseling and Testing Centre projects and service delivery outlets such as ICTCs, STI clinics, etc. Under the Targeted Condom Social Marketing IDU Injecting Drug Users Programme, condoms are provided at subsidized rates for HRG as well as general population through traditional and non-traditional condom outlets, rural outlets, and outlets at TIs and truck halt points. IEC Information Education & Communication LAC Link ART Centre 5. Core Composite TI: Targeted Interventions providing HIV prevention services to more than one High Risk MSM Men who have Sex with Men Group. NACO National AIDS Control Organisation 6. Counseling and Testing Services: Integrated Counseling and Testing Centre (ICTC) is a place where a person NACP National AIDS Control Programme is counseled and tested for HIV on his/her own volition (Client-Initiated) or as advised by a health service provider (Provider-Initiated) in a supportive and confidential environment. These centres are the entry points for reinforcing NFHS National Family Health Survey HIV prevention messages and linking HIV positive people to HIV care, support and treatment services. There are PLHIV People Living with HIV several contexts for providing HIV testing services - voluntary counseling and testing, prevention of parent to child PPTCT Prevention of Parent to Child Transmission transmission, screening of TB patients and diagnostic testing of symptomatic patients. RRC Red Ribbon Club 7. Drop-in-Centre (DIC): DIC is a platform to provide PLHIV psycho-social support, linkages with services counseling RTI Reproductive Tract Infection on drug adherence, nutrition, livelihood and legal issues. They have been set up in the high prevalent districts and SACS State AIDS Control Society are managed primarily by PLHIV networks. SCA State Coordinating Agency 8. High Risk Groups (HRG): Populations with high risk behaviour for contracting HIV, include Female Sex Workers STD Sexually Transmitted Disease (FSW), Men who have Sex with Men (MSM) and Injecting Drug Users (IDU). The other risk groups identified STI Sexually Transmitted Infection as Bridge Population (between the General population and HRG) include the Single Male Migrants and Long TB Tuberculosis Distance Truckers. TI Targeted Interventions vi vii Acronyms Glossary

AIDS Acquired Immune Deficiency Syndrome 1. ART Centre: Free first line and second line Anti-Retroviral Treatment (ART) is provided to clinically eligible PLHIV ANC Antenatal Clinic at designated centres across the country. As soon as the persons are detected to be HIV positive at ICTC, they are ART Anti-Retroviral Therapy referred to the ART centre for pre-ART registration. At the time of registration, all the baseline investigations are done including CD4 count. If these persons are clinically eligible for treatment, they are started on first line ART. BSS Behavioral Surveillance Survey Otherwise, PLHIV are followed up every six months for CD4 count. The number of PLHIV on ART mentioned in the CCC Community Care Centre document refers to those on first line ART at NACO-supported ART centres. Another 30,000 PLHIV are estimated CMIS Computerised Management Information System to be receiving ART in the private sector. DEP District Epidemiological Profile 2. Blood Safety: Under the Blood Safety programme, Blood Banks across the country are supported by NACO and DIC Drop-in-Centre voluntary blood donation is strongly promoted to ensure that every blood unit collected is screened and is free DLHS District Level Health Survey from HIV and other infections. DLN District Level Network for HIV positive people 3. Community Care Centres (CCC): CCC have been set up in the non-government sector with the objective of FSW Female Sex Workers providing PLHIV with psychosocial support, counseling for drug adherence and nutrition, treatment of opportunistic HIV Human Immunodeficiency Virus infections, home-based care, referral and outreach services for follow up, besides tracing patients lost to follow up HRG High Risk Group and those missing anti-retroviral drugs as per schedule. HSS HIV Sentinel Surveillance 4. Condom Promotion: The condom promotion strategy under NACP focuses on two aspects: ensuring availability IBBA Integrated Biological and Behavioral Assessment of and creating demand for condoms. There are two channels of condom supply by the Government, namely IBBS Integrated Biological and Behavioral Survey free and socially marketed. Under the programme, free condoms are distributed to High Risk Groups through TI ICTC Integrated Counseling and Testing Centre projects and service delivery outlets such as ICTCs, STI clinics, etc. Under the Targeted Condom Social Marketing IDU Injecting Drug Users Programme, condoms are provided at subsidized rates for HRG as well as general population through traditional and non-traditional condom outlets, rural outlets, and outlets at TIs and truck halt points. IEC Information Education & Communication LAC Link ART Centre 5. Core Composite TI: Targeted Interventions providing HIV prevention services to more than one High Risk MSM Men who have Sex with Men Group. NACO National AIDS Control Organisation 6. Counseling and Testing Services: Integrated Counseling and Testing Centre (ICTC) is a place where a person NACP National AIDS Control Programme is counseled and tested for HIV on his/her own volition (Client-Initiated) or as advised by a health service provider (Provider-Initiated) in a supportive and confidential environment. These centres are the entry points for reinforcing NFHS National Family Health Survey HIV prevention messages and linking HIV positive people to HIV care, support and treatment services. There are PLHIV People Living with HIV several contexts for providing HIV testing services - voluntary counseling and testing, prevention of parent to child PPTCT Prevention of Parent to Child Transmission transmission, screening of TB patients and diagnostic testing of symptomatic patients. RRC Red Ribbon Club 7. Drop-in-Centre (DIC): DIC is a platform to provide PLHIV psycho-social support, linkages with services counseling RTI Reproductive Tract Infection on drug adherence, nutrition, livelihood and legal issues. They have been set up in the high prevalent districts and SACS State AIDS Control Society are managed primarily by PLHIV networks. SCA State Coordinating Agency 8. High Risk Groups (HRG): Populations with high risk behaviour for contracting HIV, include Female Sex Workers STD Sexually Transmitted Disease (FSW), Men who have Sex with Men (MSM) and Injecting Drug Users (IDU). The other risk groups identified STI Sexually Transmitted Infection as Bridge Population (between the General population and HRG) include the Single Male Migrants and Long TB Tuberculosis Distance Truckers. TI Targeted Interventions vi vii 9. Link ART Centres: In order to facilitate the delivery of ART services nearer to the homes of beneficiaries, the Link ART Centres (LAC), located mainly at ICTC in the District/Sub-district level hospitals, were set up and linked to nodal ART centres within accessible distance. Introduction 10. PLHIV Networks: Networks of HIV positive persons have been formed at the national, state and district levels. The National AIDS Control Programme under National AIDS Control Organisation has a strong focus on district level Such networks act as platforms for People Living with HIV/AIDS (PLHIV) to share their concerns, and seek support planning, implementation and monitoring of interventions for prevention and control of HIV/AIDS. This approach and legal aid. They address stigma and discrimination-related cases among their members and also provide social requires consolidated information for each district to understand the HIV epidemic scenario and to identify programme support for those isolated by their family and community. The networks are encouraged to advocate and promote areas for priority attention. the utilisation of HIV related services. During the past few years, greater information related to HIV has become available for a substantial number of 11. Prevention of Parent to Child Transmission (PPTCT): Mother to child transmission of HIV may take place districts in the country in the form of monthly programme reports, mapping and size estimations of risk groups, data during pregnancy, during childbirth or through breast feeding. To prevent this, under the PPTCT programme every from HIV Sentinel Surveillance, behavioural surveys research studies, and etc. pregnant woman visiting antenatal clinics or visiting hospital at the time of delivery is tested for HIV infection. A pregnant woman found positive for HIV infection is closely followed up to ensure institutional delivery. At the In view of this context, the Department of AIDS Control had undertaken a project titled “Epidemiological Profiling time of delivery, the pregnant woman and the new-born baby are given a single dose of Nevirapine to prevent of HIV/ AIDS Situation at District and Sub-district Level using Data Triangulation”/“District Epidemiological Profiling mother to child transmission of HIV. (DEP)” in 25 states (539 districts) in two phases during 2009-10 and 2010-11. 12. Red Ribbon Clubs: Red Ribbon Clubs (RRC) formed in colleges provide a forum for students to come together The exercise of District Epidemiological Profiling involved two broad components – Descriptive Analysis and Data to share information on HIV/AIDS and safe behaviours, to discuss related issues and also motivate them to Triangulation. The former part is guided by thematic areas and describes the ‘what, who, when & where’ of the HIV participate in voluntary blood donation. epidemic, while the latter ‘Triangulation’ part explains the ‘how and why’ of it by synthesizing data from multiple sources into a meaningful framework. The available epidemiological data, behavioural/ vulnerability data and 13. STI/RTI Services: Sexually Transmitted Infections/Reproductive Tract Infections increase the risk of HIV transmission programme data for the district level were compiled and analysed to get a comprehensive picture of the HIV/AIDS significantly. STI/RTI services are aimed at preventing HIV transmission and promoting sexual and reproductive epidemic scenario, in order to guide programme decisions appropriately in each district. health under the National AIDS Control Programme and the Reproductive and Child Health programme of the National Rural Health Mission (NRHM). The important outcomes of the District Epidemiological Profiling exercise included the generation of reports describing the HIV profile and programme response in each district, identification of information gaps for planning strategic 14. Targeted Intervention: Targeted Interventions (TI) are peer-led preventive interventions focused on HRG and information activities, capacity building of district level personnel in data management, institutional strengthening bridge populations, implemented by Non-Government Organisations and Community-based Organisations in a and fostering linkages between programme units and academic institutions for addressing strategic information defined geographic area. They provide prevention services such as behavioural change communication, condom needs in the programme. distribution, STI/RTI services, needle and syringe exchange, Opioid substitution therapy, referrals and linkages to health facilities providing HIV/AIDS services, community mobilisation and creating enabling environment. This technical document consists of the epidemiological profile summary along with the available updated information for each district of the State. Each district summary highlights the key epidemiological features of the district and key recommendations based on these findings. The document would be useful to programme managers, academicians and researchers as a quick reference for the HIV/AIDS situation in a district.

viii 9. Link ART Centres: In order to facilitate the delivery of ART services nearer to the homes of beneficiaries, the Link ART Centres (LAC), located mainly at ICTC in the District/Sub-district level hospitals, were set up and linked to nodal ART centres within accessible distance. Introduction 10. PLHIV Networks: Networks of HIV positive persons have been formed at the national, state and district levels. The National AIDS Control Programme under National AIDS Control Organisation has a strong focus on district level Such networks act as platforms for People Living with HIV/AIDS (PLHIV) to share their concerns, and seek support planning, implementation and monitoring of interventions for prevention and control of HIV/AIDS. This approach and legal aid. They address stigma and discrimination-related cases among their members and also provide social requires consolidated information for each district to understand the HIV epidemic scenario and to identify programme support for those isolated by their family and community. The networks are encouraged to advocate and promote areas for priority attention. the utilisation of HIV related services. During the past few years, greater information related to HIV has become available for a substantial number of 11. Prevention of Parent to Child Transmission (PPTCT): Mother to child transmission of HIV may take place districts in the country in the form of monthly programme reports, mapping and size estimations of risk groups, data during pregnancy, during childbirth or through breast feeding. To prevent this, under the PPTCT programme every from HIV Sentinel Surveillance, behavioural surveys research studies, and etc. pregnant woman visiting antenatal clinics or visiting hospital at the time of delivery is tested for HIV infection. A pregnant woman found positive for HIV infection is closely followed up to ensure institutional delivery. At the In view of this context, the Department of AIDS Control had undertaken a project titled “Epidemiological Profiling time of delivery, the pregnant woman and the new-born baby are given a single dose of Nevirapine to prevent of HIV/ AIDS Situation at District and Sub-district Level using Data Triangulation”/“District Epidemiological Profiling mother to child transmission of HIV. (DEP)” in 25 states (539 districts) in two phases during 2009-10 and 2010-11. 12. Red Ribbon Clubs: Red Ribbon Clubs (RRC) formed in colleges provide a forum for students to come together The exercise of District Epidemiological Profiling involved two broad components – Descriptive Analysis and Data to share information on HIV/AIDS and safe behaviours, to discuss related issues and also motivate them to Triangulation. The former part is guided by thematic areas and describes the ‘what, who, when & where’ of the HIV participate in voluntary blood donation. epidemic, while the latter ‘Triangulation’ part explains the ‘how and why’ of it by synthesizing data from multiple sources into a meaningful framework. The available epidemiological data, behavioural/ vulnerability data and 13. STI/RTI Services: Sexually Transmitted Infections/Reproductive Tract Infections increase the risk of HIV transmission programme data for the district level were compiled and analysed to get a comprehensive picture of the HIV/AIDS significantly. STI/RTI services are aimed at preventing HIV transmission and promoting sexual and reproductive epidemic scenario, in order to guide programme decisions appropriately in each district. health under the National AIDS Control Programme and the Reproductive and Child Health programme of the National Rural Health Mission (NRHM). The important outcomes of the District Epidemiological Profiling exercise included the generation of reports describing the HIV profile and programme response in each district, identification of information gaps for planning strategic 14. Targeted Intervention: Targeted Interventions (TI) are peer-led preventive interventions focused on HRG and information activities, capacity building of district level personnel in data management, institutional strengthening bridge populations, implemented by Non-Government Organisations and Community-based Organisations in a and fostering linkages between programme units and academic institutions for addressing strategic information defined geographic area. They provide prevention services such as behavioural change communication, condom needs in the programme. distribution, STI/RTI services, needle and syringe exchange, Opioid substitution therapy, referrals and linkages to health facilities providing HIV/AIDS services, community mobilisation and creating enabling environment. This technical document consists of the epidemiological profile summary along with the available updated information for each district of the State. Each district summary highlights the key epidemiological features of the district and key recommendations based on these findings. The document would be useful to programme managers, academicians and researchers as a quick reference for the HIV/AIDS situation in a district.

viii District HIV/AIDS Epidemiological Profiles :Maharashtra | 1 Methodology Framework of District Epidemiological Profling (DEP): DEP has two broad components Descriptive Analysis Concept of Data Triangulation: Data Triangulation is an Analytical Approach that synthesizes data from and Data Triangulation. multiple sources to improve the understanding of a public health issue and guide programmatic decision-making to address the issue (Fig. 2). By putting different bits of information from different sources into a meaningful framework, Table 1: Components of District Epidemiological Profling it explains and improves the understanding of HIV/AIDS scenario in the district. By providing answers to vital programme questions, it helps in taking effective decisions for planning and implementation of HIV prevention and Components Guiding control efforts. It helps to understand the gap between need and programme response and also helps to identify the of District What it Does? Action To Do Output Elements information gaps that hinder effective planning. Proling Describes Descriptive Analyse Data & Descriptive Section of (What? Who? When? Themes Analysis Describe the Themes District Report Where?) HIV & STIs Explains Triangulate Data & Synthesis Section of Triangulation Questions in Different (How? Why?) Answer the Questions District Report Groups

Descriptive analysis of different datasets is organized into the following four thematic areas (Fig.1): TRIANGULATION 1. Current state of HIV epidemic (levels, trends, differentials and burden of HIV; profle of PLHIV) 2. Drivers of the epidemic (size and profle of risk groups; vulnerabilities STI, risk behaviour, Migration, contextual factors/regional vulnerabilities) Size & Vulnerability Programme 3. Programme response and gaps of Risk Response Groups 4. Information gaps Programme Fig. 2: Conceptual Framework of Data Triangulation Drivers of Response & Synthesis of Epidemiological, Behavioural and Programme Data Epidemic Gaps The basic principle of Data Triangulation is “to analyse and interpret a dataset in the light of information emerging Current from other datasets, so that the synthesis offers a better understanding of the issues than what will be inferred from a Information State of single dataset.” Triangulation involves compilation, examination, comparison and collective interpretation Gaps Epidemic District of data from multiple independent data sources, followed by reasonable explanation of facts pertaining to the issue Profle under consideration (Fig. 3). The explanation is aimed towards developing a comprehensive picture of the issue, building an epidemiological framework that depicts the possible interplay among various factors and answering some pre-specified questions. Fig. 1: Thematic Areas of District Profling Epidemiological Framework of HIV/AIDS Scenario in the District

Data Triangulation may be of information on same data element from different data sources or of information on different data elements. Triangulation may be done in the time plane or geographical plane. Triangulation synthesizes the data on the following three elements to explain the inferences arrived at in the descriptive analysis and provides answers to the programmatic questions. 1. Information on HIV and STIs in different population groups (epidemiological data) 2. Information on vulnerabilities (mapping and behavioural data on Risk Groups, district vulnerabilities)

3. Information on programme response (programme data) Fig. 3: Schematic representation of processes involved in Data Triangulation

2 | District HIV/AIDS Epidemiological Profiles :Maharashtra Methodology Framework of District Epidemiological Profling (DEP): DEP has two broad components Descriptive Analysis Concept of Data Triangulation: Data Triangulation is an Analytical Approach that synthesizes data from and Data Triangulation. multiple sources to improve the understanding of a public health issue and guide programmatic decision-making to address the issue (Fig. 2). By putting different bits of information from different sources into a meaningful framework, Table 1: Components of District Epidemiological Profling it explains and improves the understanding of HIV/AIDS scenario in the district. By providing answers to vital programme questions, it helps in taking effective decisions for planning and implementation of HIV prevention and Components Guiding control efforts. It helps to understand the gap between need and programme response and also helps to identify the of District What it Does? Action To Do Output Elements information gaps that hinder effective planning. Proling Describes Descriptive Analyse Data & Descriptive Section of (What? Who? When? Themes Analysis Describe the Themes District Report Where?) HIV & STIs Explains Triangulate Data & Synthesis Section of Triangulation Questions in Different (How? Why?) Answer the Questions District Report Groups

Descriptive analysis of different datasets is organized into the following four thematic areas (Fig.1): TRIANGULATION 1. Current state of HIV epidemic (levels, trends, differentials and burden of HIV; profle of PLHIV) 2. Drivers of the epidemic (size and profle of risk groups; vulnerabilities STI, risk behaviour, Migration, contextual factors/regional vulnerabilities) Size & Vulnerability Programme 3. Programme response and gaps of Risk Response Groups 4. Information gaps Programme Fig. 2: Conceptual Framework of Data Triangulation Drivers of Response & Synthesis of Epidemiological, Behavioural and Programme Data Epidemic Gaps The basic principle of Data Triangulation is “to analyse and interpret a dataset in the light of information emerging Current from other datasets, so that the synthesis offers a better understanding of the issues than what will be inferred from a Information State of single dataset.” Triangulation involves compilation, examination, comparison and collective interpretation Gaps Epidemic District of data from multiple independent data sources, followed by reasonable explanation of facts pertaining to the issue Profle under consideration (Fig. 3). The explanation is aimed towards developing a comprehensive picture of the issue, building an epidemiological framework that depicts the possible interplay among various factors and answering some pre-specified questions. Fig. 1: Thematic Areas of District Profling Epidemiological Framework of HIV/AIDS Scenario in the District

Data Triangulation may be of information on same data element from different data sources or of information on different data elements. Triangulation may be done in the time plane or geographical plane. Triangulation synthesizes the data on the following three elements to explain the inferences arrived at in the descriptive analysis and provides answers to the programmatic questions. 1. Information on HIV and STIs in different population groups (epidemiological data) 2. Information on vulnerabilities (mapping and behavioural data on Risk Groups, district vulnerabilities)

3. Information on programme response (programme data) Fig. 3: Schematic representation of processes involved in Data Triangulation

District HIV/AIDS Epidemiological Profiles :Maharashtra | 3 Other key features of the process of Data Triangulation are as follow: Process of District Epidemiological Profling: The process starts with identifying a broad set of important, 1. It gives importance to every bit of information actionable and appropriate questions that the programme wants to find answers to, in a given region, and revisits 2. It helps overcome limitations and biases inherent in each dataset and refines the questions at every step of the process. The process of DEP has the following steps: 3. It adds value to each dataset and improves their utility 1. Understanding thematic areas and questions for District Profiling and Triangulation 4. It gives high importance to quality analysis of data and undertakes thorough quality checks and validation 2. Review of data sources and assessment of data availability in the district 5. Indicates the level of reliability in any inference or conclusion 3. Decision on themes to be described and questions to be answered for the district 4. Compilation of secondary data 5. Quality check for completeness, correctness and consistency Table 2: Data Sources used for District Epidemiological Profiling 6. Data validation, adjustments and filling data gaps Thematic areas for HIV Epidemiological Major Sources 7. Preparation of data tables with clean data for analysis Profling 8. Data analysis, interpretation and inferences; describe thematic areas HIV Levels, Trends and Differentials HIV Sentinel Surveillance (HSS); Integrated Biological & 9. Data Triangulation (hypotheses building; answer triangulation questions) Behaviroual Assessment (IBBA); ICTC data; PPTCT data; Blood 10. Preparation of district and State reports bank data; NFHS-III; Any other HIV prevalence studies 11. Discussions and consultation with SACS, local experts, district level programme managers and service delivery STI Levels, Trends and Differentials Behaviroual Surveys (IBBA); STI Clinic data; Targeted functionaries on draft reports Intervention (TI) data; NFHS-I,II & III; DLHS-I ,II & III; 12. Presentation and discussion of draft reports with the National Technical Team Other Behavioral studies 13. Finalisation of District Epidemiological Profile reports HIV burden in the district HIV estimations Size Estimates of General Population and Census Population Projections; Mapping of HRG; TI data Important Outcomes of District Epidemiological Profiling include: Other Risk Groups 1. Cleaning and validation of programme data (since 2004) Profile, Turn-over & Migration of key risk HSS ;IBBA; BSS; Mapping of HRG ;ICTC data; STI Clinic data; 2. Systematic compilation of all data related to HIV for each district at one place for routine use groups TI data; Other Studies on High Risk Groups; DLHS 3. District reports describing the profile of HIV epidemic and programme response in each district Size & Patterns of Migration among Census data; Mapping of Migrants; Population Council studies; 4. Development of framework for re-prioritisation of districts under the programme General Population Other studies on migrants 5. Prioritisation extended upto Sub-district/Block level with high priority blocks identified Risk Behaviours and Prevention Practices BSS; IBBA; DLHS; TI data; Mapping of HRG; Other published/ 6. Identification of information gaps at district and state level for planning strategic Information activities among key risk groups and general population unpublished data 7. Capacity building of district level programme managers and staff of service delivery units in handling and analyzing Profile of PLHIV HSS; IBBA; ICTC data; PPTCT data; ART data; Positive person data, enabling them to understand the importance of the data they generate and the need for ensuring its quality, networks; Blood Bank Data; NFHS-III; Any other HIV prevalence and appreciate the use of data for programme review, decision-making and effecting improvements. studies 8. Enhanced understanding among the programme managers of HIV epidemic and response in the state and District Vulnerabilities Local Knowledge; Open sources such as Wikipedia; District different districts Websites; State Government Websites; etc. 9. Better use of data in developing District and State Annual Action Plans Programme Response Programme reporting through CMIS 10. Institutional strengthening (building state level resource pools) and fostering linkages between programme units and academic institutions for addressing Strategic Information needs in the programme

4 | District HIV/AIDS Epidemiological Profiles :Maharashtra Other key features of the process of Data Triangulation are as follow: Process of District Epidemiological Profling: The process starts with identifying a broad set of important, 1. It gives importance to every bit of information actionable and appropriate questions that the programme wants to find answers to, in a given region, and revisits 2. It helps overcome limitations and biases inherent in each dataset and refines the questions at every step of the process. The process of DEP has the following steps: 3. It adds value to each dataset and improves their utility 1. Understanding thematic areas and questions for District Profiling and Triangulation 4. It gives high importance to quality analysis of data and undertakes thorough quality checks and validation 2. Review of data sources and assessment of data availability in the district 5. Indicates the level of reliability in any inference or conclusion 3. Decision on themes to be described and questions to be answered for the district 4. Compilation of secondary data 5. Quality check for completeness, correctness and consistency Table 2: Data Sources used for District Epidemiological Profiling 6. Data validation, adjustments and filling data gaps Thematic areas for HIV Epidemiological Major Sources 7. Preparation of data tables with clean data for analysis Profling 8. Data analysis, interpretation and inferences; describe thematic areas HIV Levels, Trends and Differentials HIV Sentinel Surveillance (HSS); Integrated Biological & 9. Data Triangulation (hypotheses building; answer triangulation questions) Behaviroual Assessment (IBBA); ICTC data; PPTCT data; Blood 10. Preparation of district and State reports bank data; NFHS-III; Any other HIV prevalence studies 11. Discussions and consultation with SACS, local experts, district level programme managers and service delivery STI Levels, Trends and Differentials Behaviroual Surveys (IBBA); STI Clinic data; Targeted functionaries on draft reports Intervention (TI) data; NFHS-I,II & III; DLHS-I ,II & III; 12. Presentation and discussion of draft reports with the National Technical Team Other Behavioral studies 13. Finalisation of District Epidemiological Profile reports HIV burden in the district HIV estimations Size Estimates of General Population and Census Population Projections; Mapping of HRG; TI data Important Outcomes of District Epidemiological Profiling include: Other Risk Groups 1. Cleaning and validation of programme data (since 2004) Profile, Turn-over & Migration of key risk HSS ;IBBA; BSS; Mapping of HRG ;ICTC data; STI Clinic data; 2. Systematic compilation of all data related to HIV for each district at one place for routine use groups TI data; Other Studies on High Risk Groups; DLHS 3. District reports describing the profile of HIV epidemic and programme response in each district Size & Patterns of Migration among Census data; Mapping of Migrants; Population Council studies; 4. Development of framework for re-prioritisation of districts under the programme General Population Other studies on migrants 5. Prioritisation extended upto Sub-district/Block level with high priority blocks identified Risk Behaviours and Prevention Practices BSS; IBBA; DLHS; TI data; Mapping of HRG; Other published/ 6. Identification of information gaps at district and state level for planning strategic Information activities among key risk groups and general population unpublished data 7. Capacity building of district level programme managers and staff of service delivery units in handling and analyzing Profile of PLHIV HSS; IBBA; ICTC data; PPTCT data; ART data; Positive person data, enabling them to understand the importance of the data they generate and the need for ensuring its quality, networks; Blood Bank Data; NFHS-III; Any other HIV prevalence and appreciate the use of data for programme review, decision-making and effecting improvements. studies 8. Enhanced understanding among the programme managers of HIV epidemic and response in the state and District Vulnerabilities Local Knowledge; Open sources such as Wikipedia; District different districts Websites; State Government Websites; etc. 9. Better use of data in developing District and State Annual Action Plans Programme Response Programme reporting through CMIS 10. Institutional strengthening (building state level resource pools) and fostering linkages between programme units and academic institutions for addressing Strategic Information needs in the programme

District HIV/AIDS Epidemiological Profiles :Maharashtra | 5 Specific Notes on Fact sheets

1. Each district fact sheet has two parts: a narrative part consisting of background along with a map, HIV epidemic 12. Information on major vulnerabilities that are influencing the epidemic/high risk behaviour i.e drivers ofthe profile and key recommendations, and a tabular part consisting HIV levels and trends, PLHIV profile, block-level epidemic is included under the “vulnerabilities” section. It includes: details, vulnerabilities and programme response. While the narrative part gives an overview of the district HIV/ a. Size and Profile of HRG AIDS profile, the table provides detailed information about the HIV/AIDS scenario in the district. b. STIs – levels and trends 2. ‘Background’ gives a brief overview of the district with respect to its geographic location, key demographic c. Migration patterns information like total population with male-female distribution, literacy status – based on 2011 Census. The section also describes the district characteristics or contextual factors that makes it vulnerable to spread of HIV. d. District Vulnerabilities/ Contextual Factors 3. ‘Epidemic profile’ describes the thematic areas mentioned above (under the data sources) for each district based 13. Information on size and profile (demographic or sub-typology) of HRG is available from mapping data. Size of on available information. HRG as a proportion of the districts population has been stated wherever available, for comparison purposes. The Taluks/Blocks with high concentration of different HRGs have been given under block level details, wherever 4. From DLHS-III, percentages of ever married women aged 15-49 years who have heard of HIV/AIDS and RTI/STI available. Targeted Intervention (TI) targets and coverage of HRG population are also mentioned, wherever have been taken as awareness indicators among women for HIV and RTI/STI respectively. available under “HRG size”. 5. ‘Key recommendations’ is the final section of the factsheet where ‘Triangulation’ of data is attempted to highlight 14. Based on CMIS-STI data, number of episodes of STI/RTI managed using syndromic approach and VDRL/RPR test the key programme priorities for the district based on the HIV epidemic profile and programme gaps. Any future results for syphilis in the district are given under “STI/RTI”. potential for spread of infection, if indicated by any information or results, is highlighted and appropriate action to address the situation is suggested. On the basis of this analysis, recommendations for improving existing 15. Wherever possible, an attempt has been made to describe the male out-migration patterns in the district based programme, and the need for initiation of new programmes, etc. are highlighted. The recommendation section on Census 2001 data. The table also includes the proportion of male migrants going to other states (inter-state) also highlights information gaps, if any. along with top five destination districts. 6. Data on ANC utilization mentioned in the table refer to the proportion of women who received at least three or 16. The section on programme response describes the number of facilities offering HIV services under NACP and more antenatal checkups (Data source: DLHS-III). services provided in the district till 2012. This covers both prevention interventions and care, support and treatment interventions. 7. HIV positivity rates among HSS-ANC, PPTCT and Blood Bank attendees are used to represent levels and trends of HIV Infection among general population. Level is interpreted as high (HIV positivity ≥1%), moderate (HIV 17. The number of TIs mentioned in the document includes only NACO-supported TIs. Migrant TIs include source, positivity between 0.5-1%) or low (HIV positivity ≤ 0.5%). HIV trend is interpreted as rising, stable or declining. transit and destination TIs. 8. HIV positivity rates among HSS-HRG, HSS-STD and ICTC general clients disaggregated by sex and nature of client 18. All maps used in this document have been prepared from the Survey of India. (direct walk-in and referred) are used to represent levels and trends of HIV Infection among high risk groups 19. The district wise factsheets include updated information till 2012. Therefore, the districts newly created after and vulnerable population. Level is interpreted as high (HIV positivity ≥ 10%), moderate (HIV positivity between 2012 have not been shown as separate districts. The districts with insufficient data are also not included in 5-10%) or low (HIV positivity ≤ 5%). HIV trend is interpreted as rising, stable or declining. this report. 9. Positivity at HSS, PPTCT, Blood bank and ICTC sites is presented only for those years where the sample size is valid i.e. HSS-ANC: ≥ 300 tested, HSS-HRG/STD: ≥ 187 tested, ICTC (male + female/direct walk-in + referred): ≥ 600 tested, PPTCT and BB: ≥ 900 tested. 10. HIV positivity among PPTCT and ICTC attendees at sub-district level wherever data is available is presented under block level details. 11. Size, demographic and risk profile of PLHIV in a district is inferred from three data sources: ICTC data, ART Registration data and data from the PLHIV Network in the district.

