District HIV/AIDS Epidemiological Profiles

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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 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 Karnataka

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 13. Dharwad ...... 34

Methodology ...... 2 14. Gadag ...... 36

Specific Notes on Fact sheets ...... 6 15. Gulbarga ...... 38

District Map of Karnataka ...... 9 16. Hasssan ...... 40

1. Bagalkot ...... 10 17. Haveri ...... 42

2. Bangalore Rural ...... 12 18. Kodagu ...... 44

3. Bangalore Urban ...... 14 19. Kolar ...... 46

4. Belgaum ...... 16 20. Koppal ...... 48

5. Bellary ...... 18 21. Mandya ...... 50

6. Bidar ...... 20 22. Mysore ...... 52

7. Bijapur ...... 22 23. Raichur ...... 54

8. Chamaraj Nagar ...... 24 24. Shimoga ...... 56

9. Chikmagalur ...... 26 25. Tumkur ...... 58

10. Chitradurga ...... 28 26. Udupi ...... 60

11. Dakshina Kannada ...... 30 27. Uttra Kannada ...... 62

12. Davanagere ...... 32

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

vi vii Acronyms Glossary

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 : Karnataka | 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 : Karnataka 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

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

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

District HIV/AIDS Epidemiological Profiles : Karnataka | 7

District Map of Karnataka Bagalkot

Background: Bagalkot is an administrative district in Northern Karnataka Bagalkot District and borders Belgaum, Gadag, Koppal, Raichur, and Bijapur. The district has a population of 18.90 lakhs, a sex ratio of 984 females per 1,000 males, and a female literacy rate of 58.55% with an overall literacy rate of 69.39% (2011 Census). The district holds numerous historical and tourist locations, and a UNESCO World Heritage site. These attractions bring in many tourists throughout the year to Bagalkot. Over 65% of the working population is engaged in agriculture, either through cultivation or agro- industries. However, animal husbandry, sericulture, other factories and industries also contribute to the economy of Bagalkot. A large number of the immigrants in the district are comprised of money lenders or cloth merchants. The district is well connected via roads and railway, and National Highway 13 connects it to other districts of the state.

HIV Epidemic Profle: • According to 2012 HSS-ANC data, HIV positivity was moderate at 0.58% among the ANC attendees, with a fluctuating trend. • According to 2012 PPTCT data, the level of HIV positivity was moderateat 0.54% among the PPTCT attendees, with a declining trend. • According to 2012 Blood Bank data, the level of HIV positivity was moderate at 0.58% among the Blood bank attendees, with a fluctuating trend. • Based on 2010 HSS-FSW data, HIV prevalence was high (17.89%) among the FSWs, however, due to lack of previous years data, a trend could not be determined. • As per 2012 ICTC data, the level of HIV positivity was moderate among male (9.74%) and female (7.99%) attendees. It was also moderate among referred (9.51%) and direct walk-in (6.22%) attendees. A declining trend was observed among all the ICTC attendees. • According to 2009 HRG mapping data, MSM (1,542; 61.88% of total HRG) was the largest HRG in the district, followed by FSW (950; 38.12% of total HRG). • In 2012, 28,191 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 2.06%. • According to 2001 census, 9.61% of the males were migrants, among them 6.67% migrated to other states and 37.09% migrated to other districts within the state. • The top two destinations for inter-state out-migration were Kolhapur in Maharashtra and South Goa. • In 2012, HIV transmissions though parent to child accounted for 7.84% of the district’s total HIV transmissions in the district. • According to DLHS-III data, HIV and RTI/STI awareness rate among women was 83.90% and 38.50%, respectively. Key Recommendations: • There is a need for an increase in the number of targeted intervention (TI) sites for MSM in the district, since the current number of TI sites are not enough to deal with the large number of MSM in the area. • Carryout disaggregated analysis of HSS-ANC data to identify risk factors responsible for the fluctuating HIV epidemic among general population. • Carry out differential analysis of ICTC attendees (representative of vulnerable populations), owing to moderate HIV positivity rate. HIV prevalence among them can be explored by further analyzing the ICTC data. • Conduct disaggregated analysis of PPTCT and Blood Bank data to assess risk factors in the district. • Analyze risk factors and client profiles among FSWs due to the high level of positivity among the group. As well as focus on hard to reach sub groups like home-based FSWs. • Review available differential analysis carried out by different agencies for evidence based planning since the HIV prevalence in the district was very high.

10 | District HIV/AIDS Epidemiological Profiles : Karnataka positive, NT = number tested; * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 18,90,826 (3.09% of Karnataka Population); Female Literacy Bagalkot ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=3328) % of Total FSW No. HRG- MSM No. HRG- IDU No. HRG- ICTC % Pos; PPTCT % Pos; DLN (NA) ART (25665) 5

Bagalkot, 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 2.7 4 4 % On ART - - - - 91.56 36 - 40.42 36.06 39.81 38.23 2484 2543 1982 2252 2922 2005 4234 0.72 2.88 800 ------Badami, 5 1.3 General clients & pregnant women. - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 25.58 20.26 25.31 25.31 6193 2991 1861 1920 1263 2006 3781 0.87 2.13 800 0.21 % 15-24 yrs ------Bilagi, 2.2 - - - - HIV Levels and Trends 9 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 11739 23.62 23.98 28.06 33.12 2367 3915 3485 2914 6692 5340 2007 0.99 3.26 0.63 gund, 1.4 800 ------Transfusion Hun - - - - - Blood 0.12 % Ill., Prim. Edu. 11691 10072 15509 33737 25.58 24.34 23.48 27.00 34.33 6193 8156 3764 2008 0.61 2.50 2.13 233 800 Jamkan - di, 3.6 2 ------Source: DLHS III;Source:DLHS 79 - - - - - 3 Needle/ Syringe 0.06 10440 14349 23.62 24.50 21.97 27.00 2367 4342 3746 2963 7640 2009 Mudhol, 0.71 1.60 3.4 - - - - 1 % Married : 58.55%; 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 12410 11634 12872 23034 42742 19.33 23.50 19.98 24.80 17.89 7298 8074 2010 0.38 1.30 3.50 54 246 800 - Parent to ------Child 7.84 24632 18805 13990 13329 37873 70668 13.74 10.67 15.39 8163 2011 9.16 0.64 0.63 - - - - - % Widowed or Divorced Unknown 21 0.21 - 29321 21392 16623 16170 33899 71914 2 8694 2012 1200 6.22 9.51 7.99 9.74 0.58 0.54 0.58 : 62.9% ------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. Year: NA) Size Est., (Mapping, Typology Program Coverage No. episodes treated % Total HRG % Married % <25 yrs. % Syphilis positivity % Total Pop. Program Target 84.70%; 13.60% HRG Size 1.70%; Brothel based- based- based- 10.20 38.12 Home Street 2004 0.05 FSW 950 2009 5454 NA 22 1 1 6 1 ------