6 | District HIV/AIDS Epidemiological Profiles :Maharashtra Specific Notes on Fact sheets

1. Each district fact sheet has two parts: a narrative part consisting of background along with a map, HIV epidemic 12. Information on major vulnerabilities that are influencing the epidemic/high risk behaviour i.e drivers ofthe profile and key recommendations, and a tabular part consisting HIV levels and trends, PLHIV profile, block-level epidemic is included under the “vulnerabilities” section. It includes: details, vulnerabilities and programme response. While the narrative part gives an overview of the district HIV/ a. Size and Profile of HRG AIDS profile, the table provides detailed information about the HIV/AIDS scenario in the district. b. STIs – levels and trends 2. ‘Background’ gives a brief overview of the district with respect to its geographic location, key demographic c. Migration patterns information like total population with male-female distribution, literacy status – based on 2011 Census. The section also describes the district characteristics or contextual factors that makes it vulnerable to spread of HIV. d. District Vulnerabilities/ Contextual Factors 3. ‘Epidemic profile’ describes the thematic areas mentioned above (under the data sources) for each district based 13. Information on size and profile (demographic or sub-typology) of HRG is available from mapping data. Size of on available information. HRG as a proportion of the districts population has been stated wherever available, for comparison purposes. The Taluks/Blocks with high concentration of different HRGs have been given under block level details, wherever 4. From DLHS-III, percentages of ever married women aged 15-49 years who have heard of HIV/AIDS and RTI/STI available. Targeted Intervention (TI) targets and coverage of HRG population are also mentioned, wherever have been taken as awareness indicators among women for HIV and RTI/STI respectively. available under “HRG size”. 5. ‘Key recommendations’ is the final section of the factsheet where ‘Triangulation’ of data is attempted to highlight 14. Based on CMIS-STI data, number of episodes of STI/RTI managed using syndromic approach and VDRL/RPR test the key programme priorities for the district based on the HIV epidemic profile and programme gaps. Any future results for syphilis in the district are given under “STI/RTI”. potential for spread of infection, if indicated by any information or results, is highlighted and appropriate action to address the situation is suggested. On the basis of this analysis, recommendations for improving existing 15. Wherever possible, an attempt has been made to describe the male out-migration patterns in the district based programme, and the need for initiation of new programmes, etc. are highlighted. The recommendation section on Census 2001 data. The table also includes the proportion of male migrants going to other states (inter-state) also highlights information gaps, if any. along with top five destination districts. 6. Data on ANC utilization mentioned in the table refer to the proportion of women who received at least three or 16. The section on programme response describes the number of facilities offering HIV services under NACP and more antenatal checkups (Data source: DLHS-III). services provided in the district till 2012. This covers both prevention interventions and care, support and treatment interventions. 7. HIV positivity rates among HSS-ANC, PPTCT and Blood Bank attendees are used to represent levels and trends of HIV Infection among general population. Level is interpreted as high (HIV positivity ≥1%), moderate (HIV 17. The number of TIs mentioned in the document includes only NACO-supported TIs. Migrant TIs include source, positivity between 0.5-1%) or low (HIV positivity ≤ 0.5%). HIV trend is interpreted as rising, stable or declining. transit and destination TIs. 8. HIV positivity rates among HSS-HRG, HSS-STD and ICTC general clients disaggregated by sex and nature of client 18. All maps used in this document have been prepared from the Survey of India. (direct walk-in and referred) are used to represent levels and trends of HIV Infection among high risk groups 19. The district wise factsheets include updated information till 2012. Therefore, the districts newly created after and vulnerable population. Level is interpreted as high (HIV positivity ≥ 10%), moderate (HIV positivity between 2012 have not been shown as separate districts. The districts with insufficient data are also not included in 5-10%) or low (HIV positivity ≤ 5%). HIV trend is interpreted as rising, stable or declining. this report. 9. Positivity at HSS, PPTCT, Blood bank and ICTC sites is presented only for those years where the sample size is valid i.e. HSS-ANC: ≥ 300 tested, HSS-HRG/STD: ≥ 187 tested, ICTC (male + female/direct walk-in + referred): ≥ 600 tested, PPTCT and BB: ≥ 900 tested. 10. HIV positivity among PPTCT and ICTC attendees at sub-district level wherever data is available is presented under block level details. 11. Size, demographic and risk profile of PLHIV in a district is inferred from three data sources: ICTC data, ART Registration data and data from the PLHIV Network in the district.

District HIV/AIDS Epidemiological Profiles :Maharashtra | 7

District Map of Maharastra Ahmednagar

Background: Ahmednagar is the largest district of Maharashtra. Ahmadnagar District The neighbouring districts to Ahmednagar are Solapur, Osmanabad, Beed, Aurangabad, Nashik, Thane, and Pune. The district has a population of 45.43 lakh, a sex ratio of 934 females per 1,000 males, and a female literacy rate of 71.15% with an overall literacy rate of 80.22% (Census 2011). It is one of the twelve districts in Maharashtra currently receiving funds from the Backward Regions Grant Fund Programme (BRGF). This district is known for the town of Shirdi associated with Sai Baba, attracting a large number of devotees and tourists. Ahmednagar is well connected by roads with various major cities of Maharashtra and other states. National Highway-222 passes through the district.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was low (0.13%) among the ANC attendees, while the prevalence for last five rounds showed a fluctuating trend. • Based on 2012 PPTCT and Blood Bank data, the level of HIV positivity was low for PPTCT (0.18%) and blood bank (0.31%) attendees, with an overall decreasing trend for both. • As per 2010 HSS-FSW data, HIV positivity was high (18.40%) among the FSWs, with a rising trend in the last three recorded years but last five rounds showed fluctuations. • According to 2012 ICTC data, HIV positivity was low among male (2.85%) and female (3.37%) attendees, as well as among referred (3.06%) attendees and direct walk-ins (3.10%), with a decreasing trend among all the ICTC attendees. • According to 2008 HRG size mapping data, MSM (465; 55.96% of total HRG) was the largest HRG in the district followed by FSW (366; 44.04% of total HRG). • As per 2001 Census;13.24% of the males were migrants, among them 1.20% migrated to other states and 40.02% migrated to other districts within the state. • In 2012, the number of STI/RTI episodes treated was 11,554 and the syphilis positivity rate among STI clinic attendees was 0.09%. • The top two destinations for out-of-state migration were Surat, and Belgaum, . • As per 2012 ICTC data, HIV transmission through parent to child route accounted for 8.86% of the total route of HIV transmissions in the district • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 91.6% and 38.6%,respectively.

Key Recommendations: • The parent to child HIV transmission rate was high, thus more needs to be done to understand the profile of these attendees through in-depth analysis of ICTC & ART data. • The prevalence and risk behavior among MSM and its sexual dynamics with FSWs and migrants requires IBBS like or HSS surveys to provide further information to understand the epidemic in the district among risk groups and its HIV spread. • Conduct socio-demographic analysis of HSS-ANC data to understand risk factors for HIV epidemic among general population. • Ensuring the quality of services for HIV prevention and control and ART support to be strengthened further to keep the epidemic contained. • Analyze risk factors and client profiles among FSWs, due to the high level of positivity among the group. • Strengthen outreach programme for risk groups and migrants through awareness campaigns around source and transit points like railway stations and bus stands and using mass and mid media activities.

10 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not size;Data sample - Inadequate * District Population: 45,43,083 (4.04% of Maharashtra Population); Female Literacy Ahmednagar (N=1739) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (11771) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 89.13 47 - 33.74 38.16 38.08 32.76 16.40 2076 1352 2005 2.66 1.62 572 152 260 464 250 801 0 0 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 24.64 23.95 25.73 23.44 26.80 7311 1185 1024 5533 2006 1.39 0.75 593 754 250 800 0.81 % 15-24 yrs 0 0 ------35 HIV Levels and Trends - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 23942 11018 16390 13.95 17.19 14.24 15.22 5435 2117 2788 4764 2007 8.80 0.48 0.73 1.00 250 800 ------Transfusion - - - - - Blood 0.23 % Ill., Prim. Edu. 50041 15070 13234 27562 28076 12.07 11.16 13.99 10.33 14.80 6900 8736 2008

0.55 0.56 0.51 250 785 2 ------Source:III; DLHS 23 ------3 Needle/ Syringe 0.06 81886 21635 14275 15302 20608 36746 40977 2009 6.28 5.53 6.56 5.56 0.55 0.27 - - - - - % Married 1 : 71.15%; ANC Utilization 3 Data presented only for years where sample size is valid(HSS-ANC is size sample where years for only presented Data 85269 24649 21400 19406 26643 37443 39220 18.40 2010 4.60 4.21 5.03 3.97 0.58 0.23 0.63 10 250 800 - Parent to ------Child 8.86 71654 36636 35018 29530 42124 31471 2011 3.22 2.88 3.28 2.89 0.43 ------% Widowed or Divorced Unknown 8 0.92 - 2 98652 28841 29281 25228 32894 40530 : 83.3% 2012 1966 3.10 3.06 3.37 2.85 0.31 0.18 0.13 800 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 44.04 Home Street 2004 0.01 FSW 366 NA; NA; 2009 NA NA 10 808 2

------0

≥

STI/RTI 300, HSS-HRG/STD Panthi - decker- 2005 Double Kothi - 55.96 MSM 0.01 12 465 NA; NA; 1 2 1 1 NA NA ------3429 2010 0.22 - - -

Non daily Injectors- Injectors- 2006 Programme Response 30 Daily 1 1 2 1 1 ------NA; IDU NA NA 11711 2011 ------0.42 Vulnerabilities ≥ 187, ICTC 2007 30 1 1 1 1 2 1 1 ------migration % total pop. % of male migration No. out- Gujarat 11554 Surat, 2012 0.09 ≥ Top 5 districts for inter-state out-migration 600, PPTCT 2008 30 1 1 1 1 1 2 1 1 - - - - - Karnataka Belgaum, Belgaum, Male Migration, 2001 Census 278810 Overall 13.24 100 2009 41 1 1 1 1 1 2 1 1 - - - - - ≥ 900 and BB and 900 , 3333 Inter- State 1.20 0.16 2010 56 9 1 1 1 5 2 1 3 1 1 - - - ≥ Gujarat 111585 Valsad, 900); 40.02 Intra- state 5.30 2011 15 86 1 1 1 5 2 1 3 1 1 - - - 4

PP = percent = ­ PP 163892 Gujarat district Surat, 58.78 Intra- 7.78 2012 38 90 1 1 1 8 2 1 3 1 1 - - -

District HIV/AIDS Epidemiological Profiles :Maharashtra | 11 Akola

Background: Akola forms the central part of , and was a former Berar province. It is surrounded by Amravati in the north, Washim in the south, Amravati and Washim in the east and in the west. The district has a population of 18.18 lakh, a sex ratio of 942 females per 1,000 males, and a female literacy rate of 81.91% with an overall literacy rate of 87.55% (Census 2011). The economy of Akola is mostly agriculture based. Akola is well connected via roads and railway, and National Highway 6 connects it to the rest of the districts within the state.

HIV Epidemic Profle: • As per 2010 HSS-ANC data, HIV prevalence was low (0.13%) among the ANC attendees, with a decreasing trend. • Based on 2012 PPTCT and Blood Bank data, the level of HIV positivity was low for PPTCT (0.10%) and blood bank (0.42%) attendees. HIV positivity levels showed a fluctuating trend for PPTCT, while a decreasing trend was observed for Blood Bank attendees till 2011, but a sudden rise was seen in 2012. • As per 2008 HSS-FSW data, HIV positivity was moderate (6%) among the FSWs, with a fluctuating trend for last three rounds. • According to 2012 ICTC data, HIV prevalence was low among male (1.50%) and female (1.62%) attendees, as well as among referred (0.82%) attendees and direct walk-ins (2.49%), with a decreasing trend among all the ICTC attendees. • According to 2008 HRG size mapping data, FSW (1,234; 77.56% of total HRG) was the largest HRG in the district followed by MSM (357; 22.44% of total HRG). • As per 2001 Census;11.73% of the males were migrants, among them 5.06% migrated to other states and 47.75% migrated to other districts within the state. • In 2012, the number of STI/RTI episodes treated was 5,033 and the syphilis positivity rate among STI clinic attendees was 0.11%. • The top two destinations for out-of-state migration were Surat in Gujarat and Indore in Madhya Pradesh. • As per 2012 ICTC data, 5.26% of the district’s total route of HIV transmissions was the transmission through parent to child. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 80% and 21.2%, respectively. • In 2012, total of only one TI site for FSWs was operational in the district. • In 2012, a total of 35 ICTCs were operational, and an overall 70,669 attendees were tested for HIV in the district.

Key Recommendations: • HIV prevalence and risk behavior among MSM and its sexual dynamics with FSWs and migrants requires IBBS like or HSS surveys or operational research, to provide further information to understand the epidemic in the district among risk groups and HIV spread. • Ensuring the quality of services for HIV prevention and control, and ART support to be strengthened further to keep the epidemic contained. • There is a need to strengthen quality of services provided through number of TI sites in the district, with respect to coverage and quality of services. . • Analyze risk factors and client profiles among FSWs, due to the moderate level of HIV positivity among the group and their large number in the district. • The parent to child HIV transmission rate was high, thus more needs to be done to understand the profile of these attendees through in- depth analysis of ICTC data. Strengthen outreach programme for risk groups and migrants through awareness campaigns around source and transit points like railway stations and bus stands and using mass and mid media activities.

12 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 18,18,617 (1.62% of Maharashtra Population); Female Literacy Akola (N=551) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (7488) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 93.83 32 - 13.07 13.81 12.27 14.14 4376 2868 2005 0.73 972 536 652 856 250 800 10 0 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 20.99 18.04 17.53 21.77 6496 1477 1277 4426 2006 5.20 9.20 0.86 0.63 593 793 250 250 800 % 15-24 yrs ------0 - - - - - 12 HIV Levels and Trends - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 18607 10176 10.23 14.80 13.20 6392 2039 3170 5261 1929 2007 7.01 8.90 9.79 0.47 1.01 0.63 250 250 800 - - - - Transfusion - - - - - Blood 0.54 % Ill., Prim. Edu. 27326 19588 15434 11.01 8993 2899 4574 7318 2008

5.22 3.86 4.92 4.86 6.00 0.54 0.56 0.51 250 227 787 2 - - - - Source: DLHS III;Source:DLHS 65 ------3 Needle/ Syringe 35515 21496 19218 8993 2899 4574 7318 2009 5.22 3.86 4.92 4.86 0.29 0.21 0 - - - - - % Married 1 : 81.91%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 36840 11945 11211 19116 18304 6591 7325 2010 4.45 2.75 3.90 3.81 0.33 1.11 0.13 47 800 - Parent to ------Child 5.26 24862 12031 12831 10321 14541 11184 2011 3.44 1.22 2.36 2.24 0.21 - - - - - % Widowed or Divorced Unknown 13 0.36 - 2 70669 17481 22381 16621 23241 30807 : 69.1% 2012 3796 2.49 0.82 1.62 1.50 0.42 0.10 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 77.56 Home Street 2004 1234 FSW NA; NA; 2009 NA NA 713 3 2 1

------0

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - 22.44 MSM 357 NA; NA; 3 4 1 NA NA ------2801 2010 0.20 - - - -

Non daily Injectors- Injectors- 2006 Programme Response 12 Daily 1 3 1 ------NA; IDU NA NA 4796 2011 ------0.08 Vulnerabilities ≥ 187,ICTC 2007 12 1 1 3 1 ------migration % total pop. % of male migration No. out- Gujarat Surat, 5033 2012 0.11 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 12 1 1 1 3 1 ------Madhya Madhya Pradesh Indore, Indore, Male Migration, 2001 Census Overall 98645 11.73 100 2009 12 1 2 1 1 3 ------≥ 900 and BB and 900 East Nimar, Madhya Pradesh 4991 Inter- State 5.06 0.59 2010 100 20 1 1 3 2 4 1 2 3 - - - - ≥ Gujarat Valsad, 900); 47104 47.75 Intra- state 5.60 2011 122 30 1 1 5 2 4 1 2 3 1 - - - ­ 4 percent = PP Daman & Daman, district 46550 47.19 Intra- 5.54 2012 Diu 162 35 1 9 2 4 1 2 3 1 - - - -

District HIV/AIDS Epidemiological Profiles :Maharashtra | 13 Amravati

Background: Amravati is bordered by Betuldistrict of Madhya Pradesh to the north, and by Nagpur to the northeast, Wardha to the east, Yavatmal to the south, Washim to the southwest, and Akola and Buldhana to the west. It has a population of 28.87 lakh, a sex ratio of 947 females per 1,000 males, and a female literacy rate of 83.52% with an overall literacy rate of 88.23% (Census 2011). The district is one of the twelve districts in Maharashtra currently receiving funds from the Backward Regions Grant Fund Programme (BRGF). Amravati is the main growing region for the Ellachipur Sanman Chili pepper. It is also a major station in the Central Railway line. Road network is also developed in the district, with National Highway 6 connecting it to the rest of the districts within the state.

HIV Epidemic Profle: • As per 2010 HSS-ANC data, HIV prevalence was moderate (0.50%) among the ANC attendees, with an increasing trend in the last three rounds. • Based on 2012 PPTCT and Blood Bank data, the level of HIV positivity was low among PPTCT (0.14%) and Blood bank (0.18%) attendees. A fluctuating trend was observed for PPTCT attendees in the last three recordings, whereas, a decreasing trend was seen for blood bank attendees in the last three years. • According to 2012 ICTC data, HIV positivity was low among male (1.58%) and female (1.46%) attendees, as well as among referred (1.92%) and direct walk-in (1.24%) attendees, with a stable trend for all the ICTC attendees. • According to 2008 HRG size mapping data, FSW (1,658; 95.56% of total HRG) was the largest HRG in the district. • As per 2001 Census;10.30% of the males were migrants, among them 4.91% migrated to other states and 34.61% migrated to other districts within the state. • In 2012, the number of STI/RTI episodes treated was 7,034 and the syphilis positivity rate among STI clinic attendees was 0.01%. • The top two destinations for out-of-state migration were Surat in Gujarat and Betul in Madhya Pradesh. • As per 2012 ICTC data, 6.47% of the HIV transmission in the district was through parent to child route. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 63.9% and 21.7%, respectively. • The estimate of FSWs was considerable in the district, but there was only one FSW targeted intervention site operational in the district. • In 2012, 58 ICTCs were functional and a total of 93,073 attendees got tested for HIV in the district.

Key Recommendations: • There is a need to increase the number of TI’s and ensuring quality of service provision in the district due to sizable FSW population. • Conduct socio-demographic analysis of HSS ANC data to understand risk factors for HIV epidemic among general population. • Due to the high rate of parent to child HIV transmission, as well as large numbers of migrants, it is recommended to strengthen positive prevention and PPTCT programmes in order to curb the possible spread of HIV to migrants & their spouses. • Continue HIV prevention strategies to maintain HIV prevalence at low levels, due to a low HIV prevalence of positivity in the district. • Strengthen outreach programme for risk groups and migrants through awareness campaigns around source and transit points, like railway stations and bus stands and using mass and media activities.

14 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 28,87,826 (2.57% of Maharashtra Population); Female Literacy Amravati (N=479) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (2859) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 90.19 45 - 12.63 15.38 15.51 12.88 7888 1095 6290 2005 0.21 0.63 974 624 503 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 15368 12746 13.76 14.53 1459 1163 1872 2006 8.84 9.62 0.46 0.25 750 800 0.21 % 15-24 yrs ------HIV Levels and Trends 7 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 27993 17908 6712 3373 2829 7256 4830 2007 2.86 7.14 4.81 4.09 0.35 0.42 0.63 800 ------Transfusion - - - - - Blood 0 % Ill., Prim. Edu. 43699 14192 13063 19770 24403 5104 6233 2008

2.29 4.60 2.87 2.92 4.00 0.30 0.34 0.13 250 783 2 ------Source: DLHS III;Source:DLHS ------3 Needle/ Syringe 0.21 53611 14381 15320 27023 25464 8568 7629 2009 1.93 2.92 2.24 2.33 0.35 0.20 - - - - - % Married 1 : 83.52%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 55188 17496 13268 10121 20643 24600 24424 2010 1.61 2.12 2.06 1.71 0.34 0.45 0.25 800 - - Parent to ------Child 6.47 49608 30399 19209 17201 32407 21103 2011 1.06 1.73 1.30 1.32 0.29 - - - - - % Widowed or Divorced Unknown 2.92 - - 2 93073 16695 12987 10595 19087 63391 : 77.8% 2012 8649 1.24 1.92 1.46 1.58 0.18 0.14 0.50 800 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 95.56 Home Street 2004 1658 0.06 FSW NA; NA; 2009 NA NA 877 1 3

------0

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - MSM 4.44 NA; NA; 1 5 NA NA ------77 3671 2010 0 - - - 0

Non daily Injectors- Injectors- 2006 Programme Response 16 Daily 1 1 ------NA; IDU NA NA 5187 2011 ------0.22 Vulnerabilities ≥ 187,ICTC 2007 16 1 1 1 ------migration % total pop. % of male migration No. out- Gujarat Surat, 7034 2012 0.01 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 16 1 1 1 1 ------Madhya Madhya Pradesh Male Migration, 2001 Census 138356 Betul, Betul, Overall 10.30 100 2009 28 1 1 3 1 1 2 1 1 - - - - - ≥ 900 and BB and 900 East Nimar, Madhya Pradesh 6791 Inter- State 4.91 0.51 2010 86 45 1 1 6 1 1 2 1 1 - - - - ≥ Madhya Chhind Pradesh 900); 47880 wara, 34.61 Intra- state 3.56 2011 59 25 52 1 1 1 3 1 2 1 - - - - - 4 PP = percent = ­ PP Daman & Daman, district 83685 60.49 Intra- 6.23 2012 Diu 28 27 58 1 1 1 3 1 2 1 1 - - -

District HIV/AIDS Epidemiological Profiles :Maharashtra | 15 Aurangabad

Background: Aurangabad is located mainly on the Aurangabad District Basin and partly on the Tapi River Basin. It is bordered by the districts of Nashik to the west, to the north, Jalna to the east, and Ahmednagar to the south. It has a population of 36.96 lakh, a sex ratio of 917 females per 1,000 males, and a female literacy rate of 70.81% with an overall literacy rate of 80.40% (Census 2011). It is one of the twelve districts in Maharashtra currently receiving funds from the Backward Regions Grant Fund Programme. The district is well connected via roads and railway, National Highway 211 connecting it to the rest of the districts within the state.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was low among the ANC attendees, with a decreasing trend. • Based on 2012 PPTCT and Blood Bank data, HIV positivity was low for PPTCT (0.11%) and Blood bank (0.15%) attendees. HIV positivity levels showed a decreasing trend for PPTCT and blood bank attendees. • According to 2012 ICTC data, HIV positivity was low among male (2.26%) and female (1.87%) attendees, as well as among referred (1.60%) and direct walk-ins (2.59%) attendees. The HIV positivity levels showed a stable trend for all the ICTC attendees in the last three recordings, though the positivity has declined if observed for seven years. • According to 2008 HRG size mapping data, FSW (2,238; 95.56% of total HRG) was the largest HRG in the district. • In 2012, the number of STI/RTI episodes treated was 14,913 and the syphilis positivity rate among STI clinic attendees was 0.09%. • As per 2001 Census, 9.31% of the males were migrants, among them 3.14% migrated to other states and 38.37% migrated to other districts within the state. • The top two destinations for out-of-state migration were Ludhiana in Punjab and Panipat in . • As per 2012 ICTC route of HIV transmission data, 6.34% of the district’s total HIV transmissions were via Parent to child route. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 51.3% and 9.4%, respectively. • In 2012, a total of two TI sites were operational in the district.

Key Recommendations: • Though HIV prevalence has declined among both HSS-ANC and ICTC attendees, district needs continued attention to decrease and limit the spread of the infection further. • Asses the size and profile of FSWs client population, including migrants and truckers, to improve the understanding of district vulnerabilities, since the largest HRG was FSW. • More needs to be done to understand the profile of the attendees through in depth analysis of ICTC data as the parent to child HIV ransmission rate was high. • Strengthen outreach programme through awareness campaigns around source and transit points, like railway stations and bus stands.

16 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 36,95,928 (3.29% of Maharashtra Population); Female Literacy Aurangabad (N=899) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (10356) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 88.54 30 - 12213 20.19 17.64 1337 2192 1760 1769 8684 2005 8.39 8.07 6.80 0.44 250 800 0 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 18574 13406 22.56 16.30 22.96 18.31 2868 2300 1629 3539 2006 4.18 0.75 250 800 0.78 10 % 15-24 yrs ------14 HIV Levels and Trends - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 33295 22706 13.30 14.63 15.56 13.04 10.04 6303 4286 3341 7248 4318 2007 0.42 0.35 0.25 249 800 ------Transfusion - - - - - Blood 0.33 % Ill., Prim. Edu. 39834 10710 10734 36715 22608 6516 6492 2008

9.92 9.41 9.92 9.60 2.00 0.52 0.34 0.28 250 722 2 ------Source: DLHS III;Source:DLHS 67 ------3 Needle/ Syringe 37266 15575 10211 14354 33982 8990 2009 5.16 5.39 5.14 5.32 0.30 0 * * - - - - - % Married 1 : 70.81%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 4079 1814 1064 2035 2010 3.91 1.93 1.69 2.65 0.29 0.38 51 230 980 250 798 - * * Parent to ------Child 6.34 38405 16911 19821 17422 19310 1673 2011 3.57 2.19 2.34 3.26 0.18 * * - - - - - % Widowed or Divorced Unknown 12 4.00 - 2 83642 22478 24113 21823 24768 20293 37051 : 58% 2012 2.59 1.60 1.87 2.26 0.15 0.11 400 0 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 95.56 Home Street 2004 2238 0.06 FSW NA; NA; 3700 2009 NA NA 1 5 2

------0

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - MSM 3.80 21252 NA; NA; 1 5 2 NA NA ------89 2010 0.40 0 - - -

Non daily Injectors- Injectors- 2006 Programme Response 15 Daily 1 1 2 0.64 ------NA; IDU NA NA 24757 15 2011 0 - - - 0.12 Vulnerabilities ≥ 187,ICTC 2007 21 1 1 6 2 ------migration % total pop. % of male migration No. out- Ludhiana, 14913 Punjab 2012 0.09 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 21 1 1 5 1 1 6 3 ------Haryana Panipat, Panipat, Male Migration, 2001 Census 141643 Overall 9.31 100 2009 22 1 1 5 1 2 6 3 ------≥ 900 and BB and 900 Faridabad, Haryana 4446 Inter- State 3.14 0.29 2010 25 1 1 5 1 2 6 1 3 - - - - - ≥ Gujarat 900); 54348 Surat, 38.37 Intra- state 3.57 2011 41 1 1 4 2 2 6 1 3 - - - - - ­ 4 percent = PP Haryana district 82849 58.49 Hisar, Intra- 5.44 2012 42 1 1 4 2 2 6 2 ------

District HIV/AIDS Epidemiological Profiles :Maharashtra | 17 Beed

Background: Beed which is also known as Bhir, falls under Aurangabad division in Maharashtra. It is surrounded by Aurangabad and Jalna in the north, Parbhani and Latur in the east, Ahmednagar and Osmanabad in the south and Ahmednagar in the west. It has a population of 25.85 lakh, a sex ratio of 912 females per 1,000 males, female literacy rate of 62.29% with an overall literacy rate of 73.53% (Census 2011). Beed is greatly dependent on monsoon being the agricultural hub of the state. It is also one of the largest suppliers of man power as laborers in India. The district is well connected via roads and railways. National Highway 211 connects it to the rest of the districts within the state.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was low (0.13%) among the ANC attendees, with a decreasing trend. • Based on 2012 PPTCT and Blood Bank data, the level of HIV positivity was low for PPTCT (0.14%) attendees while moderate among blood bank (0.54%) attendees. Overall a stable trend was observed among the PPTCT and blood bank attendees. • As per 2010 HSS-FSW data, HIV positivity was moderate among FSWs (7.60%), but due to lack of data, a trend was not determined. • According to the 2012 ICTC data, HIV positivity was low among male (2.73%) and female (2.09%) attendees, and also among referred (1.26%) attendees and direct walk-ins (4.10%), with an overall declining trend among all the ICTC clients. • According to 2008 HRG size mapping data, FSW (310; 69.35% of total HRG) was the largest HRG in the district followed by MSM (137; 30.65% of total HRG). • In 2012, the number of STI/RTI episodes treated was 14,321. • As per 2001 Census;16.09% of the males were migrants, among them 4.07% migrated to other states and 67.68% migrated to other districts within the state. • The top two destinations for out-of-state migration were Belgaum and Bagalkot in Karnataka. • In 2012, parent to child HIV transmission which accounted for 7.24% of the total HIV transmissions in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 73.5% and 21.4%, respectively. • In 2012, a total of three TI sites were operational in the district. • In 2012, a total of 39 ICTCs were functional and an overall 71,053 attendees got tested for HIV in the district.

Key Recommendations: • Migration to high prevalent districts within the state could be a driver of HIV epidemic in the state, outreach efforts should be focused towards migrants at source and transit sites. • More vulnerability could be studies through in depth analysis of ICTC data, to know transmission dynamics like place, person infected and profile of attendees at PPTCT as the parent to child HIV transmission rate was also high. • Asses the size and profile of FSWs client population, including migrants and truckers, to improve the understanding of district vulnerabilities, since the largest HRG was FSW. • Generate information on typology of HRG population to better understand district epidemiological profile. • Availability of ART or DLN data would help to understand the district vulnerabilities more precisely

18 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 25,85,962 (2.30% of Maharashtra Population); Female Literacy Beed (N=898) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; No. HRG-IDU No. HRG-MSM No. HRG-FSW DLN (NA) ART (8927) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT Aurad, PP PP PP PP PP PP PP PP PP PP 0.29 4 4 % On ART - - - - 91.20 36 - 25.35 15.81 17.67 25.51 2710 1704 1006 1279 1431 2005 0.88 800 ------5 Balki, 0.5 General clients & pregnant women. - - - - Homo-sexual

Route of HIV Transmission, ICTC 2012 23.29 18.94 23.54 21.23 4161 3031 1130 1589 2572 2006 0.75 800 0.45 kalyana, % 15-24 yrs ------Basava 0.71 - - - - HIV Levels and Trends 9 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 18.23 15.26 18.55 16.74 9583 6830 2753 3353 6230 4682 2007 0.53 0.63 800 ------Transfusion , 0.26 - - - - Blood 0.22 % Ill., Prim. Edu.

18274 12627 11338 19431 12.08 12.06 11.60 5647 6936 5396 2008

7.19 9.65 0.65 0.36 0.63 250 799 Humna 2 ------0.41 bad, Source: DLHS III;Source:DLHS 69 - - - - -

- 3 Needle/ Syringe 50299 14839 13983 20742 8852 9708 8510 2009 7.60 4.37 6.90 6.04 0.52 0.36 0 - - - - - % Married 1 : 62.29%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 26559 13107 13452 11701 14858 19797 9293 2010 6.78 3.00 4.82 4.89 7.60 0.23 0.38 0.13 50 250 800 - Parent to ------Child 7.24 26640 12035 14605 12979 13661 7530 2011 5.74 2.06 3.69 3.76 0.44 - - - - - % Widowed or Divorced Unknown 15 0.89 - 2 71053 16846 25575 22632 19789 28632 : 61.5% 2012 5025 4.10 1.26 2.09 2.73 0.54 0.14 0.13 800 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 69.35 Home Street 2004 0.01 FSW 10.53 310 NA; NA; 1865 2009 NA NA 89 1 2 1 1 2 2 4 1 1

------

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - 30.65 MSM 0.01 89 137 NA; NA; 1 2 1 1 2 2 4 1 1 NA NA - - - - 6872 2010 1.12 - - -

Non daily Injectors- Injectors- 2006 Programme Response 89 17 Daily 1 2 1 1 2 2 1 1 - - - - NA; IDU NA NA 9861 2011 ------0.54 Vulnerabilities ≥ 187,ICTC 2007 89 17 1 2 1 1 2 2 1 1 - - - - Karnataka migration % total pop. % of male migration No. out- Belgaum, 14321 2012 - ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 89 17 1 2 1 1 2 2 1 1 - - - - Karnataka Bagalkot, Bagalkot, Male Migration, 2001 Census 180313 Overall 16.09 100 2009 89 19 1 2 1 1 2 2 1 2 - - - - ≥ 900 and BB and 900 Gujarat Surat, 7342 Inter- State 4.07 0.66 2010 89 63 47 1 1 1 4 1 2 2 1 2 - - Karnataka ≥ , 122030 900); 67.68 10.89 Intra- state 2011 314 63 47 1 1 1 5 1 2 2 1 2 - - ­ 4 percent = PP district 50941 28.25 Intra- 4.55 2012 314 63 39 - 1 1 4 2 2 3 1 2 - - -

District HIV/AIDS Epidemiological Profiles :Maharashtra | 19 Bhandara

Background: Bhandara is one of the major districts in Maharashtra, situated in the . It is known as, ‘ bowl of Maharashtra’ and is popularly known as the district of lakes. It is enveloped by (Madhya Pradesh) in the north, Gondia in the east, Chandrapur in the south and Nagpur in the west. Bhandara has a population of 11.98 lakh, a sex ratio of 984 females per 1,000 males, and a female literacy rate of 77.02% with an overall literacy rate of 85.14% (Census 2011). Bhandara has a mixed economy with agriculture, industries and forest resources contributing to it. It is one of the twelve districts in Maharashtra currently receiving funds from the Backward Regions Grant Fund Programme (BRGF). The district is well connected via roads and railway, National Highway 6 connecting it to the rest of the state.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was moderate (0.26%) among the ANC attendees, with a fluctuating trend. • Based on 2012 PPTCT and Blood Bank data, the level of HIV positivity was low for PPTCT (0.10%) and Blood bank (0.11%) attendees. HIV positivity levels showed a decreasing trend for PPTCT attendees and also for Blood Bank attendees. • According to the 2012 ICTC data, HIV prevalence was low among male (1.27%) and female (2.32%) attendees, as well as among referred (1.29%) attendees and direct walk-ins (2.31%). The HIV positivity levels showed a decreasing trend for all the ICTC attendees. • According to 2008 HRG size mapping data, FSW (406; 92.06% of total HRG) was the largest HRG in the district. • In 2012, the number of STI/RTI episodes treated was 3,273. • As per 2001 Census, 12.35% of the males were migrants, among them 5.73% migrated to other states and 47.85% migrated to other districts within the state. • The top two destinations for out-of-state migration were Balaghat, Madhya Pradesh and Surat, Gujarat. • In 2012, HIV transmission from parent to child was high at 7.20%, out of all the HIV transmission in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 68.2% and 31.7%,respectively. • In 2012, there was no information for TI site in the district.

Key Recommendations: • Though HIV prevalence has declined among both HSS-ANC and ICTC attendees, district needs continued attention to decrease and limit the spread of the infection further. • Analyse vulnerability factors in transmission of HIV from ICTC and STI data, although there was a low level of HIV epidemic in the district. • Considering high rate of migration to high HIV prevalent state, strengthen outreach programme through awareness campaigns around source and transit points like railway stations and bus stands. • Parent to child HIV transmission was high in the district; therefore, it is necessary to strengthen PPTCT program coverage in the district.

20 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 11,98,810 (1.07% of Maharashtra Population); Female Literacy Bhandara (N=347) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (2776) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 91.35 52 - 17.60 5334 2125 2361 2005 7.46 7.67 7.01 0.80 1.13 500 992 848 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 17137 6066 2006 0.97 0.38 800 0.58 % 15-24 yrs ------HIV Levels and Trends 7 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 29621 13195 14458 9963 2528 1968 2007 2.45 5.58 6.05 3.21 0.59 0.75 800 * * ------Transfusion - - - - - Blood 0 % Ill., Prim. Edu. 33838 12187 13538 16612 4696 3688 3149 2008

3.18 5.03 5.42 2.90 0.42 0.38 799 0 2 ------Source: DLHS III;Source:DLHS 82 ------3 Needle/ Syringe 0.29 32262 13269 13968 9923 6836 3490 5756 2009 3.20 3.45 5.64 2.69 0.42 0.49 - - - - - % Married 1 : 77.02%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 38143 12155 15426 17216 8772 5501 6830 2010 2.36 2.09 3.53 1.73 0.26 0.29 0.26 65 779 - Parent to ------Child 7.20 24943 16175 16877 8768 8066 6101 2011 2.51 2.03 2.76 1.93 0.21 - - - - - % Widowed or Divorced Unknown 17 0.58 - 2 40912 16028 15796 18130 : 84.5% 2012 6754 6986 4655 2.31 1.29 2.32 1.27 0.11 0.10 0.63 799 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 92.06 Home Street 2004 0.03 FSW 406 NA; NA; 2009 NA NA 10 759 1 2

------0

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - MSM 7.94 10 NA; NA; 1 2 NA NA ------35 2147 2010 0.14 0 - - -

Non daily Injectors- Injectors- 2006 Programme Response 20 12 Daily 1 1 1 ------NA; IDU NA NA 3244 2011 ------0.34 Vulnerabilities ≥ 187,ICTC 2007 20 12 1 1 1 ------migration % total pop. % of male migration No. out- Balaghat, Madhya Pradesh 3273 2012 0 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 20 12 1 1 1 1 ------Gujarat Male Migration, 2001 Census Surat, Surat, Overall 70812 12.35 100 2009 20 16 1 1 1 1 1 ------≥ 900 and BB and 900 Chhatis , garh 4061 Inter- State 5.73 0.71 2010 215 26 1 1 4 1 1 1 1 ------≥ Chhatis 900); 33881 , 47.85 Intra- garh state 5.91 2011 215 27 1 5 1 4 1 1 1 1 - - - - - ­ 4 percent = PP Rajnand Chhatis district 32870 46.42 gaon, Intra- garh 5.73 2012 215 28 1 5 1 4 1 1 1 ------

District HIV/AIDS Epidemiological Profiles :Maharashtra | 21 Buldana

Background: Buldana is a district in the Amravati division of Maharashtra Buldana District in western India. It is situated at the westernmost border of region of Maharashtra and is 500 km from the state capital, Mumbai, bordered by Madhya Pradesh on the north, Akola, Washim, and Amravati on the east, Jalna on the south, and Jalgaon and Aurangabad on the west. Buldana has a population of 25.88 lakh, a sex ratio of 928 females per 1,000 males, and a female literacy rate of 72.95% with an overall literacy rate of 82.09% (Census 2011). The district has major industrial areas and its economy depends upon agriculture. The district is well connected via roads and railway, National Highway 6 and 20-A connecting it to the rest of the districts within the state.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was low (0.25%) among the ANC attendees, with a fluctuating trend. • Based on 2012 PPTCT and Blood Bank data, the level of HIV positivity was low for PPTCT (0.05%) and Blood bank (0.28%) attendees. HIV positivity levels showed a decreasing trend for PPTCT attendees while a stable trend was observed for Blood Bank attendees. • According to 2012 ICTC data, HIV prevalence was low among male (1.02%) and female (1.12%) attendees, as well as among referred (0.85%) and direct walk-in (1.58%) attendees. The HIV positivity levels showed an overall decreasing trend for all the ICTC attendees. • According to 2008 HRG size mapping data, FSW (1,237; 89.96% of total HRG) was the largest HRG in the district followed by MSM (138; 10.04% of total HRG). • In 2012, the number of STI/RTI episodes treated was 11,008. • As per 2001 Census; 10.91% of the males were migrants, among them 4.64% migrated to other states and 38.49% migrated to other districts within the state. • The top two destinations for out-of-state migration were Surat in Gujarat and North-West Delhi. • In 2012, the route of HIV transmission was high from parent to child at 7.48%, out of all the HIV transmissions in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 69.1% and 22.7%, respectively. • A total of two TI sites were operational in the district in the year 2012.

Key Recommendations: • Continue attention on the district to decrease and limit the spread of HIV infection further, though HIV prevalence has declined from high to low levels among ICTC attendees. • The parent to child HIV transmission rate was high, thus more needs to be done to understand the profile of the attendees through in- depth analysis of ICTC data. • Since the largest HRG was FSW, improved assessment of the size and profile of FSW’s client population, including migrants and truckers, will help in better understanding of district vulnerabilities. As well as availability of typology data would help to analyze risk factors. • Strengthen outreach programme through awareness campaigns around source and transit points, like railway stations and bus stands.

22 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 25,88,039 (2.30% of Maharashtra Population); Female Literacy Buldana (N=401) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (1503) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 89.28 44 - 14.53 26.72 22.35 16.47 2064 1217 2005 0.57 0.38 585 262 264 583 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 11.72 17.71 15.96 12.18 7270 1169 1125 5700 2006 0.40 0.88 401 445 800 1.50 % 15-24 yrs ------HIV Levels and Trends 8 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 21422 15123 4911 1383 1671 4628 2007 4.26 8.89 6.88 4.56 0.40 0.25 800 * * ------Transfusion - - - - - Blood 0.75 % Ill., Prim. Edu. 32333 10015 18946 3372 3601 9786 6189 2008

2.93 4.42 4.69 2.79 0.39 0.14 0.83 727 2 ------Source: DLHS III;Source:DLHS 90 ------3 Needle/ Syringe 44271 11113 10958 15214 19885 6857 8272 2009 1.84 1.89 2.46 1.60 0.23 0.13 0 - - - - - % Married 1 : 72.95%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 40124 10189 13822 16129 16113 7882 8700 2010 2.17 1.48 2.17 1.58 0.33 0.11 66 799 - 0 Parent to ------Child 7.48 36586 14233 22353 13496 23090 8964 2011 1.38 1.07 1.40 1.07 0.23 - - - - - % Widowed or Divorced Unknown 19 1.00 - 2 70555 10388 26207 13820 22775 33960 : 66.7% 2012 3966 1.58 0.85 1.12 1.02 0.28 0.05 0.25 800 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 89.96 Home Street 2004 1237 0.05 FSW NA; NA; 3671 2009 NA NA 1 5 2

------0

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - 10.04 MSM 0.01 138 NA; NA; 1 5 4 NA NA ------2625 2010 - - - 0

Non daily Injectors- Injectors- 2006 Programme Response 16 Daily 1 6 ------NA; IDU NA NA 6429 2011 ------Vulnerabilities 0 ≥ 187,ICTC 2007 21 1 6 ------migration % total pop. % of male migration No. out- Gujarat 11008 Surat, 2012 0 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 21 1 6 ------West Delhi West Male Migration, 2001 Census 124897 North North Overall 10.91 100 2009 21 1 1 6 ------≥ 900 and BB and 900 East Nimar, Madhya Pradesh 5794 Inter- State 4.64 0.51 2010 26 1 1 1 4 1 1 6 1 - - - - - ≥ Madhya Pradesh Indore, 900); 48073 38.49 Intra- state 4.20 2011 40 1 1 1 4 1 1 6 1 1 - - - - ­ 4 percent = PP Gujarat Valsad, district 71030 56.87 Intra- 6.21 2012 47 1 1 1 4 1 1 6 1 1 - - - -

District HIV/AIDS Epidemiological Profiles :Maharashtra | 23 Chandrapur

Background: Chandrapur was formerly known as Chanda district. It shares border with Adilabad to the west, Bhandara to the North, Gadchiroli to the East, Wardha to the North, and Yavatmal to the west. Chandrapur has a population of 21.94 lakh, a sex ratio of 959 females per 1,000 males, and a female literacy rate of 73.65% with an overall literacy rate of 81.35% (Census 2011). In 2006, the Ministry of Panchayati Raj named Chandrapur one of the country’s 250 most backward districts and is one of the twelve districts in Maharashtra currently receiving funds from the Backward Regions Grant Fund Programme. The district is well connected via roads and railway to the rest of the districts within the state.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was low (0.25%) among the ANC attendees, with a decreasing trend. • Based on 2012 PPTCT and Blood Bank data, the level of HIV positivity was low for PPTCT (0.17%) and Blood bank (0.19%) attendees, with a decreasing trend for both. • As per 2010 HSS data, HIV positivity was moderate among FSWs (6.80%), with a decreasing trend. • According to 2012 ICTC data, HIV prevalence was low among male (1.93%) and female (2.22%) attendees, as well as among referred (1.13%) attendees and direct walk-ins (3.33%). The HIV positivity levels showed a decreasing trend for all the ICTC attendees. • According to 2008 HRG size mapping data, FSW (2,355; 98.62% of total HRG) was the largest HRG in the district. • In 2012, the number of STI/RTI episodes treated was 18,398 and the syphilis positivity rate among STI clinic attendees was 0.46%. • As per 2001 Census, 12.76% of the males were migrants, among them 2.20% migrated to other states and 25.16% migrated to other districts within the state. • The top two destinations for out-of-state migration were Adilabad and Karimnagar in . • As per 2012 ICTC data, the route of HIV transmission was high through parent to child at 6.27%, out of all the HIV transmissions in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 59.4% and 11.1%, respectively. • While there were over 2,300 mapped HRGs in the district, there was only one TI site operational in the district in 2012.

Key Recommendations: • Strengthen targeted interventions sites in the district; the current number of TI sites is not enough to deal with the large number of HRGs in the area. • Since the largest HRG was FSW, better assessment of the size and profile of FSW’s client population, including migrants and truckers, will help in better understanding of district vulnerabilities. As well as availability of typology data would help to analyze risk factors. • Due to the high rate of parent to child HIV transmission as well as large numbers of migrants to high prevalent districts, more needs to be done to strengthen positive prevention and PPTCT programmes in order to curb the possible spread of HIV to migrant’s spouses. • Conduct special awareness campaign especially among pockets of out-migrants transit points and around truck halting halt points and highways in the district.

24 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 21,94,262 (1.95% of Maharashtra Population); Female Literacy Chandrapur (N=638) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (6329) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 92.01 42 - 10.26 12.87 22.00 15.20 6289 1740 1441 1235 3613 2005 9.77 7.43 1.08 2.63 936 250 250 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 17553 11760 15.12 13.54 20.80 3194 2599 1728 4065 2006 7.23 9.59 8.40 0.96 1.75 250 250 800 0.47 % 15-24 yrs ------10 HIV Levels and Trends - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 30711 10033 17238 12.80 16.80 7713 5762 3440 1071 2007 4.86 7.32 8.46 5.04 0.56 0.63 1.13 250 250 800 - - - - Transfusion - - - - - Blood 0.94 % Ill., Prim. Edu. 43268 10146 16639 13964 19254 11.89 8735 7375 2008

6.82 5.40 7.09 5.38 8.40 0.54 0.53 1.41 250 244 780 2 - - - - Source: DLHS III;Source:DLHS 40 ------3 Needle/ Syringe 52466 14732 16675 16714 22234 9074 7131 2009 4.10 3.65 5.03 3.45 0.45 0.39 0 - - - - - % Married 1 : 73.65%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 56552 14952 16519 22111 16097 25081 9360 2010 4.27 1.78 3.82 2.60 6.80 0.31 0.20 0.38 33 250 799 - Parent to ------Child 6.27 39656 16732 22924 12585 27071 14138 2011 3.51 1.45 2.80 2.10 0.23 - - - - - % Widowed or Divorced Unknown 7 0.31 - 2 59156 13479 19581 11670 21390 26096 : 83.2% 2012 4751 3.33 1.13 2.22 1.93 0.19 0.17 0.25 799 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 98.62 Home Street 2004 2355 0.11 FSW NA; NA; 4330 2009 NA NA 0.59 2 1 2 1

------

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - MSM 1.38 14232 NA; NA; 1 2 1 2 1 NA NA ------33 2010 1.52 0 - - -

Non daily Injectors- Injectors- 2006 Programme Response 15 Daily 1 2 1 1 ------NA; IDU NA NA 14138 2011 ------0.96 Vulnerabilities ≥ 187,ICTC 2007 25 15 1 1 1 2 1 1 ------migration % total pop. % of male migration No. out- Adilabad, Pradesh Andhra 18398 2012 0.46 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 25 15 1 1 2 2 2 1 1 - - - - - Pradesh Andhra Andhra Karim nagar, nagar, Male Migration, 2001 Census 135228 Overall 12.76 100 2009 - 25 33 1 1 2 2 2 1 1 - - - - - ≥ 900 and BB and 900 Madhya Chhind Pradesh wara, 2969 Inter- State 2.20 0.28 2010 50 34 1 1 2 4 2 1 1 1 - - - - - ≥ Chhatis 900); 34023 Durg, 25.16 Intra- garh state 3.21 2011 100 53 1 1 2 4 2 1 1 1 - - - - - 4 PP = percent = ­ PP Rajnand Chhatis district 98236 72.64 gaon, Intra- garh 9.27 2012 100 55 1 1 2 4 2 1 1 1 ------

District HIV/AIDS Epidemiological Profiles :Maharashtra | 25 Dhule

Background: Dhule previously comprised tracts of land predominantly inhabited by tribal population. The district was then bifurcated on 1st July 1998 into two separate districts now known as Dhule and Nandurbar, the latter comprising the tribal region. The district shares its borders with Nandurbar lying in the north-east, Nashik in the south and Jalgoan lies to the east of the district. It has a population of 20.48 lakh and a sex ratio of 941 females per 1,000 males, and a female literacy rate of 66.21% with an overall literacy rate of 74.61% (Census 2011). Agriculture remains the basic profession of the population in this district. Around 26.11% population of Dhule district resides in urban area. The district is well connected via roads and railway, there are 3 major National Highways passing through the Dhule district. (NH-6, NH-3 and NH-211)

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was low (0.25%) among the ANC attendees, with a decreasing trend. • Based on 2012 PPTCT and Blood Bank data, the level of HIV positivity was high for PPTCT (0.10%) and low among Blood bank (0.14%) attendees. HIV positivity levels showed a fluctuating trend for PPTCT in the last three recordings and a stable trend was observed for Blood Bank attendees. • According to 2012 ICTC data, HIV prevalence was low among male (3.02%) and female (2.92%) attendees, as well as among referred (2%) and direct walk-in (4.35%) attendees. The HIV positivity levels showed a decreasing trend for all the ICTC attendees. • According to 2008 HRG size mapping data, FSW (511; 79.43% of total HRG) was the largest HRG in the district. • In 2012, the number of STI/RTI episodes treated was 6,068 and the syphilis positivity rate among STI clinic attendees was 0.12%. • As per 2001 Census, 17.14% of the males were migrants; among them, 21.14% migrated to other states and 37.77% migrated to other districts within the state. • The top two destinations for out-of-state migration were Surat and Bharuch in Gujarat. • According to 2012 ICTC data, route of HIV transmission was high through parent to child at 6.47% in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 56.1% and 21.8%, respectively. • In 2012, one FSW-TI site was functional in the district.

Key Recommendations: • Conduct socio-demographic analysis of ANC data to understand risk factors for HIV epidemic among general population. • Strengthen efforts to wards assessing route of HIV transmission at the ICTCs. • It is necessary to strengthen PPTCT program coverage in the district as parent to child HIV transmission was high. • Generate information on typology of HRG population to better understand district epidemiological profile. • Strengthen outreach programme through awareness campaigns around source and transit points, like railway stations and bus stands.