- 300,HSS-HRG/STD ≥ STI/RTI Kothi-NA; decker- 2005 Double Panthi- 100% 31.30 61.88 1542 MSM 0.08 16652 NA; 1 1 1 6 1 NA ------49 2010 -

- Non daily Injectors- Injectors- 2006 Programme Response 11 Daily 1 1 1 3 1 1 ------NA; IDU NA NA 20043 2011 ------Vulnerabilities - 187,ICTC ≥ 2007 19 1 1 1 3 1 1 ------Maharash - migration % total pop. % of male migration No. out- Kolhapur, 28191 2012 2.06 tra 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 19 1 2 1 1 3 1 1 ------South Goa South Male Migration, 2001 Census Overall 80283 9.61 100 2009 62 2 1 5 1 1 4 1 1 - - - - - 900 and BB and 900 ≥ Maharash - Pune, 5357 Inter- State 6.67 0.64 tra 2010 71 2 1 7 5 1 4 1 1 - - - - - 900);≥ 29776 North 37.09 Intra- Goa state 3.56 2011 10 70 1 5 3 4 1 4 ------ 4 percent = PP Maharash - Satara, district 45150 56.24 Intra- 5.40 2012 tra 10 84 1 5 3 4 1 4 ------

District HIV/AIDS Epidemiological Profiles : Karnataka | 11 Bangalore Rural

Background: Bangalore Rural is a district in Karnataka formed in the year Bangalore Rural District 1986, when Bangalore district was divided into Bangalore Rural and Bangalore (Urban). The district has a population of 9.87 lakhs, a sex ratio of 945 females for every 1,000 males, anda female literacy rate of 70.73% with an overall literacy rate of 78.29% (Census 2011). The economy in Bangalore Rural is dependent upon agriculture. Although, with the advent of socio-economic zones (SEZ) in the area, service and IT industries are booming, this lead to daily in and out migration for employment. The major highways that pass through Bangalore Rural are National Highways 4, 7 and 48. The district is also well connected to other districts and states through state roads and railways.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV positivity level was moderate at 0.75% among the ANC attendees, with a fluctuating trend. • According to 2012 PPTCT data, the level of HIV positivity was lowat 0.19% among the PPTCT attendees, with a declining trend. • According to 2008 Blood Bank data, the level of HIV positivity was lowat 0.27% among the Blood bank attendees, with a stable trend. • According to 2010 HSS-FSW data, HIV positivity was low at 4% among FSWs, but a trend could not be determined due to a lack of a historical data. • According to 2012 data, HIV positivity among ICTCs attendees was low among male (1.51%) and female (1.97%) attendees, as well as among referred (1.80%) and direct walk-in (1.44%) attendees. Positivity levels showed an overall declining trend among female and referred attendees, but male attendees and direct walk-ins represented a stable trend. • As per the HRG size mapping data, the largest HRG in the district was MSM (3,212; 65.85% of total HRGs) followed by FSW (1,666; 34.15% of total HRGs). • In 2012,10,522 STI/RTI episodes were treated and the syphilis positivity rate among STI attendees was 0.48%. • According to 2001 census, 4.61% of the males were migrants, among them 4.62% migrated to other states and 49.84% migrated to other districts within the state. • The top two destinations for inter-state out-migration were Ratnagiri and Solapur, Maharashtra. • According to DLHS-III data, HIV and STI/RTI awareness rate among women was 94.2% and 39.2%, respectively. • In 2012, there were two TI sites functional in the district (one for FSW and one for MSM). Key Recommendations: • Since there were close to 5,000 individuals classified as high risk, increase the number of TI sites optimally to cover the large number of HRGs in the area. • Since the largest HRG was MSM, better assessment of the size and profile of MSM and partner population, will help in better understanding of district vulnerabilities. • Considering high rate of migration to high HIV prevalent districts, better assessment of the size and profile of migrants will further improve understanding of district vulnerabilities. • Focus on hard to reach HRG subgroups like street-based FSWs, which was a prominent typology, among FSWs in the district. • Strengthen outreach programs through awareness campaigns for HIV among migrants and women, as well as around truck halting points and highways in the district. • Assess and analyze HIV positive people at HSS-ANC, ICTC/PPTCTand Blood Banks to understand the source and spread of HIV, since the rate of unknown HIV route of transmission was high.

12 | District HIV/AIDS Epidemiological Profiles : Karnataka positive, NT = number tested; * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 9,87,257 (1.61% Karnataka’s Population); Female Literacy Bangalore Rural ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=540) % of Total FSW No. HRG- MSM No. HRG- IDU No. HRG- ICTC % Pos; PPTCT % Pos; 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 - - - - - 92.78 162098 - - 2005 0.26 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 77421 2006 0.40 1.85 % 15-24 yrs ------HIV Levels and Trends - - Block-Level Details PLHIV Pro f le, 2012 1 202975 2011 Census;2011 6039 2007 6039 0.30 0.40 ------Transfusion - - - - - Blood 0.19 % Ill., Prim. Edu. 105603 22179 5878 7688 3736 9830 8613 2008 2.50 6.48 6.80 3.98 0.27 0.29 0.38 800 2 ------Source: DLHS III;Source:DLHS ------3 Needle/ Syringe 18332 0.19 28831 6746 3753 2009 5.11 2.75 0.29 0 0 0 0 ------1 : 70.73%; 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 15346 16779 10318 21807 27585 59710 2010 1.79 2.57 3.18 1.74 4.00 0.25 0.13 250 800 - - Parent to ------Child 2.41 20167 23730 15611 28286 33545 77442 2011 1.37 1.83 1.99 1.41 0.22 ------% Widowed or Divorced Unknown 2 2.59 : 95.6% - - 10906 20918 11725 20099 25445 57269 2012 1.44 1.80 1.97 1.51 0.19 0.75 800 ------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. Year: NA) Size Est., (Mapping, % Married % <25 yrs. Typology Program Coverage No. episodes treated % Total HRG % Syphilis positivity % Total Pop. Program Target 30.95%; 66.43% HRG Size 2.62%; Brothel based- based- based- 60.20 25.40 34.15 Home Street 2004 1666 0.17 FSW 2009 NA 562 4 1 ------

- 300,HSS-HRG/STD ≥ STI/RTI 59.25%; 40.75% decker- 2005 Double Panthi- Kothi- 18.10 45.60 65.85 3212 MSM 0.33 NA; 1 4 1 NA ------2010 2068 -

- Non daily Injectors- Injectors- 2006 Programme Response Daily 1 6 1 1 ------NA; IDU NA NA 2011 4059 ------0.71 Vulnerabilities 187,ICTC ≥ 2007 1 7 1 1 ------Maharash - migration % total pop. % of male migration No. out- Ratnagiri, 2012 3779 tra - 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 1 8 1 1 ------Maharash Solapur, Solapur, Male Migration, 2001 Census Overall 44360 tra 4.61 100 2009 22 1 1 1 1 ------900 and BB and 900 ≥ - Maharash - Raigarh, 2050 Inter- State 4.62 0.21 tra 2010 24 1 2 1 1 1 ------durg, Ma - harashtra 900);≥ Sindhu - 22109 49.84 Intra- state 2.30 2011 22 1 4 1 1 1 ------ 4 PP = percent = PP district 20201 45.54 Intra- 2.10 2012 30 - 1 5 1 1 1 ------

District HIV/AIDS Epidemiological Profiles : Karnataka | 13 Banglore Urban

Background: Bangalore Urban is a district of Karnataka that was Bangalore Urban District created in the year 1986 with the partition of the erstwhile Bangalore district into Bangalore Urban and Bangalore Rural. It has a population of 95.88 lakhs, a sex ratio of 908 female per 1,000 males, and a female literacy rate of 84.80% with an overall literacy rate of 88.48% (Census 2011). It is surrounded by the Bangalore Rural district on the west, east and north and the Krishnagiri district of Tamil Nadu on the south. Bangalore Urban is housing information technology (IT) industry; biotechnology sector and several other large and small-scale industries. The district attracts many tourists and youths seeking employment opportunities all throughout the year. Bangalore Urban is the fastest growing metropolis with the country’s fourth largest economy. The district is well connected via National Highways 4 and 7, and also by state roads and railway, to the rest of the districts of the state.

HIV Epidemic Profle: • According to 2012 HSS-ANC data, HIV positivity was moderate (0.75%) among the ANC attendees, with a fluctuating trend. • According to 2012 PPTCT data, the level of HIV positivity was low at 0.25% among the PPTCT attendees, with a declining trend. • According to 2008 Blood Bank data, the level of HIV positivity was low at 0.23% among the Blood Bank attendees, with a stable trend. • Based on 2010 HSS-FSW data, HIV positivity was low (1.40%) among the FSWs, with an overall declining trend, with a rise was observed in 2008. • As per 2010 HSS-MSM data, HIV positivity levels were moderate (8.40%) among MSM, with a declining trend. • According to 2010 HSS-IDU data, HIV prevalence was low among the IDUs, with a decreasing trend at low levels. • As per 2012 ICTC data, HIV positivity was low among male (3.17%) are female (2.22%) attendees. It was also low among referred (2.52%) and direct walk in (3.17%) attendees. Positivity levels showed a declining trend among all the ICTC attendees. • As per the HRG mapping data, the largest HRG in the district was FSW (21,621; 78.82% of total HRGs) followed by MSM (5,811; 21.18% of total HRGs). Among FSWs, 51.95% were home-based and 35.94% were street-based. • In 2012, the syphilis positivity rate among STI attendees was 0.45% and the number of STI/RTI treated was 1,07,233. • According to DLHS-III data, HIV and STI/RTI awareness rate among women was 97.4% and 46.9%, respectively. • According to 2001 census, 6.79% of the males were migrants, among them 6.42% migrated to other states and 36.39% migrated to other districts within the state. • The top two destinations for inter-state out-migration were Dharmapuri, Tamil Nadu and Mumbai (Suburban), Maharashtra. • As per 2012 ICTC data, unknown routes of HIV transmissions accounted for 8.67% of all the HIV transmissions in the district. • In 2012, a total of 97 ICTCs were operational, which tested a total of 2,44,149 attendees for HIV in the district. Key Recommendations: • Strengthen HIV preventive measures through awareness campaign especially for women, in order to maintain a decreasing trend among ANC attendees. • Continue HIV prevention strategies to maintain HIV a declining prevalence of positivity in among ICTC attendees. • Assessment of the size and profile of attendees’ population including migrants and truckers, will help in better understanding of district vulnerabilities, since the largest HRG was FSW. • Focus on hard to reach sub groups like street and home-based FSWs, as these accounted as the largest typology among the group. • Understanding of the dynamics of HIV transmission through further assessment and analysis of ICTC/PPTCT data is needed for focused interventions in the district.

14 | District HIV/AIDS Epidemiological Profiles : Karnataka positive, NT = number tested; * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 95,88,910 (3.09% of Karnataka Population); Female Literacy Bangalore Urban ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=4430) % of Total FSW No. HRG- MSM No. HRG- IDU No. HRG- ICTC % Pos; PPTCT % Pos; DLN (NA) ART (26877) 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 - - - - - 86.48 39 162098 - 20.80 13.20 2005 0.26 0.50 250 250 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 77421 19.20 2006 3.60 9.20 5.60 0.40 1.38 250 250 750 250 800 1.11 % 15-24 yrs ------HIV Levels and Trends 7 - Block-Level Details PLHIV Pro f le, 2012 1 202975 2011 Census;2011 33787 33787 17.60 2007 2.00 5.33 1.60 0.30 1.25 1.25 250 250 750 250 800 ------Transfusion - - - - - Blood 0.72 % Ill., Prim. Edu. 105603 11997 17823 12661 17159 39079 68899 10.59 11.28 10.17 11.62 16.60 10.42 16.74 2008 2.00 0.27 0.60 0.75 250 247 720 221 800 2 Source: DLHS III;Source:DLHS 82 ------3 Needle/ Syringe 228817 29530 38208 0.29 15167 82905 2009 6.66 7.33 0.26 0.50 ------% Married 1 3 : 84.80%; ANC Utilization Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 253798 180549 33357 77111 52662 57806 70081 2010 4.26 4.27 3.73 4.77 8.40 1.40 0.20 0.49 0.25 51 250 250 500 800 - 0 Parent to ------Child 2.73 105933 236744 229957 38546 67086 77393 85478 2011 3.82 3.21 2.76 3.92 0.17 0.24 - - - - - % Widowed or Divorced Unknown 15 8.67 - 119884 141674 244149 44256 80841 83299 80009 2012 3.17 2.52 2.22 3.17 0.23 0.25 0.75 2 800 : 98.1% ------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. Year: NA) Size Est., (Mapping, % Married % <25 yrs. Typology Program Coverage No. episodes treated % Total HRG % Syphilis positivity % Total Pop. Program Target 51.95%; 12.11%; 35.94% HRG Size Brothel based- based- based- 21621 60.80 35.00 78.82 Home Street 2004 23127 FSW 2009 NA 1- 4 1 1 4 ------