26 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 20,48,781 (1.82% of Maharashtra Population); Female Literacy Dhule (N=726) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (10123) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 88.98 34 - 29.63 12.68 17.50 18.92 8350 1325 1263 6350 2005 0.43 675 737 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 11937 28.28 18.30 24.95 23.57 2203 1579 1487 2295 8155 2006 3.27 1.13 800 0.14 % 15-24 yrs ------HIV Levels and Trends 7 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 20019 11643 22.72 11.58 16.05 18.31 4362 4014 3439 4937 2007 0.58 1.13 800 * * ------Transfusion - - - - - Blood 0 % Ill., Prim. Edu. 31013 17670 16365 17.89 10.94 12.24 6652 7996 6217 8431 2008

6.53 0.24 0.34 0.63 798 2 ------Source: DLHS III;Source:DLHS 51 ------3 Needle/ Syringe 41339 19264 19643 7535 9282 7114 9703 2009 9.17 6.31 7.23 7.86 0.21 0.31 0 - - - - - % Married 1 : 66.21%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 43089 12546 12397 28387 21493 9050 9199 2010 6.35 4.31 4.55 5.62 0.16 1.16 0.63 35 800 - Parent to ------Child 6.47 32555 13304 19251 14318 18237 17004 2011 3.92 2.68 2.86 3.44 0.17 - - - - - % Widowed or Divorced Unknown 11 4.41 - 2 58771 11784 16681 13031 15434 30306 : 59.5% 2012 5834 4.35 2.00 2.92 3.02 0.14 0.10 0.25 800 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 94.45 Home Street 2004 0.02 FSW 511 NA; NA; 1231 2009 NA NA 1 3

------0

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - MSM 3.70 NA; NA; 1 3 NA NA ------20 2743 2010 4.26 0 - - -

Non daily Injectors- Injectors- 2006 Programme Response 11 Daily 1 1 1 1 1 1.85 ------NA; IDU NA NA 10 21.13 2870 2011 0 - - - Vulnerabilities ≥ 187,ICTC 2007 11 1 1 1 1 1 ------migration % total pop. % of male migration No. out- Gujarat Surat, 6068 2012 0.12 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 11 1 1 1 1 1 1 ------Bharuch, Bharuch, Gujarat Male Migration, 2001 Census 150591 Overall 17.14 100 2009 11 1 1 1 1 1 1 1 ------≥ 900 and BB and 900 Navsari, Gujarat 31842 21.14 Inter- State 3.62 2010 17 1 1 1 1 1 1 1 1 1 1 - - - ≥ Gujarat Valsad, 900); 56876 37.77 Intra- state 6.47 2011 39 1 1 1 1 1 1 1 1 1 1 - - - ­ 4 percent = PP Barwani, Madhya Pradesh district 61873 41.09 Intra- 7.04 2012 50 1 1 1 1 1 1 1 1 1 - - - -

District HIV/AIDS Epidemiological Profiles :Maharashtra | 27 Gadchiroli

Background: Gadchiroli is situated in the southeastern corner of Maharashtra, bordered by Chandrapur to the west, Gondia to the north, Chhatisgarh to the east, and Andhra Pradesh to the south and southwest. It has a population of 10.71 lakh, a sex ratio of 975 females per 1,000 males, and a female literacy rate of 60.66% with an overall literacy rate of 70.55% (Census 2011). The district is currently a part of the .In 2006, the Ministry of Panchayati Raj named Gadchiroli one of the country’s 250 most backward districts and is one of the twelve districts in Maharashtra currently receiving funds from the Backward Regions Grant Fund Programme. The district is well connected via roads and railway, National Highway 16 connecting it to the rest of the districts within the state.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was low (0.13%) among the ANC attendees, with a fluctuating trend in the last three recordings. • Based on 2012 PPTCT and Blood Bank data, the rate of HIV positivity was low for PPTCT (0.05%) as well as among Blood bank (0.10%) attendees; HIV positivity rates showed a stable trend for PPTCT and blood bank had a declining trend in the last three years. • According to 2012 ICTC data, HIV positivity rate was low among male (0.74%) and female (0.86%) attendees, as well as among referred (0.65%) and direct walk-in (0.92%) attendees. The positivity rate showed a stable to declining trend for all the ICTC attendees in the last five years. • According to 2008 HRG size mapping data, FSW (415; 99.05% of total HRG) was the largest HRG in the district. • In 2012, the syphilis positivity rate among STI clinic attendees was 0.03%. • As per 2001 Census; 10.44% of the males were migrants, among them 1.23% migrated to other states and 18.44% migrated to other districts while 80.33% migrated within district and could play possible role in HIV spread. • The top two destinations for out-of-state migration were Rajnandgaon and Dantewada in . • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 30.3% and 18%, respectively. • A total of 42 ICTCs were functional in the district in the year 2012, which tested a total of 38,389 attendees.

Key Recommendations: • Presence of HRGs especially FSWs should be considered for the initiation of TI site in the district. • Conduct socio-demographic analysis of HSS-ANC data to understand risk factors for HIV epidemic among general population. • Conduct special awareness campaign especially among pockets of out-migrants transit points and around truck halting points and highways in the district. • Generate information on typology of HRG population to better understand district epidemiological profile. • Availability of DLN data will help in understanding the district vulnerabilities.

28 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 10,71,795 (0.95% of Maharashtra Population); Female Literacy Gadchiroli (N=171) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (755) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 94.15 35 - 10.20 2239 1473 2005 8.27 9.26 9.02 0.14 0.38 423 343 367 399 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 4655 3524 2006 3.03 5.40 6.07 3.62 0.28 0.25 594 537 247 884 800 0.58 % 15-24 yrs ------HIV Levels and Trends 9 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 13283 2946 3713 1733 4926 6624 2007 1.32 2.07 2.14 1.60 0.21 800 * * 0 ------Transfusion - - - - - Blood 2.34 % Ill., Prim. Edu. 21424 8132 4603 4253 8482 4202 8689 2008

0.91 1.43 1.31 0.99 0.62 0.13 787 0 2 ------Source: DLHS III;Source:DLHS 89 ------3 Needle/ Syringe 29955 13256 8766 4757 4554 8969 5332 2009 0.84 1.18 1.08 0.90 0.24 0.10 0 - - - - - % Married 1 : 60.66%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 25416 11207 8667 5542 4896 9313 5979 2010 0.72 0.78 0.84 0.69 0.59 0.13 0.63 70 799 - Parent to ------Child 2.92 20306 11226 12892 9080 7414 4827 2011 0.74 0.72 0.74 0.72 0.37 - - - - - % Widowed or Divorced Unknown 13 - 2 38389 10288 10356 12699 17745 0 : 72.5% 2012 7945 2935 0.92 0.65 0.86 0.74 0.10 0.05 0.13 800 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 99.05 Home Street 2004 0.04 FSW 415 NA; NA; 2009 NA NA 925 1 2 2

------0

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - MSM 0.95 NA; NA; 1 2 2 NA NA ------2383 2010 1.14 0 4 - - -

Non daily Injectors- Injectors- 2006 Programme Response Daily 1 2 2 ------NA; IDU NA NA 3611 2011 ------0.03 Vulnerabilities ≥ 187,ICTC 2007 14 1 2 ------migration % total pop. % of male migration No. out- Rajnand Chhatis gaon, 2850 2012 0.03 garh ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT - - 14 1 1 2 ------Dantewa Chhatis Male Migration, 2001 Census Overall 51253 garh 10.44 da, da, 100 2009 34 - 1 1 1 2 1 ------≥ - 900 and BB and 900 Inter- State 1.23 0.13 628 - 2010 37 1 1 1 1 2 1 ------≥ 900); 18.44 Intra- 9453 state 1.93 2011 - 37 1 1 1 1 2 ------­ 4 percent = PP district 41172 80.33 Intra- 8.39 2012 42 - 1 1 1 2 ------

District HIV/AIDS Epidemiological Profiles :Maharashtra | 29 Gondia

Background: , also known as Gondiyain Maharashtra, Gondia District is surrounded by of Madhya Pradesh in the north and of Chhattisgarh in the east. The Bhandara and Chandrapur districts are to the west and south. It has a population of 13.22 lakh, a sex ratio of 996 females per 1,000 males, and a female literacy rate of 77.30% with an overall literacy rate of 85.41% (Census 2011). In 2006, the ministry of Panchayati Raj named Gondia as one of the country’s 250 most backward districts and it is one of the twelve districts in Maharashtra currently receiving funds from the Backward Regions Grant Fund Programme. It is well connected via roads and railway, National Highway 6 connecting it to the rest of the districts within the state.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was low among the ANC attendees, with a declining trend. • According to 2012 PPTCT data, HIV positivity was high for PPTCT (2.44%) attendees, with a fluctuating trend in the last 4 recordings • As per 2010 Blood Bank data, HIV positivity was low among Blood donors (0.17%), with a fluctuating trend. • According to 2012 ICTC data, HIV prevalence was low among male (1%) and female (1.64%) attendees, as well as among referred (1.32%) attendees and direct walk-ins (1.03%). The HIV positivity levels showed a decreasing trend for all the ICTC attendees. • According to 2008 HRG size mapping data, FSW (388; 89.40% of total HRG) was the largest HRG in the district. • In 2012, the number of STI/RTI episodes treated was 1,770 and the syphilis positivity rate among STI clinic attendees was 0.10%. • As per 2001 Census, 8.92% of the males were migrants. Among the male migrants 8.93% migrated to other states and 40.42% migrated to other districts with in the state. • The top two destinations for out-of-state migration were Balaghat in Madhya Pradesh and Raipur in Chhattisgarh. • As per 2012 ICTC data, Parent to child HIV transmission accounted for 5.67% of all HIV transmissions in the districts. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 54.7% and 28.3%, respectively. • A total of 36 ICTCs were functional, which tested a total of 36,255 attendees for HIV in the district in the year 2012.

Key Recommendations: • Conduct socio-demographic analysis of HSS-ANC data to understand risk factors for HIV epidemic among general population and strengthen the PPTCT program in the district. • When the IBBS data will be available, analyze on FSW and other groups in the district to improve the understanding of the vulnerabilities. • Since the largest HRG was FSW, better assessment of the size and profile of FSW’s client population including migrants and truckers, will help in better understanding of district vulnerabilities. As well as the availability of typology data would help to analyze risk factors. • Strengthen outreach programme through awareness campaigns around source and transit points like railway stations and bus stands. • Expand coverage of HIV counseling and testing in the district to detect HIV positive cases at an early stage, due to high percentage of PLHIV on ART (47%).

30 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 13,22,331 (1.18% of Maharashtra Population); Female Literacy Gondia (N=282) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (1433) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 89.01 47 - 3186 2184 2005 6.67 5.79 4.44 7.94 0.46 0.38 570 432 473 529 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 11.01 14.07 5533 1071 4199 2006 6.28 6.26 0.76 0.63 907 427 263 800 1.42 % 15-24 yrs ------HIV Levels and Trends 6 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 16738 10024 5048 1667 1221 5493 1784 2007 2.52 7.62 8.44 2.75 1.40 0.41 0.38 800 ------Transfusion - - - - - Blood 2.48 % Ill., Prim. Edu. 24987 13777 6836 4123 2945 8014 6372 2008

2.56 3.61 4.07 2.55 0.25 0.25 792 0 2 ------Source: DLHS III;Source:DLHS 5 ------3 Needle/ Syringe 0.71 23732 11982 6048 4332 2689 7691 3446 2009 1.85 2.75 3.16 1.90 0.49 1.24 - - - - - % Married 1 : 77.30%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 20840 11504 4504 4832 2076 7260 2929 2010 1.51 2.40 3.61 1.50 0.17 0.22 800 3 - 0 Parent to ------Child 5.67 16557 12443 7548 9009 4114 2011 1.19 2.18 2.80 1.37 ------% Widowed or Divorced Unknown 2 0.71 - 2 36255 11129 13853 16444 : 83% 2012 8682 5958 1.03 1.32 1.64 1.00 2.44 799 0 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 89.40 Home Street 2004 0.03 FSW 388 NA; NA; 2009 NA NA 648 1 2

------0

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - 10.60 MSM NA; NA; 1 2 NA NA ------46 1659 2010 0.83 0 - - -

Non daily Injectors- Injectors- 2006 Programme Response Daily 1 3 ------NA; IDU NA NA 1699 2011 ------3.37 Vulnerabilities ≥ 187,ICTC 2007 11 1 1 1 ------migration % total pop. % of male migration No. out- Balaghat, Madhya Pradesh 1770 2012 0.10 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 11 1 1 1 1 ------Chhatis Raipur, Raipur, Male Migration, 2001 Census Overall 53410 garh 8.92 100 2009 11 - 1 1 1 1 1 ------≥ 900 and BB and 900 Rajnand Chhatis gaon, garh 4767 Inter- State 8.93 0.80 2010 19 1 1 1 1 1 ------≥ Chhatis 900); 21588 Durg, 40.42 Intra- garh state 3.61 2011 36 1 1 1 1 1 ------­ 4 percent = PP West Delhi, district 27055 North 50.66 Intra- Delhi 4.52 2012 36 1 1 1 1 1 1 ------

District HIV/AIDS Epidemiological Profiles :Maharashtra | 31 Hingoli

Background: Hingoli, a part of the , shares border with Parbhani to the south, Washim to the north. One of the twelve shrines, the is located in Hingoli. It has a population of 11.78 lakh, a sex ratio of 935 females per 1,000 males, and a female literacy rate of 64.73% with an overall literacy rate of 76.04% (Census 2011). In 2006, the Ministry of Panchayati Raj named Hingoli as one of the most backward district and it is one of the twelve districts in Maharashtra currently receiving funds from the Backward Regions Grant Fund Programme. It is well connected via roads and railways, State Highway, SH-68 connects it to the rest of the districts within the state.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was low (0.13%) among the ANC attendees, with a decreasing trend. • Based on 2012 PPTCT data, HIV positivity was low (0.08%) for PPTCT attendees, with a decreasing trend. • According to 2012 ICTC data, HIV positivity was low among male (2.07%) and female (1.81%) attendees, as well as among referred (1.61%) attendees and direct walk-ins (2.99%). The HIV positivity levels showed an overall decreasing trend for all the ICTC attendees. • According to 2008 HRG size mapping data, FSW (565; 98.60% of total HRG) was the largest HRG in the district. • In 2012, the number of STI/RTI episodes treated was 2,524 and the syphilis positivity rate among STI clinic attendees was 0.91%. • As per 2001 Census, 6.70% of the males were migrants. Among the male migrants,1.89% migrated to other states and 46.54% migrated to other districts within the state. • The top destination for out-of-state migration was Dadra and Haveli Nagar Haveli. • According to ICTC 2012 data, parent to child HIV transmission route accounted for 10.94% of all HIV transmissions in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 67.7% and 20.4%, respectively. • In 2012, a total of 25 ICTCs were functional that tested an overall 32,348 attendees in the district.

Key Recommendations: • Strengthen PPTCT program so as to reduce the high HIV transmission from parent to child. • When the IBBS data will beavailable, analyze on FSW and other groups in the district to improve the understanding of the vulnerabilities. • Strengthen outreach programmes through awareness campaigns for HRGs; also around truck halt points and highways in the district. • Generate information on typology of HRG population to better understand district epidemiological profile. • Increase STI awareness among women of the district. • Expand coverage of HIV counseling and testing in the district to detect HIV positive cases at an early stage, due to 51% of PLHIV on ART.

32 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 11,78,973 (1.05% of Maharashtra Population); Female Literacy Hingoli (N=329) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (1565) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 87.84 51 - 1012 2005 1.38 800 * * * * * * * * * * ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 16.99 12.78 13.17 15.19 2670 1671 2006 0.54 1.63 412 587 334 665 800 % 15-24 yrs ------0 - - - - - HIV Levels and Trends 8 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 8893 2198 2148 1562 2571 4760 2007 9.42 9.31 9.15 8.52 0.38 0.25 800 ------Transfusion - - - - - Blood % Ill., Prim. Edu. 12568 2441 1903 1607 2737 6901 2008

6.02 5.25 6.97 4.93 0.28 0.26 777 2 ------Source: DLHS III;Source:DLHS 87 ------3 Needle/ Syringe 20225 5102 3969 3637 5434 8928 2009 3.00 4.01 3.88 3.15 0.35 0 ------% Married 1 : 64.73%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 22113 7140 6019 5816 7343 8954 2010 2.59 2.38 2.49 2.49 0.21 0.38 65 799 - Parent to ------10.94 Child 16330 11561 4769 7917 8413 2011 3.29 1.68 1.87 2.41 ------% Widowed or Divorced Unknown 20 1.22 - 2 32348 11562 17107 : 69.3% 2012 3679 7467 7774 2.99 1.61 1.81 2.07 0.08 0.13 799 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 98.60 Home Street 2004 0.05 FSW 565 NA; NA; 2009 NA NA 915 2

------0

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - MSM 1.40 NA; NA; 2 NA NA ------2250 2010 0 8 - - - 0

Non daily Injectors- Injectors- 2006 Programme Response Daily 1 6 ------NA; IDU NA NA 2487 2011 ------Vulnerabilities 0 ≥ 187,ICTC 2007 1 1 6 ------migration % total pop. % of male migration No. out- Dadra & Dadra & Haveli, Haveli Nagar Nagar 2524 2012 0.91 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 1 1 1 6 1 ------Male Migration, 2001 Census Overall 33867 6.70 100 - 2009 1 1 1 1 1 6 1 ------≥ 900 and BB and 900 Inter- State 1.89 0.13 639 - 2010 1 1 1 1 1 7 1 ------≥ 900); 15762 46.54 Intra- state 3.12 2011 - 24 1 1 1 1 3 1 1 ------­ 4 percent = PP district 17466 51.57 Intra- 3.46 2012 25 - 1 1 1 3 1 1 1 ------

District HIV/AIDS Epidemiological Profiles :Maharashtra | 33 Jalgaon

Background: Jalgao, formerly known as East district, is bordered by Madhya Pradesh to the north and by Buldhana to the east, Jalna to the southeast, Aurangabad to the south, Nashik to the southwest, and Dhule to the west. It has a population of 42.24 lakh and a sex ratio of 922 females per 1,000 males, and a female literacy rate of 70.92% with an overall literacy rate of 79.73% (Census 2011). Agriculture is the main source of income in Jalgaon. It is well-connected to Mumbai, Pune as well as other major cities by an extensive road network. National Highway 6 passes through the district of Jalgaon.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was low (0.13%) among the ANC attendees, with a fluctuating downside trend. • Based on 2012 PPTCT and Blood Bank data, the level of HIV positivity was low for PPTCT (0.12%), as well as among Blood bank (0.26%) attendees. HIV positivity levels showed a decreasing trend for PPTCT attendees but a stable trend for blood bank attendees. • As per 2010 HSS-FSW data, the level of HIV positivity was low among the FSWs (2.80%), and had a decreasing trend. • According to 2012 ICTC data, HIV prevalence was low among male (2.30%) and female (1.88%) attendees, as well as among referred (1.93%) and direct walk-in (2.33%) attendees. HIV positivity levels showed a decreasing trend for all the ICTC attendees. • According to 2008 HRG size mapping data, MSM (1,320; 65.61% of total HRG) was the largest HRG in the district followed by FSW (672; 33.40% of total HRG). • In 2012, the number of STI/RTI episodes treated was 13,146 and the syphilis positivity rate among STI clinic attendees was 0.20%. • As per 2001 Census, 15% of the males were migrants, among them 12.64% migrated to other states and 38.38% migrated to other districts within the state. • The top two destinations for out-of-state migration were Surat in Gujarat and East-Nimar in Madhya Pradesh. • In 2012, the major route for HIV transmission was through parent to child at 5.58%, in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 70.8% and 20.1%, respectively. • In 2012, a total of three TI sites were functional in the district.

Key Recommendations: • Carry out disaggregated analysis of HSS-ANC data to identify risk factors responsible for moderate HIV epidemic among general population. • Since the largest HRG was MSM, improved assessment of the size and profile of MSM and partner population, will help in understanding of district vulnerabilities. As well as availability of typology data would help to analyze risk factors. • Though HIV prevalence has declined among ICTC attendees, district needs continued attention to decrease and limit the spread of the infection further. • The parent to child HIV transmission rate was high, thus more needs to be done to understand the profile of the attendees through in- depth analysis of ICTC data. • Conduct special awareness campaign especially among pockets of out-migrants transit points and around truck halting points and highways in the district. • Collect and analyze data at ITs and patients at ART center to understand geography and profile of groups, since 46% of PLHIV were on ART.

34 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 42,24,442 (3.76% of Maharashtra Population); Female Literacy Jalgaon (N=949) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (7967) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 92.41 46 - 16.67 14.07 12.69 18.27 21.60 4331 1260 1029 2538 2005 7.20 1.62 1.75 533 764 250 250 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 21.13 18.88 21.28 19.85 11.20 10.80 8399 2205 1123 1217 2111 5071 2006 1.89 1.50 250 250 800 0.53 % 15-24 yrs ------HIV Levels and Trends 6 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 25183 14801 12.25 10.12 11.32 5496 4902 3754 6628 1536 2007 9.36 6.40 8.00 0.46 0.75 1.75 250 250 800 - - - - Transfusion - - - - - Blood 0.32 % Ill., Prim. Edu. 49733 12152 10374 13808 15161 27207 8718 2008

9.40 6.27 8.26 7.76 1.60 7.05 0.48 0.40 0.39 250 227 765 2 - - - - Source: DLHS III;Source:DLHS 7 ------3 Needle/ Syringe 65080 15448 19047 13240 21255 14577 29838 2009 4.75 3.38 4.08 3.94 0.34 0.32 0 - - - - - % Married 1 : 70.92%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 83010 16686 31530 18462 29754 24324 34794 2010 3.69 2.25 2.98 2.61 2.80 0.43 0.21 0.50 250 796 4 - Parent to ------Child 5.58 54848 23373 31475 21835 33013 22761 2011 2.70 1.97 2.25 2.30 0.25 ------% Widowed or Divorced Unknown 1 1.16 - 109711 2 25368 30154 24112 31410 16325 54189 : 58.2% 2012 2.33 1.93 1.88 2.30 0.26 0.12 0.13 800 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 33.40 Home Street 2004 0.02 FSW 672 NA; NA; 6645 2009 NA NA 5 1 1 2 2

------0

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - 65.61 1320 MSM 0.03 NA; NA; 6 1 1 2 2 NA NA ------9712 2010 0.50 - - -

Non daily Injectors- Injectors- 2006 Programme Response 24 Daily 8 1 2 2 0.99 ------NA; IDU NA NA 12665 20 2011 0 - - - 0.53 Vulnerabilities ≥ 187,ICTC 2007 10 24 1 1 2 2 ------migration % total pop. % of male migration No. out- Gujarat 13146 Surat, 2012 0.20 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 14 24 1 1 2 1 2 ------Madhya Madhya Pradesh Nimar, Male Migration, 2001 Census 285748 Overall East East 15.00 100 2009 14 34 1 1 1 1 1 3 1 2 - - - - ≥ 900 and BB and 900 Gujarat Valsad, 36109 12.64 Inter- State 1.90 2010 83 20 47 1 1 1 7 1 1 3 1 2 - - ≥ Navsari, Gujarat 109663 900); 38.38 Intra- state 5.76 2011 69 25 54 1 1 1 7 1 1 3 1 2 - - ­ 4 percent = PP Vadodara, 139976 Gujarat district 48.99 Intra- 7.35 2012 54 36 66 1 1 7 1 1 3 1 2 - - -

District HIV/AIDS Epidemiological Profiles :Maharashtra | 35 Jalna

Background: Jalna, one of the popular tourist spots in India, is bordered on the north by Jalgaon, on the east by Parbhani and Buldhana, on the south by Beed and on the west by Aurangabad. It has a population of 19.58 lakh, a sex ratio of 929 females per 1,000 males, and a female literacy rate of 61.28% with an overall literacy rate of 73.61% (Census 2011). Agriculture is the primary industry in this region. The district is well connected via roads and railways; Nagpur-Aurangabad-Mumbai Express Highway connects it to the rest of the districts within the state.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was low (0.25%) among the ANC attendees, with a stable trend in the last three recordings. • Based on 2012 PPTCT data, HIV positivity was low (0.07%) among the PPTCT attendees, with a fluctuating trend in the last three recordings. • According to 2012 Blood Bank data, HIV positivity was low (0.23%) among the Blood bank attendees, with a stable trend. • According to 2012 ICTC data, HIV positivity rate was low among male (1.13%) and female (1.10%) attendees, as well as among referred (0.88%) attendees and direct walk-ins (1.35%). The HIV positivity levels showed an overall decreasing trend among all the ICTC attendees. • According to 2008 HRG size mapping data, FSW (1,090; 93.08% of total HRG) was the largest HRG in the district. • In 2012, the number of STI/RTI episodes treated was 9,903 and the syphilis positivity rate among STI clinic attendees was 0.77%. • As per 2001 Census, 11.51% of the males were migrants, among them 3% migrated to other states and 57.32% migrated to other districts within the state. • The top two destinations for out-of-state migration were Surat and Ahmadabad in Gujarat. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 62.8% and 21.1%, respectively. • In 2012, a total of three TI sites were functional in the district. • The district had a total of 32 ICTCs, which tested a total of 45,001 attendees for HIV in the year 2012.

Key Recommendations: • Though HIV prevalence has declined among both HSS-ANC and ICTC attendees, the district needs continued attention to decrease and limit the spread of the infection further. • HSS should be conducted among FSW • Assess the size and profile of FSWs client population, including migrants and truckers, will improve the understanding of district vulnerabilities, since the largest HRG was FSW. • Parent to child HIV transmission was high in the district; therefore, it is necessary to strengthen PPTCT program coverage in the district. • Higher HIV transmission rate through homosexual route necessitates strengthening of TI interventions for MSM population. • Improve counseling at ICTCs, since the rate of unknown route of HIV transmissions was high. • Strengthen outreach programme through awareness campaigns around source and transit points like railway stations and bus stands.

36 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 19,58,483 (1.74% of Maharashtra Population); Female Literacy Jalna (N=231) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT 2009 % Pos; ICTC 2009 % Pos; No. HRG- IDU No. HRG-MSM No. HRG- FSW DLN (NA) ART (2261) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 0.52 4 4 % On ART - - - - 94.81 46 - 14.72 21.43 2400 1313 2005 3.85 3.82 0.99 0.88 360 727 863 224 800 ------5 0.42 General clients & pregnant women. - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 19.83 15.20 19.57 17.28 6155 5180 2006 1.14 1.13 600 375 327 648 800 % 15-24 yrs ------0 0.26 - - - - HIV Levels and Trends 8 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 17952 12919 #REF! 3201 1832 1972 3061 2007 9.72 9.22 8.92 9.93 0.29 0.63 377 800 savangi Ghana ------Transfusion 0 - - - - Blood 0 % Ill., Prim. Edu. -

21159 12483 5399 3277 3739 4937 3274 2008

4.61 4.58 4.28 4.84 0.37 0.13 0.38 Jafrabad 780 2 ------0.05 Source: DLHS III;Source:DLHS 84 - - - - - 3 Needle/ Syringe 0.43 35123 11409 15493 5065 7419 9055 3818 2009 1.98 2.74 2.22 2.21 0.24 0.24 0.18 - - - - % Married 1 : 61.28%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 26991 10555 7674 9635 6754 6118 9682 2010 2.81 1.97 2.52 2.24 0.25 0.91 0.25 68 800 - Jalna 0.15 Parent to ------Child 4.76

22546 10037 12509 13291 9255 7312 2011 2.03 1.53 1.76 1.75 0.08 0 - - - - % Widowed or Divorced Unknown

16 - 2 45001 12489 12272 10848 13913 20240 0 : 69.2% 2012 5596 1.35 0.88 1.10 1.13 0.23 0.07 0.25 799 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 93.08 Home Street 2004 1090 0.06 FSW 30.77 NA; NA; 2507 2009 NA NA 1 2

------

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - MSM 6.92 NA; NA; 1 4 NA NA ------81 7027 2010 0.86 0 - - -

Non daily Injectors- Injectors- 2006 Programme Response Daily 1 2 6 ------NA; IDU NA NA 12319 2011 ------2.01 Vulnerabilities ≥ 187,ICTC 2007 2 2 2 9 ------migration % total pop. % of male migration No. out- Gujarat Surat, 9903 2012 0.77 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 12 4 1 3 3 ------madabad, madabad, Gujarat Male Migration, 2001 Census Overall 95033 11.51 Ah 100 - 2009 22 6 1 5 1 1 1 3 1 1 1 - - - ≥ 900 and BB and 900 Gujarat Valsad, 2854 Inter- State 0.35 3 2010 12 27 1 7 1 2 1 1 3 1 1 1 - - Vadodara, ≥ Gujarat 900); 54476 57.32 Intra- state 6.60 2011 15 32 1 7 1 2 1 2 3 1 1 1 - - ­ 4 percent = PP Bharuch, Gujarat district 37703 39.67 Intra- 4.56 2012 20 32 9 1 2 1 2 3 1 1 1 - - -

District HIV/AIDS Epidemiological Profiles :Maharashtra | 37 Kolhapur

Background: Kolhapur in Maharashtra is sharing its border with Belgaum to the south, Ratnagiri to the west, Sangli to the east, Sindhudurg to the south. It has a population of 38.74 lakh, a sex ratio of 953 females per 1,000 males, and a female literacy rate of 74.18% with an overall literacy rate of 82.90% (Census 2011). The district in south Maharashtra has essentially an agrarian economy, where 63% of district’s total population depends on agriculture. Kolhapur is situated at a distance of 395 km to the South of Mumbai and 240 km from Pune. The district is located on the Pune - National Highway 4.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was moderate (0.63%) among the ANC attendees, with an overall declining trend. • Based on 2012 PPTCT and Blood Bank data, the HIV positivity rate was low for PPTCT (0.17%) attendees, while it was moderate among Blood donors (0.80%). HIV positivity levels showed a decreasing trend for PPTCT attendees and a stable trend for Blood bank attendees. • Based on 2010 HSS data, HIV positivity was high among the FSWs (17.41%) and MSM (10.57%). A declining trend was observed among FSWs while a trend could not be observed among MSM due to lack of prior data. • According to 2012 ICTC data, the HIV positivity rate was low among male (4.50%) attendees while it was moderate among female (6.78%) attendees. It was also moderate among referred (5.64%) and direct walk-in (5.11%) attendees. An overall decreasing trend was observed for all the ICTC attendees. • According to 2008 HRG size mapping data, FSW (746; 53.79% of total HRG) was the largest HRG in the district followed by MSM (641; 46.21% of total HRG). • In 2012, the number of STI/RTI episodes treated was 10,930 and the syphilis positivity rate among STI clinic attendees was 0.87%. • As per 2001 Census, 11.49% of the males were migrants, among them 8.12% migrated to other states and 24.15% migrated to other districts within the state. • The top two destinations for out-of-state migration were Belgaum in Karnataka and North . • As per 2012 ICTC data, HIV transmission through parent to child which accounted for 7.95% of the total HIV transmissions in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 86.9% and 38.5%,respectively. • In 2012, a total of two TI sites were functional in the district. • The district had a total of 54 operational ICTCs, which tested an overall 60,276 attendees for HIV in the year 2012.