- 300,HSS-HRG/STD ≥ STI/RTI 38.66%; 61.34% decker- 2005 Double Panthi- Kothi- 38.90 21.18 5811 MSM 9.00 17 66835 NA; 1 1 4 4 NA ------2010 - -

- Non daily Injectors- Injectors- 2006 Programme Response 26 Daily 1 1 4 4 4 ------NA; IDU NA NA 91155 2011 ------0.25 Vulnerabilities 187,ICTC ≥ 2007 35 5 1 2 4 4 4 Tamil Nadu ------migration % total pop. % of male migration No. out- Dharma - 107233 2012 0.45 puri, 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 39 4 1 5 5 3 6 8 ------(Suburban) Mumbai Mumbai , Maha rashtra Male Migration, 2001 Census 140198 Overall 4.10 100 2009 90 - 5 1 5 3 3 6 8 ------900 and BB and 900 ≥ Tamil Nadu Chennai, 38032 27.13 Inter- State 1.11 2010 99 5 1 2 5 5 3 6 8 - - - - - Maharash - 900);≥ Thane, 45888 32.73 Intra- state 1.34 tra 2011 98 4 1 3 6 7 3 6 8 - - - - - 4PP = percent = 4PP Maharash - district 56278 40.14 Pune, Intra- 1.64 2012 tra 97 4 1 5 6 7 3 8 8 - - - - -

District HIV/AIDS Epidemiological Profiles : Karnataka | 15 Belgaum

Background: Belgaum district is nestled high among the Western Ghats Belgaum District in Karnataka. It is bordered on the west and north by Maharashtra state, on the northeast by Bijapur, on the east by Bagalkot, on the southeast by Gadaga, on the south by Dharawada and Uttar Kannada, and on the southwest by the state of Goa. It has a population of 47.78 lakhs, a sex ratio of 969 females per 1000 males, and a female literacy rate of 64.74% with an overall literacy rate of 73.94% (Census 2011). Belgaum has a predominantly agrarian economy, which is complemented by a multi-dimensional industrial base. Belgaum attracts many travelers with its verdant landscape. The district is well connected via roads and railway, and National Highway 4 and 4A connects it to other districts within the state.

HIV Epidemic Profle: • According to 2012 HSS-ANC data, HIV positivity was moderate at 0.75% among the ANC attendees, with a declining trend. • According to 2012 PPTCT data, the level of HIV positivity was low at 0.21% among the PPTCT attendees, with an overall decreasing trend. • According to 2012 Blood Bank data, the level of HIV positivity was low at 0.17% among the Blood Bank attendees, with a stable trend. • According to 2010 HSS-FSW data, HIV positivity was moderate at 8.80% among the FSWs, although a trend could not be determined due to lack of data points. • Based on 2010 HSS-MSM data, HIV prevalence was low at 0.80% among MSM, but a trend analysis could not be completed due to lack of historical data. • In 2012, the level of HIV positivity among ICTC attendees was low among male (4.56%) and female (3.19%) attendees, as well as among referred (3.81%) and direct walk-ins (3.55%). An overall declining trend was exhibited among all the ICTC attendees. • According to 2009 HRG mapping size data, FSW (2,038; 50.15% of total HRG) was the largest HRG in the district, followed by MSM (2,026; 49.85%of total HRG). Out of the FSWs, the major typology was street-based (87.20%). • In 2012, 61,290 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.16%. • According to 2001 census, 10.49% of the males were migrants, among them 22.04% migrated to other states and 13.79% migrated to other districts within the state. • The top two destinations for inter-state out-migration were Kohlapur and Sangli in Maharashtra. • According to 2012 ICTC data, HIV transmissions through parent to child accounted for 6.60% of the total HIV transmissions in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 79.50% and 39.50%, respectively. • In 2012, a total of 10 TI sites (eight for FSWs and two for MSM) for HRGs were operational in the district. Key Recommendations: • Increase the number of composite and MSM TI sites to enhance HIV preventive and referral services, considering the large number of HRG in the district. • Conduct socio-demographic analysis of ANC attendees to understand risk factors for HIV epidemic among general population. • Assess the size and profile of FSWs client population, including migrants and truckers, and also MSM and partner population, to provide better insights into district vulnerabilities, since there were a large number of individuals classified as HRGs in the district. • Strengthen outreach activities for migrants at source and transit points and for truckers at all the major halt points, considering high rate of migration to high HIV prevalent districts. • Conduct in-depth analysis of ICTC data, to understand the profile of these attendees, as the parent to child HIV transmission rate was high.

16 | District HIV/AIDS Epidemiological Profiles : Karnataka positive, NT = number tested; * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 47,78,439 (7.81% of Karnataka Population); Female Literacy Belgaum ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=3634) % of Total FSW No. HRG- MSM No. HRG- IDU No. HRG- % Pos; ICTC PPTCT % Pos; ART (28452) DLN (NA) 5

Hetero-sexual NT PP Athani, NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 1.67 4 4 % On ART - - - - 93.12 38 - 37.44 20.65 21.73 27.10 23.60 2528 1459 1889 5110 2005 3348 0.31 3.63 820 250 800 Bailahon - gal, 0.55 ------5 General clients & pregnant women. - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 37.04 14.36 16.89 16.86 3258 1652 2011 3109 2006 3663 3.60 0.00 3.13 405 Belagaum, 250 800 0.19 % 15-24 yrs ------0.94 - - - - 11 HIV Levels and Trends - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 13023 22713 37.11 13.87 13.69 27.09 10.80 1846 7844 6360 3330 6181 2007 0.31 1.40 2.00 250 800 Chikodi, ------Transfusion 0.78 - - - - Blood 0.03 % Ill., Prim. Edu. 21920 16087 12466 39331 67884 22.52 14.81 14.72 19.12 16.40 14.76 6718 2843 2008 5.69 0.35 1.00 1.50 246 250 210 800 Gokak, 2 - - 0.96 Source: DLHS III;Source:DLHS 74 - - - - - 3 Needle/ Syringe 0.03 22949 16507 29834 16.34 12.25 11.64 15.77 3537 9884 7721 5606 2009 0.39 0.90 Hukkeri, 0.93 - - - - 1 % Married : 64.74%; 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 121337 Khanapur, 14909 39761 31454 23216 23364 66667 2010 8.03 8.76 7.62 9.84 0.80 8.80 0.28 0.72 0.88 44 250 250 800 - 0.65 Parent to ------Child 6.60 181681 Raibagh, 22355 67046 51523 37878 24926 92280 2011 4.67 5.32 4.37 6.27 0.20 0.29 0.91 - - - - % Widowed or Divorced Unknown 21 Ramadurg, 0.03 - 186635 17197 79396 56096 40497 22408 90042 2 2012 3.55 3.81 3.19 4.56 0.17 0.21 0.75 : 71.5% 1.95 800 ------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. Year: NA) Size Est., (Mapping, Typology Program Coverage No. episodes treated % Total HRG % Married % <25 yrs. % Syphilis positivity % Total Pop. Program Target 87.20% HRG Size 6.06%; 6.74%; Brothel based- based- based- 59.40 15.90 50.15 Home Street 2004 2038 10193 0.04 FSW 2009 NA 1 5 7 1 ------

- 300,HSS-HRG/STD ≥ STI/RTI -62.87% 37.13%; Panthi - 2005 Double decker Kothi- 43.30 22.60 49.85 2026 MSM 0.04 38046 Na; 1 3 5 7 1 NA ------2010 - - Non daily Injectors- Injectors- 2006 Programme Response Daily 1 1 3 5 7 1 1 ------NA; IDU NA NA 53337 2011 ------0.28 Vulnerabilities 187,ICTC ≥ 2007 24 1 1 3 5 1 1 ------Maharash - migration % total pop. % of male migration No. out- Kolhapur, 61290 2012 0.16 tra 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 32 2 1 2 3 6 1 1 ------Maharash Sangli, Sangli, Male Migration, 2001 Census 225359 Overall 10.49 tra 100 2009 83 2 1 7 2 2 6 1 1 - - - - - 900 and BB and 900 ≥ - Maharash - Pune, 49658 22.04 Inter- State 2.31 tra 2010 107 11 2 1 2 3 6 2 2 - - - - - 900);≥ 31075 North 13.79 Intra- Goa state 1.45 2011 120 11 2 1 2 4 6 2 8 - - - - - 4

PP = percent = PP 144626 district South 64.18 Intra- 6.73 2012 Goa 139 11 2 1 4 4 6 2 8 - - - - -

District HIV/AIDS Epidemiological Profiles : Karnataka | 17 Bellary

Background: Bellary is a district situated on the eastern side of Karnataka. Bellary District This district is bordered by Raichur on the north, Koppal on the west, Chitradurga and Davanagere districts on the south, and Anantapur and Kurnool districts of Andhra Pradesh on the east. The district has a population of 25.32 lakhs, a sex ratio of 978 females per 1,000 males, and a female literacy rate of 58.28% with an overall literacy rate of 67.85% (Census 2011). Bellary is, presently, the second fastest growing city in the state of Karnataka after Bengaluru. Bellary district is rich in natural resources; the district has 25% of India’s Iron ore reserves. The major occupation of this district is agriculture and 75% total labour force is dependent on agriculture for its livelihood. The district is well connected to other parts of the state by ways of railways and state roads and National Highway 13.

HIV Epidemic Profle: • According to 2012 HSS-ANC data, HIV positivity was moderate (0.50%) among the ANC attendees, which showed a declining trend since 2008. • According to 2012 PPTCT data, the level of HIV positivity was low at 0.17% among the PPTCT attendees, with a declining trend. • According to 2012 Blood Bank data, the level of HIV positivity was low at 0.19% among the Blood bank attendees, with a stable trend in the last three years. • Based on 2010 HSS-FSW data, HIV prevalence was low (3.20%) among the FSWs, however, due to lack of previous year’s data, a trend could not be determined. • Based on 2010 HSS-MSM data, HIV prevalence was moderate at 9.76% among the FSWs, however, due to lack of previous year’s data, a trend could not be determined. • As per 2012 ICTC data, the level of HIV positivity was low among male (3.99%) and female (2.84%) attendees, as well as among referred (3.69%) and direct walk-in (2.63%) attendees. An overall decreasing trend was exhibited among the district’s ICTC attendees. • According to 2009 HRG mapping data, FSW (3,857; 87.50%of total HRG was the largest HRG in the district, followed by MSM (551; 12.50% of total HRG). • In 2012, 23,258 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.20%. • According to 2001 census, 6.79% of the males were migrants, among them 6.42% migrated to other states and 36.39% migrated to other districts within the state. • The top two destinations for inter-state out-migration were Anantapur and Kurnool, Andhra Pradesh. • In 2012, HIV transmissions though parent to child accounted for 5.45% of the district’s total HIV transmissions in the district. • According to DLHS-III data, HIV and RTI/STI awareness rate among women was 80.2% and 33.1%, respectively. • In 2012, a total of five TI sites (four for FSWs and one for MSM) were operational in the district. Key Recommendations: • Carryout disaggregated analysis of ANC attendees to identify risk factors responsible for the rising HIV epidemic among general population. • Increase and strengthen TI interventions for MSM population, as the level of HIV positivity is almost high. • Establish a mechanism to understand the dynamics of HIV transmission among HRGs and migrant population, as HIV positivity at ICTCs suggests continuing transmission among the attendees along with risky behavior. • Assess the size and profile of FSWs client population, including migrants and truckers, to better understand district vulnerabilities. • Strengthen outreach programmes through awareness campaigns for STI for women, migrants and around truck halting points and highways in the district. • Conduct in-depth analysis of ICTC data to understand the profile of the ICTC attendees.

18 | District HIV/AIDS Epidemiological Profiles : Karnataka positive, NT = number tested; * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 25,32,383 (4.14% of Karnataka Population); Female Literacy Bellary ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=1468) % of Total FSW No. HRG- MSM No. HRG- No. HRG- IDU % Pos;ICTC PPTCT % Pos; ART (13749) DLN (NA) 5