Key Recommendations: • Conduct socio-demographic analysis of HSS-ANC data to understand risk factors for HIV epidemic among general population. • Since the largest HRG was FSW, better assessment of the size and profile of FSW’s client population, including migrants and truckers, will help in better understanding district vulnerabilities. As well as availability of typology data would help to analyze risk factors. • The parent to child HIV transmission rate was high, thus more needs to be done to scale up and strengthen the PPTCT programme • Considering high rate of migration, strengthen outreach programme through awareness campaigns around source and transit points like railway stations and bus stands.

38 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 38,74,015 (3.44% of Maharashtra Population); Female Literacy Kolhapur (N=1598) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (15113) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 88.61 46 - 23.81 30.72 28.45 26.32 29.20 3811 1022 2072 2005 2.32 1.88 886 853 717 250 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 15836 11138 16.37 20.32 19.33 17.41 29.60 2498 2200 1976 2722 2006 1.92 1.38 250 800 0.81 % 15-24 yrs ------HIV Levels and Trends 9 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 31626 25222 17564 17.65 19.38 20.53 17.19 18.00 8047 6015 5017 9045 2007 0.99 0.95 1.38 250 800 ------Transfusion - - - - - Blood 0.06 % Ill., Prim. Edu. 50286 13583 10848 15535 30704 25875 11.54 13.03 15.29 10.43 16.00 26.00 8896 2008

0.75 0.59 0.38 250 250 784 2 - - - - Source: DLHS III;Source:DLHS 49 ------3 Needle/ Syringe 57861 11086 11662 13611 36283 30182 9137 2009 8.24 8.02 9.65 7.10 0.63 0.94 0 - - - - - % Married 1 : 74.18%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 55972 14491 14556 11150 17897 33255 26925 10.57 17.41 2010 6.80 6.67 8.41 5.69 0.64 0.37 0.75 32 246 247 796 - Parent to ------Child 7.95 37557 17482 20075 13030 24527 23379 2011 5.38 5.27 7.35 4.24 0.62 - - - - - % Widowed or Divorced Unknown 14 2.57 - 2 60276 16410 17243 13066 20587 26623 : 82.8% 2012 4488 5.11 5.64 6.78 4.50 0.80 0.17 0.63 799 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 53.79 Home Street 2004 0.02 FSW 746 NA; NA; 1911 2009 NA NA 0.00 1 2 3 1

------

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - 46.21 MSM 0.02 641 NA; NA; 1 2 5 1 NA NA ------5116 2010 0.93 - - -

Non daily Injectors- Injectors- 2006 Programme Response 25 Daily 1 2 1 ------NA; IDU NA NA 10095 2011 ------0.36 Vulnerabilities ≥ 187,ICTC 2007 25 1 2 1 ------Karnataka migration % total pop. % of male migration No. out- Belgaum, 10930 2012 0.87 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 25 1 1 1 1 2 1 ------North Goa North Male Migration, 2001 Census 207193 Overall 11.49 100 2009 30 1 1 4 1 1 2 1 1 - - - - - ≥ 900 and BB and 900 South Goa 16824 Inter- State 8.12 0.93 2010 312 43 1 1 1 4 1 1 2 1 1 - - - Bangalore, Karnataka ≥ 900); 50030 24.15 Intra- state 2.77 2011 312 14 53 1 1 1 4 2 1 2 1 1 - - 4 PP = percent = ­ PP Karnataka Bagalkot, 140339 district 67.73 Intra- 7.78 2012 312 14 54 1 1 1 4 2 1 2 1 1 - -

District HIV/AIDS Epidemiological Profiles :Maharashtra | 39 Latur

Background: Latur is the southernmost district of Maharashtra, surrounded by Parbhani in the north, Osmanabad in the west and south, Bidar in the east, Nanded in the north- east and Beed in the north-west. It has a population of 24.55 lakh, a sex ratio of 924 females per 1,000 males, and a female literacy rate of 70.02% with an overall literacy rate of 79.03% (Census 2011). Agriculture is the chief source of income in Latur. The main crops produced here are pulses, cereals, oilseeds and grapes. Latur is also well-connected to Mumbai and by rail.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was low (0.25%) among the ANC attendees with a declining trend. • Based on 2012 PPTCT and Blood Bank data, the HIV positivity rate was low for PPTCT (0.22%) and Blood bank (0.10%) attendees. HIV positivity rate showed a decreasing trend for both the attendees. • As per 2010 HSS data, HIV positivity was low among FSWs (4.02%), with a declining trend. • According to 2012 ICTC data, HIV positivity was low among male (2.58%) and female (2.74%) attendees. It was also low among referred (1.89%) and direct walk-in (4.13%) attendees. A decreasing trend was seen among all the ICTC attendees. • According to 2008 HRG size mapping data, FSW (1,507; 54.64% of total HRG) was the largest HRG in the district followed by MSM (1,226; 44.45% of total HRG). • As per 2001 Census, 8.92% of the males were migrants, among them 2.82% migrated to other states and 45.60% migrated to other districts of state and 51.58% migrated within district. • The top two destinations for out-of-state migration were Bidar in Karnataka and Rangareddy in Andhra Pradesh. • As per 2012 ICTC data, parent to child route of HIV transmission accounted for 7.02% of all the HIV transmissions in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 77.1% and 31.4%, respectively. • One MSM TI site was operational in the district in the year 2012.

Key Recommendations: • Vulnerability was observed was due to risky behavior of females and direct walk in thus ensuring campaigns to spread awareness on comprehensive knowledge, of HIV prevention & control measures. • Asses the size and profile of FSWs client population, including migrants and truckers, and MSM and client population, to improve the understanding of district vulnerabilities, since the largest HRG was FSW followed by MSM. Generate information on typology of HRG population to better understand district epidemiological profile. • Conduct disaggregated analysis of ICTC direct walk-in clients & female attendees with respect to geography, age and residence from ICTC as well PPTCT to assess risk factors. • Considering high rate of migration, strengthen outreach programme through awareness campaigns around source and transit points like railway stations and bus stands. • The percentage of transmission through parent to child route was high than state average. Therefore, there is a need to better understand the profile and dynamics of clinic attendees and their spouses, through analysis of ICTC data.

40 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 24,55,543 (2.19% of Maharashtra Population); Female Literacy Latur (N=897) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (7618) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 90.41 40 - 14.15 17.38 15.86 15.00 14.80 10.40 5539 1088 1053 3824 2005 1.18 1.00 627 662 250 250 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 13677 12.17 16.22 18.26 11.09 10.00 3360 1646 1687 3319 8671 2006 8.80 0.81 0.88 250 250 800 1.11 % 15-24 yrs ------14 HIV Levels and Trends - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 28848 16872 14.76 12.30 17.34 12.26 8585 3391 4251 7725 3098 2007 6.40 7.20 1.00 0.46 0.75 250 250 800 - - - - Transfusion - - - - - Blood 0.67 % Ill., Prim. Edu. 36833 10616 10861 16525 19332 11.16 11.08 6885 6640 2008

8.63 9.60 9.60 4.80 1.03 0.52 0.88 250 250 795 2 - - - - Source: DLHS III;Source:DLHS 51 ------3 Needle/ Syringe 0.11 54484 10816 13161 14164 12341 23166 9813 2009 7.95 4.25 6.29 5.67 0.22 0.35 - - - - - % Married 1 : 70.02%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 47217 17013 11129 15451 20513 20637 10.80 9567 2010 7.61 3.30 5.31 4.52 4.02 0.32 0.28 0.00 42 250 249 756 - Parent to ------Child 7.02 30395 20414 13633 16762 9981 9754 2011 5.01 2.83 3.59 3.50 0.18 - - - - - % Widowed or Divorced Unknown 11 0.67 - 2 57336 12193 23601 16827 18967 21542 : 76.2% 2012 7825 4.13 1.89 2.74 2.58 0.10 0.22 0.25 800 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 54.64 Home Street 2004 1507 27973 0.06 FSW NA; NA; 2009 NA NA 0.00 1 2 4 1

------

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - 44.45 1226 MSM 0.05 14841 NA; NA; 1 2 4 2 NA NA ------2010 0.56 - - -

Non daily Injectors- Injectors- 2006 Programme Response 15 Daily 1 2 2 0.91 ------NA; IDU NA NA 25 9531 2011 0 - - - 0.44 Vulnerabilities ≥ 187,ICTC 2007 23 1 1 1 1 2 2 ------Karnataka migration % total pop. % of male migration No. out- 13253 2012 Bidar, 0.11 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 23 2 1 1 1 2 1 2 ------gareddy, gareddy, Pradesh Andhra Andhra Male Migration, 2001 Census Overall Ran 97636 9.09 100 2009 - 36 1 1 4 1 1 2 1 2 - - - - - ≥

900 and BB and 900 Hyderabad, Pradesh Andhra 2751 Inter- State 2.82 0.26 2010 36 1 1 4 1 1 2 1 ------≥ Pradesh Medak, Andhra 900); 44526 45.60 Intra- state 4.14 2011 36 1 1 1 4 1 1 2 1 - - - - - ­ 4 percent = PP Pradesh Andhra Nizam district 50359 51.58 abad, Intra- 4.69 2012 36 1 1 1 4 1 1 2 1 ------

District HIV/AIDS Epidemiological Profiles :Maharashtra | 41 Mumbai (Including Mumbai Suburban)

Background: Mumbai is the capital city of the Indian state of Maharashtra. Mumbai & It is the most populous city in India, second most populous metropolitan city in India, and the fifth most populous city in the world, with a population of 124.78 lakh, a sex ratio of 847 females per 1,000 males, and a female literacy rate of 86.70% with an overall literacy rate of 90.28% (Census 2011) Mumbai lies on the west coast of India and has a deep natural harbour. It is also the wealthiest city in India, and has the highest GDP of any city in South, West or Central Asia. Mumbai is the financial and commercial capital of the country as it generates 6.16% of the total GDP. Mumbai is served by National Highway 3, 4, 8, 17 and 222 passes through the districts.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was moderate (0.75%) among the ANC attendees, with a decreasing trend. • According to 2012 PPTCT data, the level of HIV positivity was low (0.36%) among the PPTCT attendees, with a decreasing trend. • According to 2012 Blood Bank data, the level of HIV positivity was low (0.44%) among the Blood Bank attendees, with a stable trend. • As per 2010 HSS-FSW data, HIV positivity was moderate among FSWs (8.42%), with a decreasing trend. • As per 2010 HSS-MSM data, HIV positivity was high among (16.63%), with an increasing trend. • As per 2010 HSS-IDU data, HIV positivity was high among (14.17%), with a decreasing trend. • According to the 2012 ICTC data, HIV prevalence was moderate among male (5.51%) attendees, but low among female (4%) attendees, and also among referred (3.93%) attendees, but HIV prevalence was moderate for direct walk-ins (6.77%), with an overall declining trend among all the ICTC attendees. • In 2012, the number of STI/RTI episodes treated was 1,06,388 and the syphilis positivity rate among STI clinic attendees was 0.36%. • As per 2001 Census, 8.17% of the males were migrants, among them 17.83% migrated to other states and 82.17% migrated to other districts within the state. • The top two destinations for out-of-state migration were Surat, Gujarat and Bangalore, Karnataka. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 94.4% and 32%, respectively (Mumbai). • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 92.3% and 28.1%, respectively (Mumbai Suburban). • In 2012, a total of 37 TI sites were operational in the district. • In 2012, a total of 110 ICTCs were functional and an overall 31,328 attendees got tested for HIV in the district.

Key Recommendations: • Conduct socio-demographic analysis of HSS-ANC data to understand risk factors for HIV epidemic among general population. • Carry out differential analysis of direct walk-in attendees (representative of vulnerable populations), owing to moderate positivity in 2012. An increasing trend among them can be explored by further analyzing the ICTC data. • Increase the availability of additional information on the HIV epidemic profile of the district, including ART and HRG size data, to improve the understanding of district vulnerability. • Considering high HIV prevalence among IDUs and MSM in the district, prevention efforts through TIs need to be strengthened. • Conduct outreach campaign on STI awareness and sexual risk reduction messages especially among women.

42 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 1,24,78,447 (11.10% of Maharashtra Population); Female Literacy Mumbai (Including Suburban) (N=11428) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (75570) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 91.16 32 - 12.80 30.51 24.57 2400 2005 6.00 1.13 250 250 495 468 ------5 General clients & pregnant women. - - - - - Homo-sexual 236360 Route of HIV Transmission, ICTC 2012 20.40 17.87 16.89 1525 1525 2750 2006 7.60 0.58 1.25 1.05 250 250 750 438 1.96 % 15-24 yrs ------HIV Levels and Trends 9 - Block-Level Details PLHIV Pro f le, 2012 1 158739 209870 105479 2011 Census;2011 29563 23859 17298 35962 24.40 19.36 2400 2007 9.50 9.26 9.87 9.21 8.40 0.50 0.91 1.38 250 250 749 * * Transfusion - - - - - Blood 0.53 % Ill., Prim. Edu. 262641 101558 221215 102650 68666 91325 58433 10.63 10.15 10.33 10.38 10.30 1000 2399 2008

9.20 0.50 0.68 1.04 250 250 20 * * 2 Source: DLHS III;Source:DLHS 68 ------3 Needle/ Syringe 255864 261463 0.61 46409 77805 49172 75042 92009 2009 9.50 7.75 7.44 9.03 0.47 0.66 - - - - - % Married 3 1 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data : 86.70%; ANC Utilization 173507 261655 47045 70764 50142 67667 55698 14.17 16.63 1247 3197 2010 8.41 6.05 6.13 7.64 8.42 0.43 0.77 0.78 48 247 499 - Parent to ------Child 3.33 538243 153785 266835 181413 239207 256597 117623 2011 7.30 5.04 4.96 6.56 0.45 0.37 - - - - - % Widowed or Divorced Unknown 14 2.40 - 269180 160655 103862 133990 168526 77197 31328 2012 3197 2 6.77 3.93 4.00 5.51 0.44 0.36 0.63 : 91.2% ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- Home Street 2004 FSW NA; NA; 2009 NA NA 16 51 26 1 1 1 6

------

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - MSM 119269 16 50 38 NA; NA; 4 1 1 4 NA NA ------2010 0.80 ------

Non daily Injectors- Injectors- 2006 Programme Response 18 57 64 Daily 4 1 2 5 ------147046 NA; IDU NA NA 2011 ------0.37 Vulnerabilities ≥ 187,ICTC 2007 18 56 64 4 2 2 5 ------migration % total pop. % of male migration No. out- 106388 Gujarat Surat, 2012 0.36 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 24 55 74 10 4 2 6 ------Bangalore, Bangalore, Karnataka Male Migration, 2001 Census 537253 Overall 8.17 100 2009 25 57 91 13 4 2 8 ------≥ 900 and BB and 900 madabad, Gujarat 95796 17.83 Inter- State Ah 1.46 2010 - 26 58 90 14 1 7 3 6 ------Vadodara, ≥ Gujarat 441457 900); 82.17 Intra- state 6.71 2011 27 58 97 12 13 1 9 4 ------4 PP = percent = ­ PP Intra- 2012 110 10 27 57 14 19 0 0 0 1 4 ------

District HIV/AIDS Epidemiological Profiles :Maharashtra | 43 Nagpur

Background: Nagpur is a district in the Vidarbha region of Maharashtra. The city of Nagpur is the district headquarters. The district is part of Nagpur division. Nagpur district is bound by Bhandara district on the east, Chandrapur district on the southeast, on the southwest, Amravati district on the northwest and district of Madhya Pradesh state on the north. It has a population of 46.53 lakh, a sex ratio of 948 females per 1,000 males; female literacy rate of 85.07% and an overall literacy rate of 89.52% (Census 2011). Nagpur has been the main center of commerce in the Vidarbha region since early days and is an important trading location. Nagpur is also famous throughout the country as “Orange City” for being a major trade center of oranges that are cultivated in the region. Nagpur is a major junction for roadways as India’s two major national highways, - (NH 7) and Hajira- (NH-6), passing through the city.

HIV Epidemic Profle: • As per 2010 HSS-ANC data, HIV prevalence was low among the ANC attendees, with a decreasing trend in the last three years. • Based on 2012 PPTCT and Blood Bank data, the level of HIV positivity was low for PPTCT (0.21%) and moderate among Blood bank (0.64%) attendees. The rate of HIV positivity showed a decreasing trend for PPTCT attendees, and a stable trend was seen among Blood bank attendees. • According to 2008 HRG size mapping data, FSW (13,385; 86.98% of total HRG) was the largest HRG in the district followed by MSM (1,954; 12.70% of total HRG). • According to 2012 ICTC data, HIV prevalence was low among male (3.33%) and female (3.25%) attendees, as well as among referred (3.05%) attendees and direct walk-ins (3.62%). The HIV positivity levels showed a decreasing trend for all the ICTC attendees. • In 2012, the number of STI/RTI episodes treated was 41,407 and the syphilis positivity rate among STI clinic attendees was 0.41%. • As per 2001 Census, 7.74% of the males were migrants, among them 13.64% migrated to other states and 29.98% migrated to other districts within the state. • The top two destinations for out-of-state migration were Chhindwara in Madhya Pradesh and Surat in Gujarat. • In 2012, parent to child route of HIV transmission accounted for 5.93%, of all HIV transmission in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 86.4% and 50.1%, respectively. • In 2012, a total of five TI sites were operational in the district. • A total of 73 ICTCs were operational in the district, which tested a total of 1,11,051 attendees for HIV in 2012.

Key Recommendations: • Conduct disaggregated analysis of ICTC, PPTCT, ART data to assess geographical spread with in the district, HIV population infected and their occupational risk to understand the precise epidemic pattern in the district. • Since the largest HRG was FSW, in depth assessment of the size and profile of FSW’s client population including migrants and truckers, will help in understanding of district vulnerabilities • Though HIV prevalence has declined from high to low levels among both ANC and ICTC attendees, district needs continued attention to decrease and limit the spread of the infection further. • Parent to child HIV transmission was high in the district; therefore, it is necessary to strengthen PPTCT program coverage in the district. • Strengthen outreach programme for HRG, and awareness campaigns through focused, effective mass media- mid media approach around source and transit points like railway stations and bus stands for migrants as well.

44 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 46,53,171 (4.14% of Maharashtra Population); Female Literacy Nagpur (N=1854) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (23607) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 91.64 30 - 25047 17149 28.14 19.25 18.60 25.82 20.40 3244 4654 3189 4709 2005 5.83 0.88 250 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 46673 34915 19.82 21.04 21.58 20.08 20.40 4552 7206 3790 7968 2006 0.90 0.88 250 800 0.49 % 15-24 yrs ------HIV Levels and Trends 6 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 66507 11795 15229 46992 45142 14.42 12.13 10.03 13.60 9570 6136 2007 7.55 0.56 0.82 1.13 250 800 ------Transfusion - - - - - Blood 0.81 % Ill., Prim. Edu. 87700 19485 16406 10789 25102 69576 51809 17.20 13.11 2008

6.16 9.98 9.37 7.27 0.67 0.59 0.38 250 244 790 2 - - - - Source: DLHS III;Source:DLHS 67 ------3 Needle/ Syringe 0.22 96752 19651 20552 13617 26586 77196 45608 2009 5.53 7.70 7.45 6.23 0.57 0.55 - - - - - % Married 1 : 85.07%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 95313 20524 32131 16620 36035 75496 42658 2010 5.54 4.40 5.84 4.38 1.60 0.60 0.43 56 250 778 - 0 Parent to ------Child 5.93 64270 29048 35222 22350 41920 47969 2011 3.26 3.23 3.19 3.27 0.52 - - - - - % Widowed or Divorced Unknown 14 0.92 - 111051 2 26884 33840 23295 37429 20977 50327 : 95.5% 2012 3.62 3.05 3.25 3.33 0.64 0.21 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 13385 86.98 Home Street 2004 11970 0.29 FSW NA; NA; 2009 NA NA 5.38 6 7 1

------

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - 12.70 1954 MSM 0.04 39526 NA; NA; 1 1 1 6 7 1 NA NA ------2010 2.34 - - -

Non daily Injectors- Injectors- 2006 Programme Response 23 Daily 1 1 1 6 1 1 0.32 ------NA; IDU NA NA 61246 50 2011 0 - - - 1.17 Vulnerabilities ≥ 187,ICTC 2007 23 1 1 1 6 1 ------migration % total pop. % of male migration No. out- Madhya Chhind Pradesh 41407 2012 wara, 0.41 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT - 23 1 1 1 5 1 6 1 2 - - - - - Gujarat Male Migration, 2001 Census 162286 Surat, Surat, Overall 7.74 100 2009 42 1 1 1 5 2 3 6 1 2 - - - - ≥ 900 and BB and 900 Madhya Pradesh , 22141 13.64 Inter- State 1.06 2010 42 1 1 1 5 2 3 6 1 4 - - - - ≥ Chhatis Raipur, 900); 48656 29.98 Intra- garh state 2.32 2011 11 67 1 1 5 2 4 6 1 4 - - - - - 4 PP = percent = ­ PP Balaghat, Madhya Pradesh district 91489 56.38 Intra- 4.37 2012 11 73 1 1 5 2 4 6 1 4 - - - -

District HIV/AIDS Epidemiological Profiles :Maharashtra | 45 Nanded

Background: Nanded lies in the eastern portion of region, which corresponds to Aurangabad division of Maharashtra. The district is bordered by Nizamabad, Medak and Adilabad districts of Andhra Pradesh on the east, by of Karnataka falls on the south, by Parbhani and Latur districts of Marathwada on the west, and of Maharashtra’s Vidarbha region on the north. It has a population of 35.56 lakh, a sex ratio of 937 females per 1,000 males, and a female literacy rate of 66.68% with an overall literacy rate of 76.94% (Census 2011). In 2006, the Ministry of Panchayati Raj named Nanded as one of the country’s 250 most backward districts. It is one of the twelve districts in Maharashtra currently receiving funds from the Backward Regions Grant Fund Programme (BRGF). It is well connected via roads and railways, and National Highway-22 passes through the district.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was moderate (0.50%) among the ANC attendees, with a fluctuating trend. • Based on 2012 PPTCT and Blood Bank data, the level of HIV positivity was low for PPTCT (0.18%) and Blood donors (0.32%). HIV positivity levels showed a decreasing trend for both the attendees. • According to 2012 ICTC data, HIV prevalence was low among male (3.10%) and female (3.94%) attendees. It was also low among referred (3%) attendees and direct walk-ins (3.86%). HIV positivity levels showed a decreasing trend for all the ICTC attendees. • According to 2008 HRG size mapping data, FSW (518; 100% of total HRG) was the only HRG in the district. • In 2012, the number of STI/RTI episodes treated was 8,599 and the syphilis positivity rate among STI clinic attendees was 0.27%. • As per 2001 Census, 7.67% of the males were migrants. Among the male migrants, 8.53% migrated to other states and 34.40% migrated to other districts with in the state. • The top two destinations for out-of-state migration were Adilabad and Nizamabad in Andhra Pradesh. • As per 2012 ICTC data, parent to child HIV transmission accounted for 6.02% of the HIV positives in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 76.6% and 26.3%, respectively. • In 2012, there was one TI site functional in the district.

Key Recommendations: • When the IBBS data will be available, analyze on FSW and other groups in the district to improve the understanding of the vulnerabilities. Since the largest HRG was FSW, improved assessment of the size and profile of client population including migrants and truckers, will help in understanding of district vulnerabilities. As well as availability of typology data would help to analyze risk factors. • Improve PPTCT services as the rate of parent to child HIV transmissions was high in the district. • Considering high rate of migration, strengthen outreach programme through awareness campaigns around source and transit points like railway stations and bus stands.

46 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 33,56,566 (2.47% of Maharashtra Population); Female Literacy Nanded (N=1047) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (7780) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 91.79 44 - 13.71 11.39 11.54 4653 1118 2868 2005 8.88 0.73 0.63 963 822 667 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 12.43 10.61 12.58 11.36 6561 1400 1356 4426 2006 0.86 0.50 735 779 800 0.86 % 15-24 yrs ------11 HIV Levels and Trends - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 19022 10176 18.69 10.46 17.66 15.32 6115 2733 3097 5749 6265 2007 0.60 1.01 0.38 800 ------Transfusion - - - - - Blood 0 % Ill., Prim. Edu. 33548 13615 11775 12500 15434 4499 6339 2008

9.35 7.47 9.91 8.33 0.78 0.56 0.69 727 2 ------Source: DLHS III;Source:DLHS 46 ------3 Needle/ Syringe 46643 16204 14752 21976 20067 6895 8347 2009 5.54 5.58 6.01 5.29 0.67 0.39 0 - - - - - % Married 1 : 66.68%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 42357 16998 15727 28709 17854 7505 8776 2010 5.04 4.76 5.66 4.55 0.47 0.30 0.38 37 799 - Parent to ------Child 6.02 27942 18133 18472 31500 9809 9470 2011 4.32 3.73 4.86 3.74 0.40 - - - - - % Widowed or Divorced Unknown 9 1.34 - 2 52942 15844 17776 12155 21465 19322 : 76.2% 2012 7173 3.86 3.00 3.94 3.10 0.32 0.18 0.50 800 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- Home Street 2004 20424 0.02 FSW 100 518 NA; NA; 2009 NA NA 0.94 1 4 2

------

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - MSM 11018 NA; NA; 1 4 2 NA NA ------2010 0.37 ------

Non daily Injectors- Injectors- 2006 Programme Response 20 Daily 1 4 ------NA; IDU NA NA 8600 2011 ------0.20 Vulnerabilities ≥ 187,ICTC 2007 20 1 1 1 1 4 ------migration % total pop. % of male migration No. out- Adilabad, Pradesh Andhra 8599 2012 0.27 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 20 1 1 1 1 4 ------Pradesh Andhra Andhra Nizam Male Migration, 2001 Census 113296 abad, abad, Overall 7.67 100 2009 20 - 1 1 1 1 1 4 ------≥ 900 and BB and 900 gareddy, Pradesh Andhra Ran 9663 Inter- State 8.53 0.65 2010 - 21 50 29 1 1 1 6 1 1 4 1 - - -

≥ Karimna Pradesh Andhra 900); 38973 34.40 Intra- state 2.64 gar, 2011 21 50 29 1 1 1 6 1 1 4 1 - - -

­ 4 - percent = PP Pradesh Medak, Andhra district 64660 57.07 Intra- 4.38 2012 21 50 48 1 1 1 6 1 1 4 1 - - -

District HIV/AIDS Epidemiological Profiles :Maharashtra | 47 Nandurbar

Background: Nandurbar is an administrative district in the northwest corner (Khandesh region) of Maharashtra. The district is bordered to the south and south-east by Dhule, to the west and north by Gujarat, to the north and north-east is Madhya Pradesh. It has a population of 16.46 lakh, a sex ratio of 972 females per 1,000 males, and a female literacy rate of 53.90% with an overall literacy rate of 63.04% (Census 2011). Current site for the construction and operation of the world’s largest wind farm having an output of 1000M.W. is just 30 km away from Nandurbar city. It is one of the country’s 250 most backward districts and is one of the twelve districts in Maharashtra currently receiving funds from the Backward Regions Grant Fund Programme (BRGF). It is well connected via roads and railways, and National Highway 16 connects it to the rest of the districts within the state.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was low (0.25%) among the ANC attendees, with a declining trend although a rise was seen in 2010. • Based on 2012 data from PPTCT and Blood Bank programs, the level of HIV positivity was low among PPTCT attendees (0.08%), as well as among Blood donors (0.38%). HIV positivity levels showed a decreasing trend for both the PPTCT attendees and the blood donors • According to 2012 ICTC data, HIV prevalence was low among male (2.64%) and female (1.72%) attendees, as well as among referred (1.86%) and direct walk-in (4.46%) attendees. The HIV positivity levels showed a decreasing trend for all the ICTC attendees except for ICTC direct Walk-ins which experienced a stable trend. • According to 2008 HRG size mapping data, FSW (448; 79.43% of total HRG) was the largest HRG in the district. • In 2012, the number of STI/RTI episodes treated was 2,272, which was nearly two fold increase since 2011 • As per 2001 Census, 10.65% of the males were migrants. Out of the total male migrants, 22.66% migrated to other states and 17.92% migrated to other districts within the state. • The top two destinations for out-of-state migration were Surat and Navsari in Gujarat, as per the 2001 census. • According to 2012 ICTC data, the route of HIV transmission was high from parent to child at 8.87%, in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 28.9% and 7.5%, respectively. • In 2012, a total of three TI sites were operational in the district. • There were a total of 29 ICTCs operational in the district, which tested an overall of 37,639 attendees for HIV in 2012.