Hetero-sexual NT PP Bellary, NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 1.02 4 4 % On ART - - - - 93.12 31 - 11888 38.69 21.46 28.22 24.15 2656 1088 2364 2005 3452 4.40 0.52 0.88 796 250 800 manahalli, Hagaribo ------5 General clients & pregnant women. 0 - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 54.57 25.14 35.22 33.39 16.40 2164 1252 1863 6185 2006 3115 0.47 1.38 951 250 800 0.75 Hospete, % 15-24 yrs ------1.3 - - - - 81 HIV Levels and Trends - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 15190 31.49 25.22 22.95 32.43 1245 2883 2318 1810 4196 2007 8324 0.47 1.02 0.38 800 Hadagali, Huvina ------Transfusion 0.33 - - - - Blood 0.20 % Ill., Prim. Edu. 16619 29546 18.53 16.96 12.97 25.51 4484 8463 8289 4638 9859 2008 0.24 0.80 1.13 800 Kudligi, 2 ------Source: DLHS III;Source:DLHS 0.6 55 - - - - - 3 Needle/ Syringe 0.20 20215 10068 17587 16.38 12.61 10.74 17.98 2704 4823 4227 3292 2009 0.37 0.61 Sandur, 0.56 - - - - 1 % Married : 58.28%; 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 Siruguppa, 11689 11457 12679 10467 21864 30361 53507 2010 5.89 9.57 6.26 9.47 9.76 3.20 0.16 0.41 1.25 17 246 250 800 - 0.68 Parent to ------Child 5.45 102375 15003 26755 23923 17835 25297 60617 2011 3.09 4.85 3.39 5.34 0.19 0.23 - - - - - % Widowed or Divorced Unknown 15 0.27 - 13217 30373 23611 19979 20891 45369 88959 2 2012 1200 2.63 3.69 2.84 3.99 0.19 0.17 0.50 : 64.3% ------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. Year: NA) Size Est., (Mapping, % Married % <25 yrs. Typology Program Coverage No. episodes treated % Total HRG % Syphilis positivity % Total Pop. Program Target 43.20%; 44.50%; 12.30% HRG Size Brothel based- based- based- 40.40 87.50 Home Street 2004 3857 0.15 FSW 2009 2219 NA 37 5 7 1 ------

- 300,HSS-HRG/STD ≥ STI/RTI 62.54%; 37.46% decker- 2005 Double Panthi- Kothi- 17.80 51.10 12.50 MSM 0.02 551 18512 NA; 1 1 3 4 7 1 NA ------2010 -

- Non daily Injectors- Injectors- 2006 Programme Response 26 Daily 1 1 3 5 1 1 ------NA; IDU NA NA 19130 2011 ------0.14 Vulnerabilities 187,ICTC ≥ 2007 26 1 1 1 3 6 1 1 ------Anantapur, migration % total pop. % of male migration No. out- Pradesh Andhra 23258 2012 0.20 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 26 2 1 1 3 5 1 1 ------Kurnool, Kurnool, Pradesh Andhra Andhra Male Migration, 2001 Census Overall 69830 6.79 100 2009 48 2 1 4 1 3 5 1 1 - - - - - 900 and BB and 900 ≥ (Suburban) Mumbai , Maha - rashtra 4482 Inter- State 6.42 0.44 2010 57 2 1 4 2 3 5 1 1 - - - - - Maharash - 900);≥ 25414 Pune, 36.39 Intra- state 2.47 tra 2011 75 2 1 4 2 3 4 1 4 - - - - - 4

PP = percent = PP gareddy, Pradesh Andhra district 39934 57.19 Intra- Ran - 3.88 2012 76 1 1 9 2 3 4 1 4 - - - - -

District HIV/AIDS Epidemiological Profiles : Karnataka | 19 Bidar

Background: Bidar is located in the northeastern corner of Karnataka Bidar District and borders with Andhra Pradesh to the east, Maharashtra to the north and west, and Gulbarga district to the south. The district has a population of 17 lakhs, a sex ratio of 952 females per 1,000 males, and a female literacy rate of 61.66% with an overall literacy rate of 71.01% (Census 2011). Agriculture is the main occupation for the rural population. It is one of the five districts in Karnataka currently receiving funds from the Backward Regions Grant Fund Programme (BRGF). Bidar with its picturesque landscape and epigraphic edifices is a cultural mosaic, attracting tourists to the region. The district is well connected via roads, railways, and National Highway 9, which connects it to rest of the districts of the state.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV positivity was low at 0.38% among the ANC attendees with a fluctuating trend. • According to 2012 PPTCT data, the level of HIV positivity was low at 0.25% among the PPTCT attendees, with a stable trend. • According to 2012 Blood Bank data, the level of HIV positivity was low at 0.19% among the Blood bank attendees, with a stable trend. • Based on 2010 HSS-FSW data, HIV prevalence was low (1.20%) among the FSWs, however, due to lack of previous year’s data, a trend could not be determined. • As per 2012 ICTC data, the level of HIV positivity was low among male (2.49%) and female (1.58%) attendees, as well as among referred (2.09%) and direct walk-in (1.79%) attendees. An overall decreasing trend was exhibited among the district’s ICTC attendees. • According to 2009 HRG mapping data, FSW (1,354; 100% of total HRG) was the only HRG in the district. • In 2012, 14,314 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.02%. • According to 2001 census, 4.35% of the males were migrants, among them 53.99% migrated to other states and 17.19% migrated to other districts within the state. • The top two destinations for inter-state out-migration were Pune and Latur, Maharashtra. • In 2012, HIV transmissions though parent to child accounted for 6.51% of the district’s total HIV transmissions in the district. • According to DLHS-III data, HIV and RTI/STI awareness rate among women was 79.4% and 32.8%, respectively. • In 2012, two TI sites (one for FSWs and one for MSM) were operational in the district. Key Recommendations: • Increase TI sites exclusively for FSWs to further accommodate the large number of FSWs in the district. • Strengthen prevention programs and outreach activities for migrants at source and transit points and for truckers at all the major halt points. • Assess the size and profile of FSWs client population to understand the vulnerability aspects. • Re survey of HRG population is needed as the presence of one TI for MSM demonstrate the availability of other HRGs in the districts, accordingly more TIs composite or HRG specific could be established. • Conduct in-depth analysis of ICTC data to understand the profile of these attendees, as the parent to child HIV transmission rate was high.