Key Recommendations: • Conduct socio-demographic analysis of HSS-ANC data to understand risk factors for HIV epidemic among general population and strengthen the PPTCT program in the district. • Although there was a low level of HIV epidemic in the district, vulnerability factors in transmission of HIV needs to be analysed from ICTC and STI data. • Intensify outreach activities with HIV prevention messages for migrants at source and destination sites. • Strengthen efforts towards assessing route of HIV transmission at the ICTCs. • The percentage of HIV transmission via parent to child was high. Therefore, there is a need to better understand the profile and dynamics of clinic attendees and their spouses, through analysis of ICTC data.

48 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 16,46,177 (1.46% of Maharashtra Population); Female Literacy Nandurbar (N=485) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (2453) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 88.87 43 - 33.33 18.28 17.13 28.43 1889 1269 2005 0.95 0.63 177 443 321 299 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 12.06 11.75 5114 3606 2006 9.40 9.98 0.55 0.38 521 987 521 987 800 1.65 % 15-24 yrs ------HIV Levels and Trends - - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 15169 2907 2793 1967 3733 2244 9469 2007 5.06 8.06 5.54 7.05 0.84 0.57 0.38 800 ------Transfusion - - - - - Blood 0 % Ill., Prim. Edu. 25856 15638 5375 5090 4852 5613 2420 2008

4.30 5.85 4.45 5.58 0.87 0.26 0.13 800 2 ------Source: DLHS III;Source:DLHS 88 ------3 Needle/ Syringe 0.21 28061 14537 4788 6796 5350 6234 2496 2009 2.67 5.72 3.89 4.96 0.32 0.20 - - - - - % Married 1 : 53.90%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 30133 12930 13166 4037 7693 9274 3501 2010 3.47 2.58 2.43 3.08 0.20 0.26 0.50 19 795 - Parent to ------Child 8.87 22024 17656 10403 11621 4368 3996 2011 2.88 1.77 1.68 2.27 0.38 - - - - - % Widowed or Divorced Unknown 17 0.41 - 2 37639 17859 10064 10328 17247 : 38.3% 2012 2533 2355 4.46 1.86 1.72 2.64 0.38 0.08 0.25 800 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 79.43 Home Street 2004 0.03 FSW 448 NA; NA; 2009 NA NA 925 1 2 1 1 1

------0

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - 17.02 MSM 0.01 NA; NA; 1 2 1 1 1 NA NA ------96 4045 2010 - - - 0

Non daily Injectors- Injectors- 2006 Programme Response Daily 1 1 4 1 1 1 3.55 ------NA; IDU NA NA 20 1245 2011 0 - - - Vulnerabilities 0 ≥ 187,ICTC 2007 14 1 1 1 1 1 ------migration % total pop. % of male migration No. out- Gujarat Surat, 2272 2012 0 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 14 1 1 1 1 1 ------Navsari, Navsari, Gujarat Male Migration, 2001 Census Overall 70571 10.65 100 2009 14 1 1 1 1 1 1 1 ------≥ 900 and BB and 900 Bharuch, Gujarat 15989 22.66 Inter- State 2.41 2010 14 1 1 1 1 1 1 1 1 1 - - - - ≥ Barwani, Madhya Pradesh 900); 12644 17.92 Intra- state 1.91 2011 18 16 29 1 1 1 1 1 2 1 1 1 - - 4 PP = percent = ­ PP Nalanda, district 41938 59.43 Intra- 6.33 2012 26 71 29 1 1 1 1 1 2 1 1 1 - -

District HIV/AIDS Epidemiological Profiles :Maharashtra | 49 Nashik

Background: Nashik is bordered by Dhule to the north, Jalgaon to the east, Aurangabad to the southeast, Ahmadnagar to the south, Thane to the southwest, Valsad and Navsari districts of Gujarat to the west, and the Dangs district of Gujarat to the northwest. It has a population of 61.09 lakh, and a sex ratio of 931 females per 1,000 males, and a female literacy rate of 73.43% with an overall literacy rate of 80.96% (Census 2011). It is well connected via roads and railways, National Highway-3, connecting it to the rest of the districts with in the state.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, prevalence was low (0.25%) among the ANC attendees, with a decreasing trend. • Based on 2012 PPTCT and Blood Bank data, the level of HIV positivity was low for PPTCT attendees (0.08%) and blood donors (0.22%), with a fluctuating trend for PPTCT attendees and a stable trend for Blood Bank attendees. • According to 2012 ICTC data, HIV prevalence was low among male (1.65%) and female (2.09%) attendees, as well as among referred (1.02%) and direct walk-in (2.96%) attendees. The HIV positivity levels showed a decreasing trend for all the ICTC attendees. • According to 2008 HRG size mapping data, FSW (1,873; 71% of total HRG) was the largest HRG in the district followed by MSM (545; 20.66% of total HRG) and IDU (220; 8.34% of total HRG). • In 2012, the number of STI/RTI episodes treated was 22,320 and the syphilis positivity rate among STI clinic attendees was 0.06%. • As per 2001 Census, 11.93% of the total males were migrants. Among the total migrant males 3.61% migrated to other states and 20.67% migrated to other districts within the state. • The top two destinations for out-of-state migration were Surat and Valsad in Gujarat, as per Census 2001. • According to 2012 ICTC data, HIV transmission from parent to child was at 7.28%, in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 69.6% and 28.1%, respectively. • There were a total of two TI sites operational in the district in 2012, one for the FSWs and one for MSM. • In 2012, a total of 101 ICTCs were functional and 1,54,069 attendees were tested for HIV in the district.

Key Recommendations: • Conduct socio-demographic analysis of HSS-ANC data to understand risk factors for HIV epidemic among general population and strengthen the PPTCT program in the district. • Continue HIV prevention strategies to maintain the HIV prevalence at low levels in the district. • When the IBBS data will be available, analyze on FSW and other groups in the district to improve the understanding of the vulnerabilities. • Strengthen IEC programmes for creating STI/RTI awareness in district among general population, especially women.

50 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 61,09,052 (5.44% of Maharashtra Population); Female Literacy Nashik (N=1565) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (9375) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 87.28 51 - 14.09 15.54 18.40 7326 2853 1734 2566 2021 2739 2005 7.55 8.53 1.94 1.75 250 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 18795 12498 15.03 11.71 14.81 13.94 4803 1494 2214 4083 2006 9.60 0.80 0.63 250 800 0.58 % 15-24 yrs ------HIV Levels and Trends 7 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 42822 12021 10508 25822 26631 10.12 11.23 4170 5683 2007 8.68 8.97 7.20 0.25 0.57 0.38 250 800 ------Transfusion - - - - - Blood 0.77 % Ill., Prim. Edu. 62957 18904 16644 41440 37094 7527 9787 2008

8.57 5.74 9.07 6.99 9.60 0.25 0.35 0.38 250 791 2 ------Source: DLHS III;Source:DLHS 48 ------3 Needle/ Syringe 0.19 81144 22825 14782 13471 24136 44552 39584 2009 5.65 2.46 5.30 3.89 0.24 0.27 - - - - - % Married 1 : 73.43%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 75010 19218 24532 15702 28048 42628 31260 2010 4.81 1.63 3.53 2.75 8.00 0.20 0.54 0.13 37 250 800 - Parent to ------Child 7.28 83322 34844 48478 30316 53006 34326 2011 3.03 1.12 2.27 1.72 0.33 - - - - - % Widowed or Divorced Unknown 18 3.90 - 154069 2 35361 50428 32827 52962 13968 68280 : 71.6% 2012 2.96 1.02 2.09 1.65 0.22 0.08 0.25 800 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 71.00 Home Street 2004 1873 0.03 FSW NA; NA; 4857 2009 NA NA 0.00 5 2 5 1 1

------

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - 20.66 MSM 0.01 545 18163 NA; NA; 5 2 5 1 1 NA NA ------2010 0.86 - - -

Non daily Injectors- Injectors- 2006 Programme Response 35 35 Daily 2 1 1 8.34 ------220 NA; IDU NA NA 16278 2011 0 - - - 0.84 Vulnerabilities ≥ 187,ICTC 2007 35 35 1 2 1 1 ------migration % total pop. % of male migration No. out- Gujarat 22320 Surat, 2012 0.06 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 42 35 1 1 1 2 2 1 1 - - - - - Gujarat Valsad, Valsad, Male Migration, 2001 Census 309244 Overall 11.93 100 2009 42 35 1 1 1 2 2 1 1 - - - - - ≥ 900 and BB and 900 Navsari, Gujarat 11163 Inter- State 3.61 0.43 2010 180 51 1 1 1 4 1 2 3 1 1 - - - ≥ Dadra & Dadra & Haveli, 900); Haveli Nagar Nagar 63926 20.67 Intra- state 2.47 2011 180 35 65 1 1 1 4 2 2 3 1 1 - - 4 PP = percent = ­ PP Vadodara, 234155 Gujarat district 75.72 Intra- 9.03 2012 180 101 35 1 1 1 4 2 2 3 1 1 - -

District HIV/AIDS Epidemiological Profiles :Maharashtra | 51 Osmanabad

Background: Osmanabad is in the Marathwada region of Maharashtra, situated to the north of Osmanabad lies Beed, to the northeast and east is Latur, to the east and southeast is Bidar of Karnataka, to the southeast and south is Gulbarga of Karnataka, to the south and southwest is Solapur and to the northwest is Ahmednagar. It has a population of 16.60 lakh, and a sex ratio of 920 females per 1,000 males, and a female literacy rate of 66.67% with an overall literacy rate of 76.33% (Census 2011). The district is well connected via roads and railway, and National Highway 9 and 211 connect it to the rest of the districts within the state.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was moderate (0.63%) among the ANC attendees, with a fluctuating trend. • Based on 2012 PPTCT and Blood Bank data, the HIV positivity was low for PPTCT attendees (0.27%), while it was moderate among Blood donors (0.89%), with a fluctuating trend among both. • According to 2012 ICTC data, HIV positivity was low among male (2.82%) and female (2.75%) attendees. It was also low among referred (1.98%) attendees, while it was near moderate among ICTC direct walk in attendees (4.61%). A decreasing positivity trend was observed for all the ICTC attendees. • In 2012, the number of STI/RTI episodes treated was 2,223 and the syphilis positivity rate among STI clinic attendees was 0.38%. • As per 2001 Census, 10.32% of the total males were migrants. Among the total male migrants 1.69% migrated to other states and 64.14% migrated to other districts within the state. • The top two destinations for out-of-state migration were Belgaum and Gulbarga in Karnataka. • As per 2012 ICTC data, HIV route of transmission through parent to child which accounted for 7.81% of the total HIV transmissions in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 74.2% and 25.4%, respectively. • In 2012, a total of 46 ICTCs were operational, which tested a total of 46,416 attendees for HIV in the district.

Key Recommendations: • Conduct socio-demographic analysis of HSS-ANC data to understand risk factors for HIV epidemic among general population and strengthen the PPTCT program in the district. • The parent to child HIV transmission rate was high, thus more needs to be done to understand the profile of these attendees through in-depth analysis of ICTC data. • Strengthen outreach programme through awareness campaigns around source and transit points, like railway stations and bus stands. • Increase STI/RTI Awareness among women in district. • When the IBBS data will be available, analyze on FSW, MSM and other groups in the districts to improve the understanding of vulnerabilities.

52 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 16,60,311 (1.48% of Maharashtra Population); Female Literacy Osmanabad (N=743) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (4267) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 86.94 45 - 10.65 3718 2602 2005 5.08 7.49 7.84 0.88 1.38 590 526 427 689 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 18.35 15.96 6744 1378 1535 4783 2006 6.31 8.21 0.67 1.50 583 426 800 1.08 % 15-24 yrs ------10 HIV Levels and Trends - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 16170 10185 10.37 16.38 3187 2786 1880 4105 3034 2007 9.03 7.89 0.89 0.72 0.25 800 ------Transfusion - - - - - Blood 0.54 % Ill., Prim. Edu. 21573 12909 10.65 13.29 4990 3792 2972 5810 2791 2008

9.52 8.33 0.90 0.53 0.80 751 2 ------Source: DLHS III;Source:DLHS 87 ------3 Needle/ Syringe 0.13 29876 15164 6377 6189 4631 7935 3535 2009 8.50 6.51 9.09 6.60 0.91 0.67 - - - - - % Married 1 : 66.67%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 32119 10633 10648 14225 7261 7246 3906 2010 6.32 3.98 5.63 4.45 0.74 2.94 0.50 63 800 - Parent to ------Child 7.81 25059 16404 10525 14534 8655 2820 2011 5.40 2.77 4.07 3.40 0.46 - - - - - % Widowed or Divorced Unknown 22 3.50 - 2 46416 19766 13546 14897 17973 : 71.9% 2012 8677 1232 4.61 1.98 2.75 2.82 0.89 0.27 0.63 799 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- Home Street 2004 FSW NA; NA; 4828 2009 NA NA 0.00 1 1 1 1

------

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - MSM NA; NA; 2 1 1 1 NA NA ------1264 2010 1.02 ------

Non daily Injectors- Injectors- 2006 Programme Response 13 13 Daily 2 1 1 ------NA; IDU NA NA 1270 2011 ------0.24 Vulnerabilities ≥ 187,ICTC 2007 13 13 2 1 1 ------Karnataka migration % total pop. % of male migration No. out- Belgaum, 2223 2012 0.38 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 100 13 2 1 1 1 1 ------Karnataka Gulbarga, Gulbarga, Male Migration, 2001 Census Overall 78713 10.32 100 2009 100 23 1 2 1 1 1 1 ------≥ 900 and BB and 900 Gujarat Valsad, 1327 Inter- State 1.69 0.17 2010 150 15 46 1 2 3 1 1 1 1 - - - - ≥ 900); 50485 64.14 Intra- state 6.62 2011 - 213 15 48 1 1 2 3 1 1 1 0 - - - ­ 4 percent = PP district 26901 34.18 Intra- 3.53 2012 215 15 46 - 1 1 2 4 1 1 1 0 - - -

District HIV/AIDS Epidemiological Profiles :Maharashtra | 53 Parbhani

Background: Parbhani earlier also known as Prabhavatinagar, is one of the eight districts in the Marathawada region of Maharashtra. The district is enveloped by Hingoli in the north, by Nanded in the east, on the south is Latur and Beed is towards the west. It has a population of 18.36 lakh, and a sex ratio of 940 females per 1,000 males, and a female literacy rate of 64.27% with an overall literacy rate of 75.22% (Census 2011). Parbhani is an agrarian district. It is well connected via roads and railways, and National Highway 222 connects it to the rest of the districts with in the state.

HIV Epidemic Profle: • As per 2010 HSS-ANC data, HIV prevalence was low (0.25%) among the ANC attendees, with a decreasing trend in the last three years. • Based on 2012 PPTCT and Blood bank data, the level of HIV positivity was low for PPTCT attendees (0.24%) and blood donors (0.32%). HIV positivity levels showed a decreasing trend among PPTCT, while a stable trend was observed for blood bank attendees. • As per 2010 HSS data, HIV positivity was near-moderate among FSWs (4.82%) and moderate among MSM (6%). A decreasing trend was observed for FSWs, while a trend could not be determined among MSM due to lack of prior data. • According to 2012 ICTC data, HIV prevalence was low among male (4.15%) and female (2.81%) attendees, as well as among referred (2.34%) attendees, while it was moderate for direct walk-ins (5.42%). The HIV positivity levels showed a decreasing trend for all the ICTC attendees. • According to 2008 HRG size mapping data, FSW (1,749; 81.58% of total HRG) was the largest HRG in the district followed by MSM (395; 18.42% of total HRG). • In 2012, the number of STI/RTI episodes treated was 18,067. • The top two destinations for out-of-state migration were Bagalkot and Belgaum in Karnataka. • As per the Census 2001, 11.28% out of the total male population were migrants. Among the migrated, 56.62% migrated to other parts of the state and 41.41% migrated within the district and 2.07% migrated out to other states. • As per 2012 ICTC data, the route of HIV transmission through parent to child accounted for 6.16% of all transmissions in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 78.3% and 35.1%, respectively. • In 2012, a total of nine TI sites were operational in the district. • A total of 39 ICTCs were operational in the district in 2012, which tested a total of 39,855 attendees for HIV in the district.

Key Recommendations: • When the IBBS data will be available, analyze on FSW, MSM and other groups in the district to improve the understanding of the vulnerabilities • The percentage of HIV transmission via parent to child was high. Therefore, there is a need to better understand the profile and dynamics of clinic attendees and their spouses, through analysis of ICTC data. PPTCT programme has to be strengthened. • Considering high rate of migration, strengthen outreach programme through awareness campaigns around source and transit points like railway stations and bus stands. • Increase STI RTI awareness among women and integrate STI prevention and treatment into the PPTCT program. • Expand coverage of HIV counseling and testing in the district to detect HIV positive cases at an early age, due to high percentage of PLHIV on ART (50%).

54 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 18,35,982 (1.63% of Maharashtra Population); Female Literacy Parbhani (N=601) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (4417) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 92.68 50 - 17.67 16.75 15.60 2649 1373 2005 9.63 9.81 0.87 0.50 549 727 673 603 250 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 21.99 19.38 22.60 20.36 10.40 7931 1269 1228 6048 2006 0.78 0.88 614 655 250 800 1.00 % 15-24 yrs ------HIV Levels and Trends 9 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 13923 11.75 16.43 13.31 12.97 3310 1327 1683 2954 1609 9286 2007 8.80 0.49 0.60 1.13 250 800 ------Transfusion - - - - - Blood 0 % Ill., Prim. Edu. 15749 13.52 12.51 15.57 11.88 5467 1934 2761 4640 2310 8348 2008

4.40 0.43 0.59 0.53 250 759 2 ------Source: DLHS III;Source:DLHS 70 ------3 Needle/ Syringe 26263 12956 7275 3661 4315 6621 1255 2009 8.63 8.06 9.29 7.88 0.48 1.00 0 - - - - - % Married 1 : 64.27%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 25294 11851 6193 7250 6244 7199 6385 2010 7.59 5.79 6.36 6.85 6.00 4.82 0.39 0.62 0.25 66 250 249 798 - Parent to ------Child 6.16 20984 13514 11097 7470 9887 6920 2011 4.79 2.87 3.18 3.89 0.27 - - - - - % Widowed or Divorced Unknown 20 0.17 - 2 39855 12602 10665 20560 : 69% 2012 6693 8630 3807 5.42 2.34 2.81 4.15 0.32 0.24 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 81.58 Home Street 2004 1749 0.10 FSW NA; NA; 4381 2009 NA NA 1 1 2 1

------0

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - 18.42 MSM 0.02 395 11475 NA; NA; 1 1 1 2 1 NA NA ------2010 - - - 0

Non daily Injectors- Injectors- 2006 Programme Response 10 Daily 1 1 1 1 ------NA; IDU NA NA 15220 2011 ------Vulnerabilities 0 ≥ 187,ICTC 2007 10 1 1 1 1 ------Karnataka migration % total pop. % of male migration No. out- Bagalkot, 18067 2012 0 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 10 1 1 1 1 1 ------Karnataka Belgaum, Belgaum, Male Migration, 2001 Census Overall 85923 11.28 100 2009 10 1 9 1 1 1 1 5 1 3 - - - - ≥ 900 and BB and 900 Gujarat Surat, 1776 Inter- State 2.07 0.23 2010 36 1 9 1 4 1 1 1 5 1 3 - - - ≥ Gujarat Valsad, 900); 48564 56.52 Intra- state 6.37 2011 42 1 9 1 4 1 1 1 5 1 3 - - - ­ 4 percent = PP district 35583 41.41 Intra- 4.67 2012 39 - 1 9 1 4 1 1 1 5 1 3 - - -

District HIV/AIDS Epidemiological Profiles :Maharashtra | 55 Pune

Background: Pune is in the western region in Maharashtra in India. It is bordered by Thane to the northwest, Raigad to the west, Satara to the south, Solapur to the southeast, and Ahmednagar to the north and northeast. It has a population of 94.26 lakh, out of which 60.99% lives in urban region and a sex ratio of 910 females per 1,000 males, and a female literacy rate of 81.13% with an overall literacy rate of 87.19% (Census 2011). It is an industrial center, but its economy is also agriculture based. Pune has a lot of hill stations for tourist attraction. It is well connected via roads and railways, and National Highway 4, 9 and 50 connects it to the rest of the districts within the state.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, the HIV prevalence was moderate (0.67%) among the ANC attendees, with an increasing trend. • Based on 2012 PPTCT and Blood Bank data, the HIV positivity rate was low for PPTCT (0.38%)and Blood bank (0.25%) attendees. HIV positivity rate showed an overall a stable trend for PPTCT attendees, blood bank attendees. • As per 2010 HSS data, the HIV prevalence was moderate among the FSWs (8.20%) but showed sharp decline in 2010. • According to 2012 ICTC data, HIV positivity was low among male (4.63%) and among female (4.46%) attendees. It was low among referred (3.91%) attendees and moderate among direct walk-ins (5.63%). HIV positivity rates showed a decreasing trend for all the ICTC attendees. • According to 2008 HRG size mapping data, MSM (14,011; 54.91% of total HRG) was the largest HRG in the district followed by FSW (11,354; 44.50% of total HRG) and IDU (150; 0.59% of total HRG). • In 2012, the number of STI/RTI episodes treated was 19,364 and the syphilis positivity rate among STI clinic attendees was 0.10%. • As per 2001 Census, 9.26% of the males were migrants, among them, 5.33% migrated to other states and 27.68% migrated to other districts within the state. • The top two destinations for out-of-state migration were Bangalore in Karnataka and Surat in Gujarat. • As per 2012 ICTC data, HIV transmission accounted for unknown route of HIV transmission was high at 14.85% and then parent to child HIV transmission accounted for at 5.38%, of all the HIV transmissions in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 89.6% and 36.5%, respectively. • In 2012, ten TIs were functional for FSW, MSM and IDUs in the district. • A total of 109 ICTCs were operational in the district, which tested a total of 1,69,458 attendees for HIV in the year 2012.

Key Recommendations: • Conduct disaggregated analysis of ICTC, PPTCT data especially age, gender and geographic distribution to get better assessment ad spread of risk factors in the district. • Carry out differential analysis of PLHA to triangulate with current evidence and suggest appropriate recommendations. • Ensure quality of services provided to HRGs with respect to effective coverage, preventive and referral services, considering their large numbers in the district and high HIV prevalence. • Conduct site wise and, socio-demographic analysis of ANC-HSS sites to ascertain more risk factors. • Improve counseling at ICTCs, since the rate of unknown routes for HIV transmission was high in the district. • It is necessary to strengthen PPTCT program coverage in the district as parent to child HIV transmission was high. • Strengthen outreach programme through awareness campaigns for migrants with HRB around source, destination points like railway stations, industrial, construction sites bus stands etc.

56 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 94,26,959 (8.39% of Maharashtra Population); Female Literacy Pune (N=4067) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (41166) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 77.82 37 - 12328 23.31 14.73 19.24 18.37 14.80 43.15 17.20 3303 3869 2588 4584 5156 2005 0.66 1.88 250 248 250 800 - - - - 5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 30761 17295 15.12 13.26 15.13 13.60 23.60 50.00 6506 6960 4938 8528 2006 0.84 0.50 250 250 800 0.64 % 15-24 yrs ------HIV Levels and Trends 8 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 56955 16776 14553 12826 18503 89639 25626 10.79 15.20 59.20 32.20 2007 6.40 7.70 8.94 0.45 0.69 0.25 250 250 205 800 - - Transfusion - - - - - Blood 1.08 % Ill., Prim. Edu. 106210 116981 30256 28404 23854 34806 47550 12.80 41.20 2008

7.22 8.40 8.33 7.42 0.30 0.63 0.26 250 250 775 2 - - - - Source: DLHS III;Source:DLHS 75 ------3 Needle/ Syringe 110531 105993 0.22 23912 27466 20127 31251 49113 10.60 10.51 2009 8.47 8.78 0.37 0.64 - - - - - % Married 1 : 81.13%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 120387 122937 31472 43903 31285 44090 45012 1200 2010 7.33 5.38 6.90 5.70 3.60 8.20 0.33 1.33 0.58 53 250 500 - Parent to ------Child 5.38 104474 100539 37018 67456 43001 61473 2011 6.18 4.14 5.46 4.45 0.26 - - - - - % Widowed or Divorced Unknown 21 14.85 - 169458 2 40771 68423 49833 59361 23016 60264 : 89% 2012 1200 5.63 3.91 4.46 4.63 0.25 0.38 0.67 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 11354 44.50 Home Street 2004 0.12 FSW NA; NA; 3412 2009 NA NA 15 4

------0

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - 14011 54.91 MSM 0.15 15 18515 NA; NA; 1 4 NA NA ------2010 2.71 - - -

Non daily Injectors- Injectors- 2006 Programme Response 44 Daily 1 6 1 5 0.59 ------150 NA; IDU NA NA 16195 2011 0 - - - 0.25 Vulnerabilities ≥ 187,ICTC 2007 44 1 1 1 6 1 5 ------Bangalore, Karnataka migration % total pop. % of male migration No. out- 19364 2012 0.10 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 49 1 4 1 1 2 3 6 1 5 - - - - Gujarat Male Migration, 2001 Census 349099 Surat, Surat, Overall 9.26 100 2009 50 1 4 1 3 3 3 6 1 1 5 - - - ≥ 900 and BB and 900 West Delhi, South 18618 Delhi Inter- State 5.33 0.49 2010 78 1 3 1 5 4 3 5 1 - - - - - Karnataka Belgaum, ≥ 900); 96636 27.68 Intra- state 2.56 2011 70 93 1 3 1 9 4 3 5 1 - - - - 4 PP = percent = ­ PP 233845 Gujarat Valsad, district 66.99 Intra- 6.21 2012 109 70 13 1 2 1 4 3 5 1 4 5 - -

District HIV/AIDS Epidemiological Profiles :Maharashtra | 57 Raigarh

Background: Raigarh, located in the region, was renamed after Raigarh District , which was the former capital of the leader Shivaji Maharaj, and is located in the interior regions of the district. The district is bordered by to the northwest, Thane to the north, Pune to the east, Ratnagiri to the south, and the to the west. It has a population of 26.35 lakh, a sex ratio of 955 females per 1,000 males, and a female literacy rate of 76.79% with an overall literacy rate of 83.89% (Census 2011). The district is connected to Mumbai by Sion Expressway. The Mumbai-Pune expressway and NH4 passes through Panvel. NH 17, which starts at Panvel, traverses the whole district.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was low among the ANC attendees with an overall declining trend. • Based on 2012 PPTCT and Blood Bank data, HIV positivity was low for PPTCT attendees (0.18%) and Blood donors (0.18%). HIV positivity levels showed a decreasing trend for PPTCT attendees, while a stable trend was observed for Blood bank attendees. • According to 2012 ICTC data, HIV positivitywas low among male (2.05%) and female (1.75%) attendees, as well as among referred (1.42%) and direct walk-in (2.62%) attendees. HIV positivity levels showed an overall decreasing trend for all the ICTC attendees. • According to 2008 HRG size mapping data, FSW (1011; 93.18% of total HRG) was the largest HRG in the district. • In 2012, the number of STI/RTI episodes treated among clinic attendees was 7,711 and the syphilis positivity was 0.12%. • As per 2001 Census, 12% of the total males were migrants. Among the migrated males 2.63% migrated to other states and 38.60% migrated to other districts within the state. • The top two destinations for out-of-state migration were Surat in Gujarat and Vishakapatnam in Andhra Pradesh. • As per ICTC 2012 data, parent to child HIV transmission accounted for 5.66% of all HIV transmissions in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 69.1% and 34.8%, respectively. • In 2012, two TI sites were operational in the district, and both were for FSWs.