20 | District HIV/AIDS Epidemiological Profiles : Karnataka * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 17,00,018 (2.78% of Karnataka Population); Female Literacy Bidar positive, NT = number tested; ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=630) % of Total FSW No. HRG- MSM No. HRG- No. HRG- IDU % Pos; ICTC PPTCT % Pos; ART (3027) DLN (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 Aurad, 0.29 4 4 % On ART - - - - 92.70 41 - 22.07 10.72 10.55 2399 2005 1074 8.83 0.79 0.88 145 929 401 673 800 ------5 Balki, 0.5 General clients & pregnant women. - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 50.60 1210 1990 2006 1293 5.79 8.38 8.88 0.15 0.88 561 732 800 0.00 Basavaka - 83 % 15-24 yrs ------lyana, 0.71 - - - - 10 HIV Levels and Trends - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 15.32 1688 4305 5541 2007 7451 7.35 7.17 9.29 0.21 2.53 1.13 222 920 990 800 ------Transfusion Bidar, 0.26 - - - - Blood 0.16 % Ill., Prim. Edu. 16435 26502 2586 7481 5742 4325 2366 2008 7.50 5.16 4.27 7.75 0.42 0.40 0.13 800 Humna - 2 ------0.41 bad, Source: DLHS III;Source:DLHS 82 - - - - - 3 Needle/ Syringe 0.16 14061 10.15 3438 2125 2111 5693 9825 2009 4.62 4.09 7.25 0.18 0.25 798 - - - - - 1 % Married : 61.66%; 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 15641 10323 11448 25280 47051 6130 6323 2010 3.80 2.89 2.81 3.45 1.20 0.24 0.28 0.50 65 250 800 - Parent to ------Child 6.51 21368 13710 13634 33120 60464 5976 7028 2011 2.56 2.49 2.04 2.98 0.21 0.24 - - - - - % Widowed or Divorced Unknown 17 0.48 - 25251 15469 15486 29678 60633 2 5704 6705 2012 1.79 2.09 1.58 2.49 0.19 0.25 0.38 : 81.7% 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. Year: NA) Size Est., (Mapping, Typology Program Coverage No. episodes treated % Total HRG % Syphilis positivity % Total Pop. % Married % <25 yrs. Program Target HRG Size Brothel based- based- based- Home Street 2004 1354 0.08 FSW 100 NA; NA; 2009 4035 NA NA 1 3 ------

- 300,HSS-HRG/STD ≥ STI/RTI decker - Panthi - 2005 Double Kothi - MSM NA; NA; 1 1 1 3 NA NA ------2010 8714 ------Non daily Injectors- Injectors- 2006 Programme Response 14 Daily 1 1 2 ------NA; IDU NA NA 13286 2011 ------0.29 Vulnerabilities 187,ICTC ≥ 2007 17 1 1 2 ------Maharash - migration % total pop. % of male migration No. out- 14314 2012 Pune, 0.02 tra 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 1 1 1 1 2 1 1 1 ------Maharash Male Migration, 2001 Census Latur, Latur, Overall 33496 tra 4.35 100 2009 18 1 1 1 1 2 1 1

------900 and BB and 900 ≥ - (Suburban) Mumbai , Maha - rashtra 18085 53.99 Inter- State 2.35 2010 32 1 1 3 1 1 2 1 1 - - - - - 900);≥ gareddy, Pradesh Andhra 17.19 Ran - Intra- 5759 state 0.75 2011 32 1 1 4 1 1 2 1 1 - - - - - 4 percent = PP Maharash - Thane, district 28.82 Intra- 9652 1.25 2012 tra 30 1 1 6 1 1 2 1 1 - - - - -

District HIV/AIDS Epidemiological Profiles : Karnataka | 21 Bijapur

Background: Bijapur district is located in Karnataka, bordered on the Bijapur District east by Gulbarga, on the southeast by Raichur, on the south and southwest by Bagalkot, and on the west by Belgaum, and on the northwest by Sangli and on the north by Sholapur (both are the districts of Maharashtra state). It has a population of 21.75 lakhs, a sex ratio of 954 females per 1,000 males, and a female literacy rate of 56.54% with an overall literacy rate of 67.20% (census 2011). Farming and agriculture related business are the main occupations for majority of the people in the district and are the main contributors to Bijapur’s economy. The district is well connected via roads and railway, and National Highway 13 connects to the other districts of the state.

HIV Epidemic Profle: • According to 2012 HSS-ANC data, HIV positivity was moderate at 0.50% among the ANC attendees with a declining trend. • According to 2012 PPTCT data, the level of HIV positivity was lowat 0.28% among the PPTCT attendees, with a declining trend. • According to 2012 Blood Bank data, the level of HIV positivity was lowat 0.24% among the Blood bank attendees, with a stable trend. • Based on 2010 HSS-FSW data, HIV prevalence was moderate at 5.24% among the FSWs, however, due to lack of previous year’s data, a trend could not be determined. • Based on 2010 HSS-MSM data, HIV prevalence was low at 3.66% among the MSM, however, due to lack of previous year’s data, a trend could not be determined. • As per 2012 ICTC data, the level of HIV positivity was low among male (4.88%) and female (3.80%) attendees, as well as among referred (4.17%) and direct walk-in (4.61%) attendees. An overall decreasing trend was exhibited among the district’s ICTC attendees. • According to 2009 HRG mapping data, FSW (985; 56.87% of total HRG) was the largest HRG in the district, followed by MSM (747; 43.13% of total HRG). • In 2012, 25,663 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.91%. • According to 2001 census, 13.82% of the males were migrants, among them 42.23% migrated to other states and 29.12% migrated to other districts within the state. • The top two destinations for inter-state out-migration were Satara and Kolhapur, Maharashtra. • According to DLHS-III data, HIV and RTI/STI awareness rate among women was 87.5% and 45.2%, respectively. • In 2012, a total of three TI sites, two for FSWs and one for MSMs, were operational in the district. Key Recommendations: • Conduct socio-demographic analysis of ANC data to understand risk factors for HIV epidemic among general population. • Sustenance of HIV prevention strategies is suggested to maintain HIV prevalence at low levels in the district, though HIV prevalence has declined from moderate to low levels among ICTC attendees. • Strengthen outreach programmes through awareness campaigns around source and transit points for migrants like railway stations and bus stands and around truck halting points and highways in the district. • Assess the size and profile of FSWs client population, including migrants and truckers, to better understand district vulnerabilities. • Focus on hard to reach sub groups like home based FSWs (89.50% of the FSWs), which was the largest sub-typology in the district.