Key Recommendations: • Continue of HIV prevention strategies to maintain HIV prevalence at low levels in the district. • Strengthen PPTCT program coverage in the district as parent to child HIV transmission was high. • When the IBBS data will be available, analyze on FSW, MSM and other groups in the districts to improve the understanding of vulnerabilities. Focus on getting a clearer picture on the size and profile of clients of FSWs, such as migrants and truckers, as FSW was the largest HRG in the district. • Considering high rate of migration, strengthen outreach programme through awareness campaigns around source and transit points like railway stations and bus stands. • Expand coverage of HIV counseling and testing in the district to detect HIV positive cases at an early stage, since the percentage of PLHIV on ART was high (94%).

58 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 26,35,394 (2.35% of Maharashtra Population); Female Literacy Raigarh (N=548) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (176) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 92.34 94 - 24.19 17.70 24.17 21.64 16.40 4671 3767 2005 1.46 0.88 678 226 331 573 250 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 11.36 13.76 14.16 10.76 8728 2730 1144 2342 5242 2006 0.86 0.87 756 801 % 15-24 yrs ------0 - - - - - HIV Levels and Trends 5 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 21066 12005 10.89 6068 2993 2635 6426 2007 5.54 9.91 6.24 0.53 0.25 800 * * ------Transfusion - - - - - Blood 0 % Ill., Prim. Edu. 31089 15140 8621 7328 7067 8882 4255 2008

3.92 5.50 5.12 4.27 2.80 0.25 0.34 0.26 250 776 2 ------Source: DLHS III;Source:DLHS 88 ------3 Needle/ Syringe 0.18 10256 10301 10934 5562 9623 4570 2009 3.43 4.30 3.84 3.89 0.02 - - - - - % Married 1 : 76.79%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 8737 3344 5393 2968 5769 4390 2010 0.51 0.07 0.24 0.24 2.00 0.05 0.38 62 250 800 - Parent to ------Child 5.66 25433 16660 11181 14252 8773 3251 2011 3.37 1.87 2.30 2.46 0.12 - - - - - % Widowed or Divorced Unknown 23 1.82 - 2 55149 14857 20748 15742 19863 19544 : 83.8% 2012 6642 2.62 1.42 1.75 2.05 0.18 0.18 800 0 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 93.18 Home Street 2004 1011 0.04 FSW NA; NA; 2009 NA NA 1 1 2

------

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - MSM 5.71 NA; NA; 1 1 2 NA NA ------62 7990 2010 0 - - - 0

Non daily Injectors- Injectors- 2006 Programme Response 36 Daily 1 1 2 1 1.11 ------NA; IDU NA NA 10323 12 2011 0 - - - Vulnerabilities 0 ≥ 187,ICTC 2007 36 19 1 1 1 ------migration % total pop. % of male migration No. out- Gujarat Surat, 7711 2012 0.12 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 72 19 1 1 1 1 ------Visakha patnam, patnam, Pradesh Andhra Andhra Male Migration, 2001 Census 134030 Overall 12.00 100 2009 72 30 1 1 1 1 1 2 ------≥ 900 and BB and 900 Vadodara, Gujarat 3523 Inter- State 2.63 0.32 2010 304 38 1 1 3 1 1 1 3 2 - - - - ≥ Gujarat Valsad, 900); 51740 38.60 Intra- state 4.63 2011 304 37 1 1 3 1 1 1 3 2 - - - - ­ 4 percent = PP Daman & Daman, district 78767 58.77 Intra- 7.05 2012 Diu 304 44 1 1 3 1 2 1 3 2 - - - -

District HIV/AIDS Epidemiological Profiles :Maharashtra | 59 Ratnagiri

Background: is one of the six districts of the Konkan Ratnagiri District region of Maharashtra, bordered by Arabian Sea to the west, Sindhudurg to the south, Raigad to the north and Satara, Sangli and Kolhapur to the east. It has a population of 16.12 lakh, a sex ratio of 1,123 females per 1,000 males, and a female literacy rate of 74.55% with an overall literacy rate of 82.43% (Census 2011). Rice and coconut are the main crops produced in Ratnagiri. The district is well connected via roads and railways, and National Highway 17 and 204 connects it to the rest of the districts with in the state.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was moderate (0.50%) among the ANC attendees, with a fluctuating trend. • Based on the 2012 PPTCT and Blood Bank data, the level of HIV positivity was low for PPTCT attendees (0.21%) and Blood donors (0.13%).HIV positivity levels showed a for both the attendees. • According to 2012 ICTC data, HIV prevalence was low among male (1.85%) and female (1.44%) attendees. It was also low among referred (1.07%) attendees and direct walk-ins (2.90%). A decreasing trend was observed for all the ICTC attendees. • According to 2008 HRG size mapping data, FSW (186; 86.92% of total HRG) was the largest HRG in the district. • In 2012, the number of STI/RTI episodes treated was 2,456 and the syphilis positivity rate among STI clinic attendees was 0.28%. • As per 2001 Census, 18.57% of the males were migrants. Among the migrated males,1.90% migrated to other states and 55.48% migrated to other districts within the state. • The top two destinations for out-of-state migration were Surat and Walsad in Gujarat. • As per 2012 ICTC data, parent to child HIV transmission accounted for 5.82%, of the HIV transmissions in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 69.5% and 27.3%, respectively. • As per 2012 data, there were 21 ICTCs in the district, and a total of 42,862 attendees tested for HIV.

Key Recommendations: • Although there was a low level of HIV epidemic in the district, vulnerability factors in transmission of HIV needs to be analysed from ICTC and STI data. • When the IBBS data will be available, analyze on FSW and other groups in the district to improve the understanding of the vulnerabilities. • Strengthen outreach activities with STI/RTI prevention messages for migrants at source and destination sites considering high rate of migration. • Strengthen PPTCT program in the district, since the HIV transmission from parent to child was high. • Generate information on typology of HRG population to better understand district epidemiological profile. Increase STI-RTI awareness among women.

60 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 16,12,672 (1.43% of Maharashtra Population); Female Literacy Ratnagiri (N=601) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (3688) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 90.52 49 - 14.54 23.42 19.14 15.83 3102 2152 2005 0.42 1.00 681 269 350 600 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 12.36 15.43 18.91 11.45 6785 1489 1729 4395 2006 0.80 0.25 901 661 800 0.00 % 15-24 yrs ------HIV Levels and Trends 6 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 15856 12.11 11.75 4268 3105 2451 4918 2946 8487 2007 6.75 7.63 0.13 0.45 0.25 800 ------Transfusion - - - - - Blood 0.17 % Ill., Prim. Edu. 17765 10.80 5454 4343 3907 5890 4374 7715 2008

5.34 9.01 6.93 0.11 0.39 0.40 756 2 ------Source: DLHS III;Source:DLHS 83 ------3 Needle/ Syringe 0.17 28522 11035 7882 6637 6523 7996 4745 2009 2.56 4.66 3.37 3.64 0.06 0.29 - - - - - % Married 1 : 74.55%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 28526 10920 10383 7223 8899 9244 4884 2010 3.20 2.66 2.57 3.17 0.16 0.17 0.25 56 790 - Parent to ------Child 5.82 25280 16471 12761 12519 8809 3601 2011 2.85 1.45 1.77 2.11 0.14 - - - - - % Widowed or Divorced Unknown 25 3.33 - 2 42862 18643 14070 12872 15920 : 83.3% 2012 8299 2380 2.90 1.07 1.44 1.85 0.13 0.21 0.50 800 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 86.92 Home Street 2004 0.01 FSW 186 NA; NA; 2009 NA NA 248 2 3

------0

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - 13.08 MSM NA; NA; 2 3 NA NA ------28 1527 2010 0 - - - 0

Non daily Injectors- Injectors- 2006 Programme Response 11 Daily 2 ------NA; IDU NA NA 1908 2011 ------0.69 Vulnerabilities ≥ 187,ICTC 2007 14 1 2 ------migration % total pop. % of male migration No. out- Gujarat Surat, 2456 2012 0.28 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 14 1 1 1 2 ------Gujarat Valsad, Valsad, Male Migration, 2001 Census 147552 Overall 18.57 100 2009 15 1 1 1 2 ------≥ 900 and BB and 900 Daman & Daman, 2804 Inter- State Diu 1.90 0.35 2010 48 1 1 1 1 3 1 1 2 - - - - - North Goa, ≥ 900); 81863 55.48 10.30 Intra- Goa state 2011 21 48 1 1 1 1 4 1 1 2 - - - - ­ 4 percent = PP South Goa, district 62885 42.62 Intra- 7.92 2012 Goa 21 21 1 1 1 1 4 1 1 2 - - - -

District HIV/AIDS Epidemiological Profiles :Maharashtra | 61 Sangli

Background: is located in the western part of Maharashtra. Sangli District It is bound by Satara and Solapur districts to the north, Bijapur district, Karnataka to the east, Kolhapur district and belgaum, Karnataka districts to the south, and Ratnagiri district to the west. It has a population of 28.20 lakh, a sex ratio of 964 females per 1,000 males; female literacy rate of 74.66% and an overall literacy rate of 82.62% (Census 2011). Agriculture is the chief source of income in the district. Groundnut, jowar, sugarcane, soyabean and turmeric are the major food crops produced in Sangli. There are numerous places of interests in Sangli. Sangli district is well-connected by an extensive rail network with the major cities and towns. National Highway, NH-4, passes through the district.

HIV Epidemic Profle: • Based on 2012 HSS-ANC, HIV positivity was low at 0.38% among the ANC attendees, with a decreasing trend. • According to 2012 PPTCT data, the level of HIV positivity was low (0.38%) among the PPTCT attendees, with a decreasing trend. • According to 2012 Blood Bank data, the level of HIV positivity was low (0.27%) among the Blood Bank attendees, with a decreasing trend. • In 2012, HIV prevalence among ICTC attendees was near-moderate among male (4.91%) and moderate among female (6.03%) attendees. HIV prevalence was low among referred (3.81%) attendees but moderate among direct walk-in (9%) attendees. An overall declining trend was observed among all the ICTC attendees. • According to 2008 HRG size mapping data, FSW (3,793; 78.86% of the total HRG) was the largest HRG in the district followed by MSM (1,017; 21.14% of the total HRG). • In 2012, 23,369 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.29%. • As per the 2001 Census,12.39% of the male population were migrants; among them 7.92% migrated to other states and 38.88% migrated to other districts with in the state. • The top two destinations for out-of-state migration were Belgaum and Bijapur, Karnataka. • In 2012, of the 19,144 PLHIV registered at the Anti-Retroviral Therapy (ART) center, 32% were on ART, 4% were 15-24 years of age, 54% were illiterate or only had a primary school education, 34% were married. • According to DLHS-III data, the HIV awareness rate and STI/RTI awareness rate among women was 85.1% and 34.1%, respectively. • In 2012, two FSW TI and one MSMTI were operational in the district.

Key Recommendations: • There is a need for an increase in the number of targeted interventions (TI) sites in the district, the current number of TI sites is not enough to deal with the large number of HRGs in the area. • HIV Positivity at ICTC suggests continuing transmission among the attendees along with risky behavior. So there is a need to establish a mechanism to understand the dynamics of HIV transmission among HRG and migrant population. • Since the only HRG was FSW, better assessment of the size and profile of client population including migrants and truckers, will help in better understanding of district vulnerabilities. • Considering high rate of migration to high HIV prevalent districts, strengthen outreach programme through awareness campaigns around source and transit points like railway stations and bus stands.

62 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 28,20,575 (2.51% of Maharashtra Population); Female Literacy Sangli (N=2347) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (19144) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 91.10 32 - 23.89 13.76 12.55 25.54 25.20 4174 1264 1591 1602 1253 1319 2005 4.40 2.75 250 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 14334 40.65 30.03 38.91 31.41 28.40 2883 3616 2886 3613 7835 2006 2.35 2.00 250 800 0.13 % 15-24 yrs ------HIV Levels and Trends 4 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 27276 26388 12386 23.56 24.35 23.31 24.37 30.00 8127 6763 6323 8567 2007 0.62 1.35 2.25 250 800 ------Transfusion - - - - - Blood 0.17 % Ill., Prim. Edu. 33139 10341 11851 33322 13158 18.15 12.52 16.00 15.05 14.05 9640 8130 2008

0.57 1.11 1.46 242 754 2 ------Source: DLHS III;Source:DLHS 54 ------3 Needle/ Syringe 0.04 46609 10343 12014 12428 29934 18672 13.21 11.23 10.69 9929 2009 8.97 0.54 0.76 - - - - - % Married 1 : 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 74.66% 51557 11380 20069 14651 16798 26284 20108 12.32 2010 6.30 8.47 8.49 0.43 0.75 0.63 34 798 - Parent to ------Child 4.69 ; ANC Utilization 33138 10661 22477 14159 18979 20908 11.20 2011 5.30 8.04 6.57 0.31 - - - - - % Widowed or Divorced Unknown 19 3.88 - 57872 11906 26644 17142 21408 19322 2 2012 3334 : 81.6% 9.00 3.81 6.03 4.91 0.27 0.38 0.38 795 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 78.86 Home Street 2004 3793 0.13 FSW NA; NA; 2009 NA NA 11 412 1 1 1 4

------0

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - 21.14 1017 MSM 0.04 11 14723 NA; NA; 1 1 1 7 NA NA ------2010 1.75 - - -

Non daily Injectors- Injectors- 2006 Programme Response 11 Daily 1 1 1 8 1 2 ------NA; IDU NA NA 12192 2011 ------1.53 Vulnerabilities ≥ 187,ICTC 2007 11 20 1 1 1 1 2 ------Karnataka migration % total pop. % of male migration No. out- Belgaum, 23369 2012 0.29 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 30 11 20 1 2 1 1 1 2 - - - - - Karnataka Bijapur, Bijapur, Male Migration, 2001 Census 163397 Overall 12.39 100 2009 30 11 20 1 2 1 4 2 2 1 2 - - - ≥ 900 and BB and 900 Karnataka Bagalkot, 12940 Inter- State 7.92 0.98 2010 55 11 43 1 2 1 4 2 2 1 2 - - - South Goa, ≥ 900); 63529 38.88 Intra- Goa state 4.82 2011 55 11 59 1 1 1 6 2 2 1 2 - - - ­ 4 percent = PP North Goa, district 86928 53.20 Intra- 6.59 2012 Goa 55 11 62 1 1 1 6 2 2 1 2 - - -

District HIV/AIDS Epidemiological Profiles :Maharashtra | 63 Satara

Background: Satara comes under Pune administrative division along with Pune, Sangli, Solapur and Kolhapur. Pune borders it to the north, Raigad to the North-West, Solapur to the east, Sangli to the south, and Ratnagiri to the west. It has a population of 30.03 lakh, a sex ratio of 986 females per 1,000 males, and a female literacy rate of 76.29% with an overall literacy rate of 84.2% (Census 2011). Satara district is predominantly agricultural. It is well connected via roads and railways, and National Highway 4, 47 and 80 connects it to the rest of the districts with in the state.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was low (0.25%) among the ANC attendees, with a stable trend in the last three recordings. • Based on 2012 PPTCT and blood bank data, the level of HIV positivity was low for PPTCT (0.20%) and low among blood donors (0.24%) HIV positivity levels showed a decreasing trend both PPTCT and blood bank. • According to 2012 ICTC data, HIV prevalence was moderate among male (6.71%) and female (6%) attendees. It was moderate among referred (7.54%) while low in direct walk-ins (3.56%). HIV positivity levels showed stable to decreasing trend for all the ICTC attendees. • According to 2008 HRG size mapping data, FSW (1,380; 79.77% of total HRG) was the largest HRG in the district followed by MSM (350; 20.23% of total HRG). • In 2012, the number of STI/RTI episodes treated was 7,923 and the syphilis positivity rate among STI clinic attendees was 0.12%. • As per 2001 Census,17.59% of the total males were migrants. Among the migrated males, 1.59% migrated to other states and 44.35% migrated to other districts within the state. • The top two destinations for out-of-state migration were Belgaum in Karnataka and Valsad in Gujarat. • According to the 2012 ICTC data, parent to child HIV transmission accounted for 5.73% of the HIV transmissions in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 81% and 38.5%,respectively. • In 2012, a total of 52,032 attendees were tested for HIV at the 95 ICTCs in the district.

Key Recommendations: • Strengthen targeted interventions sites in the district to provide the referral and preventive services to HRGs in the area. • Continue of HIV prevention strategies to maintain HIV prevalence at low levels. • Focus on getting a clearer picture on the size and profile of clients of FSWs, such as migrants and truckers, as FSW was the largest HRG in the district. • The parent to child HIV transmission rate was high, thus there is a need to strengthen the PPTCT program in the district. • Strengthen outreach programmes through awareness campaigns for HRGs; also around truck halting points and highways in the district. • Generate information on typology of HRG population to better understand district epidemiological profile.

64 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 30,03,922 (2.67% of Maharashtra Population); Female Literacy Satara (N=2095) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (10325) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 91.36 49 - 21.35 15.89 16.82 19.76 5323 1138 1391 1213 1316 2794 2005 2.25 1.88 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 10781 12.21 14.74 15.03 12.15 2064 1642 1517 2189 7075 2006 1.34 1.50 800 1.53 % 15-24 yrs ------HIV Levels and Trends 7 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 25555 15059 13874 17.43 12.96 11.29 7590 4091 4366 7315 2007 8.95 0.51 0.95 1.63 800 ------Transfusion - - - - - Blood 0.33 % Ill., Prim. Edu. 43641 14296 11458 15861 15170 17937 11.17 11.17 9843 2008

6.95 7.38 0.39 0.49 0.14 740 2 ------Source: DLHS III;Source:DLHS 65 ------3 Needle/ Syringe 0.29 43173 11185 12960 19185 18953 9793 8018 2009 5.11 9.37 9.33 6.17 0.55 0.43 - - - - - % Married 1 : 76.29%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 46840 12534 14630 10951 16213 19044 19676 2010 4.06 6.97 6.34 5.14 0.66 0.51 0.13 42 799 - Parent to ------Child 5.73 32386 13335 19051 14533 17853 14866 2011 3.31 5.69 4.99 4.48 0.36 - - - - - % Widowed or Divorced Unknown 21 0.76 - 2 52032 22697 14869 17153 18271 20010 : 92.6% 2012 9325 3.56 7.54 6.00 6.71 0.24 0.20 0.25 799 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 79.77 Home Street 2004 1380 0.05 FSW NA; NA; 8405 2009 NA NA 1 1 1 7 3

------0

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - 20.23 MSM 0.01 350 NA; NA; 1 1 1 7 3 NA NA ------3490 2010 0.36 - - -

Non daily Injectors- Injectors- 2006 Programme Response 22 Daily 1 1 1 1 7 1 ------NA; IDU NA NA 3077 2011 ------0.22 Vulnerabilities ≥ 187,ICTC 2007 22 1 1 1 1 1 7 1 ------Karnataka migration % total pop. % of male migration No. out- Belgaum, 7923 2012 0.12 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 24 1 1 1 1 1 7 1 ------Gujarat Valsad, Valsad, Male Migration, 2001 Census 246610 Overall 17.59 100 2009 25 1 1 1 1 1 7 1 ------≥ 900 and BB and 900 Daman & Daman, 3926 Inter- State Diu 1.59 0.28 2010 216 30 1 1 1 5 2 1 7 1 - - - - ≥ Gujarat 109361 900); Surat, 44.35 Intra- state 7.80 2011 254 78 1 1 2 7 2 1 6 1 - - - - ­ 4 percent = PP madabad, 133323 Gujarat district 54.06 Intra- 9.51 2012 Ah 259 95 1 1 2 7 2 1 7 1 - - - - -

District HIV/AIDS Epidemiological Profiles :Maharashtra | 65 Sindhudurg

Background: Sindhudurg is an administrative district in the state of Maharashtra, which was carved out of the erstwhile Ratnagiri district. The district is surrounded by Ratnagiri in the north, Goa in the south, Kolhapur in the east and the Arabian Sea in the west. It has a population of 8.48 lakh, a sex ratio of 1,037 females per 1,000 males, and a female literacy rate of 79.73% with an overall literacy rate of 86.54% (Census 2011). The economy of the district depends upon agriculture. Apart from access by airways, Sindhudurg district is also well-connected to the major towns and cities like Mumbai and Goa by road and rail. There are 7 railway stations in the district and the famous Konkan Railway passes through Sindhudurg. National Highway, NH-17 also passes through the district.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was moderate (0.63%) among the ANC attendees, with a flat trend at low levels till 2010, but a rise was observed in 2012. • Based on 2012 PPTCT and Blood Bank data, the level of HIV positivity was low among ANC attendees (0.33%) and Blood donors (0.13%). HIV positivity levels showed a fluctuating trend for PPTCT, while a stable trend was observed among blood bank attendees. • According to 2012 ICTC data, HIV prevalence was low among male (0.93%) and female (1.36%) attendees. It was also low among referred (1.24%) and direct walk-in (0.89%) attendees. A decreasing trend was observed for all the ICTC attendees. • According to 2008 HRG size mapping data, there were 218 FSWs in the district. • In 2012, the number of STI/RTI episodes treated was 2,411. • As per 2001 Census, 16.69% of the total males were migrants. Among the migrated males, 4.59% migrated to other states and 51.99% migrated to other districts within the state. • The top three destinations for out-of-state migration were North Goa, South Goa and Belgaum in Karnataka. • As per 2012 ICTC data, parent to child HIV transmission accounted for 9.09%, of all the HIV transmissions in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 73.9% and 40%, respectively. • In 2012, a total of two TI sites were operational in the district. • A total of 24 ICTCs were functional in the district, which tested a total of 40,898 attendees for HIV in in the year 2012.

Key Recommendations: • Though HIV prevalence has declined among ICTC attendees, district needs continued attention to decrease and limit the spread of the infection further. • The parent to child HIV transmission rate was high; therefore PPTCT program has to be strengthened. • Conduct disaggregated analysis of PPTCT data to assess risk factors in the district. • Considering high rate of migration, strengthen outreach programme through awareness campaigns around source and transit points like railway stations and bus stands. • Generate information on typology of HRG population to better understand district epidemiological profile. • Availability of ART or DLN data will help in understanding the district vulnerabilities.

66 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 8,48,868 (0.75% of Maharashtra Population); Female Literacy Sindhudurg (N=231) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (NA) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 88.74 - - 2005 0.25 846 800 * * * * * * * * * * ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 15.79 17.92 4306 1002 1009 3057 2006 6.39 5.95 0.33 0.13 247 240 800 0.87 % 15-24 yrs ------HIV Levels and Trends - - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 11978 3549 1545 1245 3849 2303 6884 2007 4.23 6.15 8.35 3.59 0.34 0.20 0.13 800 ------Transfusion - - - - - Blood 0.43 % Ill., Prim. Edu. 15178 5191 2271 1817 5645 1816 7908 2008

2.97 3.48 5.72 2.29 0.00 0.16 0.13 784 2 ------Source: DLHS III;Source:DLHS ------3 Needle/ Syringe 18713 5605 2726 2421 5910 4706 8603 2009 1.61 2.05 2.40 1.49 0.02 0.27 0 - - - - - 1 : 79.73%; ANC Utilization % Married 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 15996 5490 3293 2813 5970 2659 7213 2010 0.97 2.06 2.03 1.07 0.04 0.93 0.13 799 - - Parent to ------Child 9.09 12188 6674 5514 3627 8561 4231 2011 1.12 1.23 1.65 0.97 0.09 - - - - - % Widowed or Divorced Unknown 0.87 2 - - : 92.3% 40898 14113 16418 10116 20415 10367 2012 5335 0.89 1.24 1.36 0.93 0.13 0.33 0.63 800 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- Home Street 2004 0.03 FSW 100 218 NA; NA; 2009 NA NA 117 1

------0

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - MSM NA; NA; 3 NA NA ------1751 2010 ------0

Non daily Injectors- Injectors- 2006 Programme Response 12 Daily 1 ------NA; IDU NA NA 2361 2011 ------Vulnerabilities 0 ≥ 187,ICTC 2007 12 1 ------North Goa migration % total pop. % of male migration No. out- 2411 2012 0 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 12 1 ------South Goa South Male Migration, 2001 Census Overall 69248 16.69 100 2009 21 1 1 1 0 1 ------≥ 900 and BB and 900 Karnataka Belgaum, 3177 Inter- State 4.59 0.77 2010 21 1 1 1 1 2 1 ------Daman & ≥ Daman, 900); 36000 51.99 Intra- state 8.68 Diu 2011 21 1 1 1 1 2 1 1 ------4 PP = percent = ­ PP district 30071 43.43 Intra- 7.25 2012 24 - 1 1 1 1 2 1 1 ------

District HIV/AIDS Epidemiological Profiles :Maharashtra | 67 Solapur

Background: Solapur is located on the south east edge of Maharashtra and lies entirely in the Bhima and Seena basins. It is surrounded by Ahmednagar and Osmanabad districts in the north, Osmanabad and Gulbarga districts (Karnataka State) in the east, Sangli and Bijapur districts (Karnataka State) in the south and Pune, and Satara in the west. It has a population of 43.15 lakh, a sex ratio of 932 females per 1,000 males, and a female literacy rate of 68.55% with an overall literacy rate of 77.72% (Census 2011). The district is well connected via roads and railways, and National Highway 9 and 13 connects it to the rest of the districts within the state.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was moderate (0.63%) among the ANC attendees, with a fluctuating trend in the moderate to high positivity bracket. • Based on 2012 PPTCT and Blood Bank data, HIV positivity was low for PPTCT attendees (0.42%), while moderate among Blood donors (0.51%). HIV positivity levels showed a decreasing trend for PPTCT attendees and a fluctuating trend among blood bank attendees. • As per 2010 HSS data, HIV positivity was moderate among FSWs (5.20%). • According to 2012 ICTC data, HIV prevalence was low among male (4.09%) and female (3.78%) attendees. It was low among referred (2.50%) attendees, but moderate among direct walk-ins (6.25%). An overall declining trend was observed among all the ICTC attendees. • According to 2008 HRG size mapping data, FSW (4,167; 79.39% of total HRG) was the largest HRG in the district followed by MSM (1,037; 19.76% of total HRG). • In 2012, the number of STI/RTI episodes treated was 23,369 and the syphilis positivity rate among STI clinic attendees was 0.29%. • As per 2001 Census, 12.12% of the total males were migrants. Among the migrated males, 3.43% migrated to other states and 44.28% migrated to other districts with in the state. • The top two destinations for out-of-state migration were Bijapur and Belgaum in Karnataka. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 81.8% and 50.7%, respectively. • As per 2012 ICTC data, HIV transmission through parent to child route was high at 6.27% in the district. • In 2012, three TIs for FSWs and one for MSM were functional in the district. • In 2012, a total of 92 ICTCs were functional in the district, which tested a total of 86,866 attendees for HIV.

Key Recommendations: • Strengthen targeted intervention sites in the district to provide the referral and preventive services to HRGs in the area. • Strengthen PPTCT program in the district and analyse disaggregated PPTCT data to understand the profile of ANC attendees. • Asses the size and profile of FSW’s client populations, including migrants and truckers, to improve the understanding of district vulnerabilities, since the largest HRG was FSW and positivity was moderate among them was moderate. • Increase STI/RTI awareness among women in the district. • Considering high rate of migration, strengthen outreach programme through awareness campaigns around source and transit points like railway stations and bus stands.

68 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 43,15 ,527 (3.84% of Maharashtra Population); Female Literacy Solapur (N=2314) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC 2009 % Pos; No. HRG- IDU No. HRG-MSM No. HRG- FSW DLN (NA) ART (13874) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP Aurad 0.29 4 4 % On ART - - - - 91.40 48 - 28.36 20.56 22.81 24.34 6946 1148 1060 5040 2005 1.05 1.75 758 846 800 ------5 Balki 0.5 General clients & pregnant women. - - - - Homo-sexual

Route of HIV Transmission, ICTC 2012 12453 19.79 12.32 16.81 13.54 1233 2337 1487 2083 8883 2006 1.86 1.00 800 0.61 Basavaka % 15-24 yrs ------lyana 0.71 - - - - 13 HIV Levels and Trends -

Block-Level Details PLHIV Pro f le, 2012 1 - 2011 Census;2011 27416 52520 17984 23.36 16.16 17.12 22.33 5026 4406 4223 5209 2007 0.60 0.88 1.00 800 ------Transfusion Bidar 0.26 - - - - Blood 0.13 % Ill., Prim. Edu.

43575 60088 27871 Humnabad 23.21 15.45 19.61 20.69 9561 6143 7515 8189 2008

6.00 0.79 0.72 1.60 250 752 2 ------0.41 Source: DLHS III;Source:DLHS 59 - - - - - 3 Needle/ Syringe 60647 15106 12284 13395 13995 59796 27991 10.24 10.20 2009 9.39 9.50 0.47 0.62 0 - - - - - % Married 1 3 : 68.55%; ANC Utilization Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 67240 18285 20434 17918 20801 65016 28521 2010 8.70 5.05 6.62 6.91 5.20 0.49 0.29 1.13 39 250 797 - Parent to ------Child 6.27 47397 18983 28414 23805 23592 58527 2011 7.35 3.39 4.56 5.39 0.65 - - - - - % Widowed or Divorced Unknown 15 1.60 - 86866 23114 37018 29045 31087 36581 26734 2 2012 6.25 2.50 3.78 4.09 0.51 0.42 0.63 : 86.5% 793 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 79.39 Home Street 2004 4167 0.10 FSW NA; NA; 2009 NA NA 412 4

------0

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - 19.76 1037 MSM 0.02 14723 NA; NA; 6 NA NA ------2010 1.75 - - -

Non daily Injectors- Injectors- 2006 Programme Response 21 Daily 1 0.86 ------NA; IDU NA NA 12192 45 2011 0 - - - 1.53 Vulnerabilities ≥ 187,ICTC 2007 21 1 1 1 ------Karnataka migration % total pop. % of male migration No. out- Bijapur, 23369 2012 0.29 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 21 1 1 1 ------Karnataka Belgaum, Belgaum, Male Migration, 2001 Census 241173 Overall 12.12 100 2009 21 1 2 1 1 ------≥ 900 and BB and 900 Karnataka Gulbarga, 8271 Inter- State 3.43 0.42 2010 66 1 1 2 1 4 1 ------North Goa, ≥ 106791 900); 44.28 Intra- Goa state 5.36 2011 28 84 1 1 1 4 2 1 4 2 1 - - - ­ 4 percent = PP Karnataka Bagalkot, 126111 district 52.29 Intra- 6.34 2012 28 92 1 1 1 5 2 1 5 1 3 - - -

District HIV/AIDS Epidemiological Profiles :Maharashtra | 69 Thane

Background: The name ‘Thane’ is derived from the ancient city ‘Shristhanaka’ which was ruled by the kings. The British took over Thane from the in the year 1817 and it became part of north Konkan. The district is borderedby Pune and Ahmadnagar on the east, Nashik on the east and northeast, of Gujarat and Union Territory of Dadra and Nagar Haveli on the north. It is bordered by Mumbai City and Mumbai Suburban on the southwest and Raigad on the south. Thane has a population of 1.10 crore, a sex ratio of 880 females per 1,000 males, and a female literacy rate of 80.78% with an overall literacy rate of 86.18% (Census 2011). Majority of the population of the district is engaged in agriculture and allied activities and the district is known as industrial hub where in-migration is substantial. The district is well connected via roads and railways, National Highway 3 and 8 connecting it to the rest of the districts with in the state.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was moderate (0.50%) among the ANC attendees, with a fluctuating trend. • Based on 2012 PPTCT and Blood Bank data, the HIV positivity rate was low for PPTCT (0.23%) and Blood bank (0.36%) attendees. HIV positivity rate showed a decreasing trend for PPTCT but a stable trend was seen in the last three recordings for Blood Bank attendees. • As per 2010 HSS data, the level of HIV positivity was moderate among FSWs (5.20%) and MSM (5.20%). A decreasing trend was observed for FSWs with sharp decline in 2010. A trend could not be determined for MSM due to lack of data. • According to 2012 ICTC data, HIV positivity rate was low among male (4.18%) and female (3.87%) attendees, as well as among referred (3.77%) and direct walk-in (4.50%) attendees. HIV positivity rate showed a decreasing trend for all the ICTC attendees. • According to 2008 HRG size mapping data, FSW (16,874; 68.27% of total HRG) was the largest HRG in the district followed by MSM (7,441; 30.11% of total HRG) and IDU (400; 1.62% of total HRG). • In 2012, syphilis positivity rate among STI clinic attendees was1.56%. • As per 2001 Census, 5.37% of the males were migrants, among them 5.72% migrated to other states and 15.57% migrated to other districts within the state and 78.71% migrated within the district. • The top two destinations for out-of-state migration were Valsad in Gujarat and Theni in Tamil Nadu. • As per 2012 ICTC data, parent to child HIV transmission accounted for 5.66%, of all the HIV transmissions in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 71.1% and 17.8%, respectively. • In 2012, a total of ten TI sites were functional in the district.

Key Recommendations: • Though HIV prevalence has declined from high to moderate levels among ICTC attendees, district needs continued attention to decrease and limit the spread of the infection further. • Since the largest HRG was FSW, assessment of the size, typology and profile of client population, including MSMs, migrants and truckers, will help in understanding better district vulnerabilities. • Carryout disaggregated analysis of HSS-MSM & FSW to further understand the profile of HRGs risk in the district. • Due to the high rate of parent to child HIV transmissions as well as homosexual route strengthening and ensuring quality of services provided should be ensured. • Due to large numbers of migrants flowing in, more focused migrant specific interventions including services at source, transit and destination with linking may be useful to track HIV spread.

70 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 1,10,54,131 (9.84% of Maharashtra Population); Female Literacy Thane (N=3198) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (25413) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 90.74 45 - 11352 20.83 15.46 25.20 2088 4973 3692 3369 4291 2005 8.43 9.02 8.00 2.14 1.38 250 250 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 35806 24284 16.12 10.37 12.95 12.62 28.40 4714 6808 3714 7808 2006 6.00 1.10 0.88 250 250 800 1.34 % 15-24 yrs ------HIV Levels and Trends 8 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 83639 15205 17617 10621 22199 50819 32.40 2007 7.35 7.95 8.07 7.57 7.20 0.85 0.88 250 250 800 * * - - - - Transfusion - - - - - Blood 0.41 % Ill., Prim. Edu. 110671 23379 24374 16361 31392 39538 62678 11.69 2008

9.19 7.84 9.69 7.88 0.54 0.70 0.65 248 774 2 ------Source: DLHS III;Source:DLHS 83 ------3 Needle/ Syringe 132771 0.19 20533 30695 18838 32390 47948 63677 2009 7.28 7.27 7.71 7.02 0.34 0.48 - - - - - % Married 3 1 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data : 80.78%; ANC Utilization 134543 36362 43859 33307 46914 71433 54322 2010 5.03 4.94 4.98 4.98 5.20 5.20 0.34 0.37 0.38 56 250 250 800 - Parent to ------Child 5.66 85854 30909 54945 31237 54617 47584 2011 4.90 4.35 4.90 4.35 0.43 - - - - - % Widowed or Divorced Unknown 18 1.66 - 167404 35162 56631 39666 52127 75611 2 2012 3304 4.50 3.77 3.87 4.18 0.36 0.23 0.50 795 : 84.7% ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 16874 68.27 Home Street 2004 0.15 FSW NA; NA; 9278 2009 NA NA 75 1 1 7 6

------0

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - 30.11 124 7441 MSM 0.07 27844 NA; NA; 1 1 9 6 NA NA ------2010 0.06 - - -

Non daily Injectors- Injectors- 2006 Programme Response 170 25 Daily 1 1 1 6 0.00 1.62 ------400 NA; IDU NA NA 78373 2011 - - - 0.15 Vulnerabilities ≥ 187,ICTC 2007 219 36 1 1 1 1 6 ------migration % total pop. % of male migration No. out- Gujarat Valsad, 46708 2012 1.56 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 368 36 1 1 2 1 6 ------Tamil Nadu Male Migration, 2001 Census Theni, Theni, 235199 Overall 5.37 100 2009 527 49 1 1 2 2 5 1 3 6 - - - - ≥ 900 and BB and 900 Dadra & Dadra & Haveli, Haveli Nagar Nagar 13454 Inter- State 5.72 0.31 2010 549 59 1 1 6 3 3 5 1 5 6 - - - ≥ Gujarat 900); 36614 Surat, 15.57 Intra- state 0.84 2011 673 75 83 1 1 6 4 3 5 1 4 7 - - ­ 4 percent = PP Daman & Daman, 185131 district 78.71 Intra- 4.23 2012 Diu 590 122 86 1 1 1 6 4 3 5 1 2 7 -

District HIV/AIDS Epidemiological Profiles :Maharashtra | 71 Wardha

Background: Wardha, a part of Nagpur division, is situated in the north Wardha District eastern part of Maharashtra. The district is bordered to the north and west by the Amravati and by the Yavatmal to the south. In the east it is bordered by Nagpur and by Chandrapur in the south east. It has a population of 12.96 lakh, a sex ratio of 946 females per 1,000 males, and a female literacy rate of 81.89% and an overall literacy rate of 87.22% (Census 2011). The district has 507 Gram Panchayats, 1,387 villages and 6 Municipal towns. Recently this district has been in news because of a number of suicides that have been committed by the farmers owing to the agricultural loans they could not repay, with the major reasons being bad crops, droughts and lack of irrigation facilities in the region. The district is well connected via roads and railway, National Highway 6 and 7 connecting it to the rest of the districts within the state.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was low (0.25%) among the ANC attendees, with a flat trend, though a rise was observed in 2008. • Based on 2012 PPTCT and Blood Bank data, the HIV positivity rate was low among PPTCT attendees (0.12%) and Blood donors (0.16%). HIV positivity levels showed a decreasing trend for PPTCT attendees while a fluctuating trend for Blood bank attendees. • According to 2012 ICTC data, HIV positivity rate was low among male (1.59%) and female (1.97%) attendees, as well as among referred (2.16%) attendees and direct walk-ins (1.21%). The HIV positivity rates showed a declining trend for all the ICTC attendees. • According to 2008 HRG size mapping data, FSW (894; 95.41% of total HRG) was the largest HRG in the district. • In 2009, the number of STI/RTI episodes treated was 45,776 and the syphilis positivity rate among STI clinic attendees was 7.20%. • As per 2001 Census, 12.34% of the males were migrants, among them 2.37% migrated to other states and 39.30% migrated to other districts within the state. • The top two destinations for out-of-state migration were Chhindwara in Madhya Pradesh and Raipur in Chhattisgarh. • As per 2012 ICTC data, parent to child HIV transmission accounted for 6.39%, of all the HIV transmission routes in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 81.8% and 37.5%, respectively. • In 2012, one TI site was functional for FSWs, in the district. • As per programme response 2012 data, 34 ICTCs were functional in the district, which tested a total of 47,344 attendees for HIV.

Key Recommendations: • Although there was a low level of HIV epidemic in the district, vulnerability factors in transmission of HIV needs to be analysed from ICTC, blood bank and STI data. • Intensify outreach activities with HIV prevention messages for risk groups (FSW, MSM) including truckers. • Generate information on typology, profile of HRG population to better understand district epidemiological profile. • FSW sentinel site may be started to monitor the trend of HIV/ STI prevalence and impact of interventions. • When the data will be available, analyze IBBS data on FSW and other groups in the district to improve the understanding of vulnerabilities. • Increase STI/RTI awareness among women and integrate STI prevention and treatment into the PPTCT programme.

72 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 12,96,157 (1.15% of Maharashtra Population); Female Literacy Wardha (N=407) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (2588) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 89.43 34 - 9032 8078 2005 8.72 6.81 5.63 9.49 0.40 0.38 367 587 480 474 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 13857 11863 1323 1338 2006 7.56 8.35 8.84 7.32 0.62 0.25 671 656 800 0.25 % 15-24 yrs ------10 HIV Levels and Trends - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 28940 19590 5538 3816 2526 6824 2007 2.80 4.82 4.55 3.28 0.39 0.25 800 * * ------Transfusion - - - - - Blood 0.25 % Ill., Prim. Edu. 33433 10447 17636 9845 5952 5350 8279 2008

2.43 3.58 3.23 2.67 0.59 0.35 0.89 787 2 ------Source: DLHS III;Source:DLHS 24 ------3 Needle/ Syringe 37403 10484 17324 7946 7759 5221 9121 2009 2.29 3.76 3.37 2.84 0.64 0.30 0 - - - - - % Married 1 : 81.89%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 35077 11891 11232 16493 9546 9038 6693 2010 1.96 3.22 2.44 2.65 0.53 0.24 0.38 17 799 - Parent to ------Child 6.39 20050 10508 12859 9542 7191 9437 2011 1.56 2.78 2.27 2.16 0.65 - - - - - % Widowed or Divorced Unknown 6 3.69 - 2 47344 11877 14408 16392 21059 : 88.6% 2012 9893 1863 1.21 2.16 1.97 1.59 0.16 0.12 0.25 800 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 95.41 Home Street 2004 0.07 FSW 894 NA; NA; 2009 NA NA 977 3 1 3

------0

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - MSM 4.59 NA; NA; 3 1 3 NA NA ------43 4043 2010 0.31 0 - - -

Non daily Injectors- Injectors- 2006 Programme Response 12 12 Daily 1 ------NA; IDU NA NA 8404 2011 ------0.24 Vulnerabilities ≥ 187,ICTC 2007 12 12 1 1 ------migration % total pop. % of male migration No. out- Madhya Chhind Pradesh 6449 2012 wara, 0.03 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT - 12 12 1 1 1 1 1 ------Chhatis Raipur, Raipur, Male Migration, 2001 Census Overall 78472 garh 12.34 100 2009 12 28 - 1 1 1 1 2 1 1 - - - - - ≥ 900 and BB and 900 Gujarat Surat, 1860 Inter- State 2.37 0.29 2010 12 41 1 1 1 1 2 1 1 - - - - - ≥ 900); 30836 39.30 Intra- state 4.85 2011 - 12 41 1 1 9 1 1 1 2 1 1 - - - 4 PP = percent = ­ PP district 45776 58.33 Intra- 7.20 2012 12 34 - 1 1 9 1 1 1 2 1 1 - - -

District HIV/AIDS Epidemiological Profiles :Maharashtra | 73 Washim

Background: Washim is a relatively a newly formed district that was created on 1st July 1998, sharing border with Akola to the north, Hingoli to the south, Yavatmal to the east. It has a population of 11.96 lakh, a sex ratio of 926 females per 1,000 males; the district has a female literacy rate of 72.26% with an overall literacy rate of 81.70% (Census 2011). Agriculture is the primary industry in this region. The district is well connected via roads and railway, and National Highway 6 connects it to the rest of the districts with in the state.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was moderate (0.50%) among the ANC attendees, with a stable trend till 2010, but a slightly increase was observed in 2012. • Based on 2012 PPTCT and 2011 Blood Bank data, HIV positivity rate was low for PPTCT attendees (0.46%) and near moderate among Blood donors (0.44%). HIV positivity rates showed a fluctuating trend for PPTCT attendees, while a stable trend was observed among blood bank attendees. • According to 2012 ICTC data, HIV prevalence was low among male (2.26%) and female (1.60%) attendees, as well as among referred (1.79%) and direct walk-in (2.29%) clients. HIV positivity levels showed a decreasing trend for all the ICTC attendees. • According to 2008 HRG size mapping data, FSW (1,043; 96.84% of total HRG) was the largest HRG in the district. • In 2012, the number of STI/RTI episodes treated was 3,415. • As per 2001 Census, 8.03% of males were migrants, among them 1.70% migrated to other states and 50.06% migrated to other districts with in the state. • The top destination for out-of-state migration was Surat in Gujarat. • As per 2012 ICTC data, HIV transmission through parent to child accounted for 6.06% of the total HIV transmissions in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 60.9% and 10.9%, respectively. • A total of 17 ICTCs were functional, which tested 24,604 attendees for HIV in the district in the year 2012.

Key Recommendations: • Considering the persistence of significant numbers of infections through mother to child transmission, strengthen PPTCT program in the district. • Start sentinel surveillance among FSW in the district. • Focus on getting a clearer picture on the size and profile of clients of FSWs, such as migrants and truckers, as FSW was the largest HRG in the district. Also, generate information on typology of HRG population to better understand the district epidemiological profile. • Continue HIV prevention strategies to maintain HIV prevalence at low levels in the district. • Strengthen outreach programme through awareness campaigns around source and transit points like railway stations and bus stands.

74 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 11,96,714 (1.06% of Maharashtra Population); Female Literacy Washim (N=198) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (1255) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 92.42 47 - 11.32 1489 2005 8.44 9.76 4.45 0.38 474 410 292 592 800 * * ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 10.29 4176 1030 2806 2006 7.56 6.71 6.12 3.53 0.13 714 656 340 800 % 15-24 yrs ------0 - - - - - HIV Levels and Trends 7 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 7581 2194 1797 1049 2942 3590 2007 5.79 7.40 7.91 6.02 0.72 0.38 800 * * ------Transfusion - - - - - Blood 1.52 % Ill., Prim. Edu. 14125 3680 3024 1762 4942 6247 2008

3.97 4.99 6.70 3.62 0.29 0.38 795 * * 2 ------Source: DLHS III;Source:DLHS 89 ------3 Needle/ Syringe 17603 5059 3457 2124 6392 2911 8078 2009 3.46 5.61 6.73 3.54 0.31 1.20 0 - - - - - % Married 1 : 72.26%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 17291 3773 5187 2800 6160 5304 8331 2010 3.18 3.43 4.14 2.95 0.36 0.24 0.38 68 795 - Parent to ------Child 6.06 10462 3929 6533 3742 6720 4985 2011 2.80 2.60 2.99 2.50 0.44 - - - - - % Widowed or Divorced Unknown 17 - 2 24604 13936 0 : 68.6% 2012 3793 6875 4687 5981 2.29 1.79 1.60 2.26 0.46 0.50 799 * * ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 96.84 Home Street 2004 1043 0.09 FSW NA; NA; 2051 2009 NA NA 1 2

------0

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - MSM 3.16 NA; NA; 1 2 NA NA ------34 2112 2010 1.03 0 - - -

Non daily Injectors- Injectors- 2006 Programme Response Daily 1 9 ------NA; IDU NA NA 3037 2011 ------Vulnerabilities 0 ≥ 187,ICTC 2007 1 9 ------migration % total pop. % of male migration No. out- Gujarat Surat, 3415 2012 0 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 1 9 1 ------Male Migration, 2001 Census Overall 42210 8.03 100 - 2009 1 1 1 1 9 1 ------≥ 900 and BB and 900 Inter- State 1.70 0.14 716 - 2010 15 1 1 4 1 1 1 1 ------≥ 900); 21131 50.06 Intra- state 4.02 2011 - 23 1 1 4 1 1 1 1 ------4 PP = percent = ­ PP district 20363 48.24 Intra- 3.87 2012 17 - 1 1 4 1 1 1 ------

District HIV/AIDS Epidemiological Profiles :Maharashtra | 75 Yavatmal

Background: Yavatmal is located in the region of Vidarbha, in the east- Yavatmal District central part of Maharashtra. It has a population of 27.75 lakh and a sex ratio of 947 females per 1,000 males; the district has a female literacy rate of 72.41% and an overall literacy rate of 80.70% (Census 2011). In 2006, the Ministry of Panchayati Raj named Yavatmal one of the country’s 250 most backward districts. It is one of the twelve districts in Maharashtra currently receiving funds from the Backward Regions Grant Fund Programme (BRGF). The district is well connected via roads and railway, and National Highway 7 connects it to the rest of the districts within the state.

HIV Epidemic Profle: • As per 2010 HSS-ANC data, HIV prevalence was low (0.38%) among the ANC attendee, with an overall decreasing trend. • Based on 2012 PPTCT and Blood Bank data, the level of HIV positivity was moderate for ANC attendees (0.60%) and low among Blood donors (0.36%). HIV positivity levels showed a fluctuating trend for PPTCT and decreasing trend for blood bank attendees. • As per 2010 HSS data, HIV prevalence was low among FSWs (2.41%). • According to 2012 ICTC data, HIV positivity rate was low among male (3.23%) and female (3.06%) attendees, as well as among referred (2.71%) and direct walk-ins (4.10%) attendees. HIV positivity levels showed a decreasing trend for all the ICTC attendees. • According to 2008 HRG size mapping data, MSM (370; 51.75% of total HRG) was the largest HRG in the district followed by FSW (345; 48.25% of total HRG). • In 2012, the number of STI/RTI episodes treated was 13,897. • As per 2001 Census, 12.55% of the males were migrants, among them 1.52% migrated to other states and 31.40% migrated to other districts within the state. • The top two destinations for out-of-state migration were Adilabad in Andhra Pradesh and Surat in Gujarat. • As per 2012 ICTC data, HIV transmission through parent to child accounted for 8.05%, of all the HIV transmission routes in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 70.7% and 26.5%, respectively. • In 2012, a total of two TI sites were operational in the district. • A total of 75 ICTCs were functional in the district, which tested 75,398 attendees for HIV in the year 2012.

Key Recommendations: • Carryout disaggregated analysis of ANC attendees in HSS to identify risk factors responsible for the high HIV epidemic among general population (e.g wives of migrant workers). • Conduct disaggregated analysis of PPTCT to assess risk factors in the district. • Although there was a high level of HIV epidemic in the district, vulnerability factors in transmission of HIV needs to be analysed from ICTC/ ART and STI data. • It is necessary to strengthen PPTCT program coverage in the district as parent to child HIV transmission was high. • Considering high rate of migration, strengthen outreach programme through awareness campaigns around source and transit points like railway stations and bus stands. • Generate information on typology of HRG population to better understand district epidemiological profile. • When the data will be available, analyze IBBS data on FSW, MSM and other groups in the district to improve the understanding of vulnerabilities.

76 | District HIV/AIDS Epidemiological Profiles :Maharashtra positive, NT = number tested; available;not Data size; - sample Inadequate * District Population: 27,75,457 (2.47% of Maharashtra Population); Female Literacy Yavatmal (N=1031) % of Total ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank PPTCT HSS-ANC PPTCT % Pos; ICTC % Pos; IDU No. HRG- MSM No. HRG- FSW No. HRG- DLN (NA) ART (8994) 5

Hetero-sexual NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 4 4 % On ART - - - - - 90.30 35 - 12.15 18.18 11.67 16.13 4802 3325 2005 0.36 1.25 971 506 634 843 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 13.78 8654 1474 1372 6585 2006 4.27 8.03 6.49 0.79 1.38 595 697 800 1.16 % 15-24 yrs ------HIV Levels and Trends 9 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 24748 13578 16.13 14.15 11.92 5843 5327 3761 7409 9607 2007 9.52 0.87 0.82 0.75 800 ------Transfusion - - - - - Blood 0.10 % Ill., Prim. Edu. 48036 11291 16409 10710 16990 20336 41.05 14.40 6353 2008

7.14 7.67 7.58 0.86 0.58 1.56 250 770 2 ------Source: DLHS III;Source:DLHS 8 ------3 Needle/ Syringe 58388 17466 10454 16908 27742 9896 8316 2009 5.99 5.75 5.78 5.88 0.46 0.46 0 - - - - - % Married 1 : 72.41%; ANC Utilization 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 58670 21851 12285 19348 12589 27037 9782 2010 5.64 3.92 4.53 4.41 2.41 0.56 0.36 1.00 249 800 5 - Parent to ------Child 8.05 38399 14170 24229 14772 23627 11977 2011 4.09 3.22 3.47 3.59 0.50 - - - - - % Widowed or Divorced Unknown 1 0.39 - 2 75398 13669 28979 17756 24892 32750 : 71.5% 2012 5313 4.10 2.71 3.06 3.23 0.36 0.60 0.38 799 ------

Condom outlets Drop-in-centres Comm. care centres Red Ribbon Clubs PLHIV Networks Link ART centres ART centres STI clinics Blood Banks ICTCs Comp. TIs IDU TIs MSM TIs FSW TIs No. % Syphilis positivity No. episodes treated % Married % <25 yrs. Typology Program Coverage Program Target % Total Pop. % Total HRG Year: 2008) Size Est., (Mapping, HRG Size based - based - Brothel based- 48.25 Home Street 2004 0.01 FSW 345 NA; NA; 1413 2009 NA NA 2.80 2 2

------

≥

STI/RTI 300,HSS-HRG/STD Panthi - decker- 2005 Double Kothi - 51.75 MSM 0.01 370 NA; NA; 2 2 1 1 NA NA ------5571 2010 - - - 0

Non daily Injectors- Injectors- 2006 Programme Response 92 17 Daily 1 1 1 1 ------NA; IDU NA NA 9627 2011 ------Vulnerabilities 0 ≥ 187,ICTC 2007 94 19 1 1 1 1 1 ------migration % total pop. % of male migration No. out- Adilabad, Pradesh Andhra 13897 2012 0 ≥ Top 5 districts for inter-state out-migration 2008 600,PPTCT 96 19 1 1 1 1 1 1 1 1 - - - - Gujarat Male Migration, 2001 Census 159056 Surat, Surat, Overall 12.55 100 2009 96 24 1 1 1 5 1 1 1 1 1 - - - ≥ 900 and BB and 900 2422 Inter- State 1.52 0.19 - 2010 96 24 1 1 2 5 1 1 1 1 1 - - - ≥ 900); 49948 31.40 Intra- state 3.94 2011 - 380 73 72 1 1 2 5 1 1 1 1 1 - - ­ 4 percent = PP 106686 district 67.07 Intra- 8.42 2012 380 97 75 - 1 1 2 5 1 1 1 1 1 - -

District HIV/AIDS Epidemiological Profiles :Maharashtra | 77

The National AIDS Control Programme has a strong focus on district level planning, implementation and monitoring of interventions for prevention and control of HIV. The Programme is generating a rich evidence base on HIV/AIDS through a robust and expanded HIV Sentinel Surveillance system, monthly reporting from programme units, mapping and size estimations, behavioural surveys as well as several studies, research projects and evaluations. In this context of increased availability of data and the requirement of decentralized planning at the district level, a project titled “Epidemiological Profiling of HIV/AIDS Situation at District and Sub-district Level using Data Triangulation” was undertaken by the National AIDS Control Organisation in 25 states (539 districts). The objective of this exercise was to develop district HIV/ AIDS epidemic profiles, by consolidating all the available information for a district at one place and drawing meaningful inferences using Data Triangulation approaches.

This technical document is an outcome of the data triangulation process and consists of a snapshot on the district background, and on the HIV epidemic profile of each district based on the available updated information, thereby giving an overview of the HIV epidemic scenario in each of the districts of the State.

This document would be useful for the HIV programme managers and policy makers at all levels to help in decision making, as well as for researchers and academicians as a quick reference guide to the HIV/AIDS situation in the districts.

National AIDS Control Organisation

India’s voice against AIDS Ministry of Health & Family Welfare, Government of India 6th & 9th Floors, Chandralok Building, 36, Janpath, New Delhi - 110001 www.naco.gov.in