22 | District HIV/AIDS Epidemiological Profiles : Karnataka * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 21,75,102 (3.55% of Karnataka Population); Female Literacy Bijapur positive, NT = number tested; ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=) % of Total FSW No. HRG- MSM No. HRG- No. HRG- IDU % Pos; ICTC PPTCT % Pos; ART (13503) DLN (NA) 5

bagewadi,

Hetero-sexual Basavaa NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 0.97 4 4 % On ART - - - - - 36 - 32.13 22.13 22.92 22.90 4253 1754 2860 5591 2005 4614 0.73 2.13 361 800 ------Bijapur, 5 1.64 General clients & pregnant women. - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 34.04 20.77 20.87 23.09 3043 1557 1815 3462 2006 3372 0.26 1.23 329 811 % 15-24 yrs ------0.73 Indi, - - - - 11 HIV Levels and Trends - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 12315 43.74 27.41 29.73 30.82 1191 5473 3024 3640 7716 5651 2007 1.33 1.57 1.00 Muddebi - 800 ------Transfusion 0.68 hal, - - - - Blood - % Ill., Prim. Edu. 15060 25155 22.72 23.38 21.70 24.76 3182 6915 5281 4814 5061 2008 0.22 1.20 2.00 800 Sindagi, 2 ------0.78 Source: DLHS III;Source:DLHS 80 - - - - - 3 Needle/ Syringe 10377 11565 26.73 20.55 22.07 23.45 1650 2886 2198 2307 7060 2009 0.28 0.80 ------1 % Married : 56.54%; 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 14911 13609 10086 11594 25346 49041 10.79 10.48 12.21 8784 2010 9.39 3.66 5.24 0.18 0.56 1.75 54 246 248 800 - Parent to ------Child - 13261 31670 24538 20393 10243 41899 86830 2011 4.46 5.96 4.83 6.37 0.21 0.29 - - - - - % Widowed or Divorced Unknown 18 - 13669 35349 26575 22443 40025 89043 - 2 9775 2012 4.61 4.17 3.80 4.88 0.24 0.28 0.50 : 65.2% 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. Year: NA) Size Est., (Mapping, Typology Program Coverage No. episodes treated % Total HRG % Married % <25 yrs. % Syphilis positivity % Total Pop. Program Target 89.50%; 10.50%; HRG Size Brothel based- based- based- 27.80 26.30 56.87 Home Street 2004 0.39 FSW 985 0% 2009 3564 NA 6 5 1 ------

- 300,HSS-HRG/STD ≥ STI/RTI 46.66%; 53.34% decker- 2005 Double Panthi- Kothi- 19.80 43.13 MSM 0.29 747 13152 NA; 1 2 6 7 1 NA ------2010 2 -

- Non daily Injectors- Injectors- 2006 Programme Response 13 Daily 1 1 2 6 1 1 ------NA; IDU NA NA 18000 2011 ------0.29 Vulnerabilities 187,ICTC ≥ 2007 23 1 1 1 2 6 1 1 ------Maharash - migration % total pop. % of male migration No. out- 25663 Satara, 2012 0.91 tra 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 23 1 1 1 2 6 1 1 ------Maharash Kolhapur, Kolhapur, Male Migration, 2001 Census 128293 Overall 13.82 tra 100 2009 51 2 1 3 1 1 6 1 1 - - - - - 900 and BB and 900 ≥ - Maharash - Ratnagiri, 54173 42.23 Inter- State 5.83 tra 2010 62 1 1 4 1 2 6 1 1 - - - - - Maharash - 900);≥ Sangli, 37363 29.12 Intra- state 4.02 tra 2011 61 1 1 4 2 3 6 1 2 - - - - - 4 percent = PP Maharash - district 36757 28.65 Pune, Intra- 3.96 2012 tra 62 1 1 6 2 3 6 1 2 - - - - -

District HIV/AIDS Epidemiological Profiles : Karnataka | 23 Chamaraja Nagar

Background: Chamaraja nagar is located in southernmost part of Chamraj Nagar District Karnataka, which came into existence after the bifurcation of Mysore district into the new Mysore district and Chamrajnagar district. Being the southernmost district of Karnataka, Chamarajanagar district borders the state of Tamil Nadu and Kerala. The population of Chamarajanagar is 10.20 lakhs with a sex ratio of 989 females for every 1,000 males, and a female literacy rate of 54.32% with an overall literacy rate of 61.12% (Census 2011). The district is richly endowed in mineral deposits, much of the southern area of the district is dense forest. Agriculture forms the main economy of the district. Chamarajanagar has shrines and historical sites, as well as an annual car rally, all of which bring in numerous pilgrims and tourists each year. The district is well connected to other districts and states by railways, state roadways, and National Highway 766.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was high at 1.25% among the ANC attendees, with an increasing trend. • According to 2012 PPTCT data, the level of HIV positivity was low (0.19%) among the PPTCT attendees, with a declining trend. • According to 2012 ICTC data, HIV prevalence was low among male (2.13%) and female (1.70%) attendees, as well as among referred (2.10%) and direct walk-in (1.18%) attendees. A declining trend was observed among all the ICTC attendees. • According to 2009 HRG size mapping data, FSW (570; 100% of total HRG) wasthe only HRG in the district. • In 2012, 7,122 STI/RTI episodes were treated the syphilis positivity rate among STI clinic attendees was 0.41%. • According to 2001 census, 4.68% of the males were migrants, among them 2.34% migrated to other states and 59.65% migrated to other districts within the state. • The top destination for inter-state out-migration was Wayanad, Kerala. • According to 2012 ICTC data, HIV transmissions from parent to child was high at 5.37% in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 80.10% and18.70%, respectively. • In 2012, there were two TI sites functional, one for FSWs and one for MSM, in the district. Key Recommendations: • Analysis of risk profile of positive individuals among ANC attendees should be done to determine associated factors for increasing vulnerability of the district. • Parent to child transmission was high in the district, therefore, it is necessary to strengthen PPTCT program coverage 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. • Further assess the size and profile of FSW’s client population to better understanding of district vulnerabilities. As well as analysis of typology data is required for the assessment. • Provision for outreach programmes during tourist season and strengthen out-reach activities around source and transit points like railway stations and bus stands.

24 | District HIV/AIDS Epidemiological Profiles : Karnataka * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 10,20,962 (1.67% of Karnataka’s Population); Female Literacy Chamarajangar positive, NT = number tested; ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=410) % of Total FSW No. HRG- MSM No. HRG- IDU No. HRG- ICTC % Pos; PPTCT % Pos; ART (2852) DLN (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 - - - - - 92.68 43 - 2005 1.63 800 0 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 2006 1.38 800 0.73 % 15-24 yrs 0 ------12 HIV Levels and Trends - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 4344 2007 4344 1.86 1.00 800 ------Transfusion - - - - - Blood 0 % Ill., Prim. Edu. 18233 4484 5108 5154 4411 8668 2008 4.17 6.44 4.11 6.89 0.50 0.50 798 2 ------Source: DLHS III;Source:DLHS 87 ------3 Needle/ Syringe 0.24 12299 29982 4229 6915 6061 5083 2009 2.81 3.64 2.85 3.90 0.28 ------% 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 : 54.32%; ANC Utilization 10434 11300 25605 3871 7059 7246 2010 2.79 3.27 2.86 3.41 0.27 0.88 67 800 - * * Parent to ------Child 5.37 18291 10587 10245 15140 35972 2541 2011 2.44 1.96 1.69 2.36 0.30 * * - - - - - % Widowed or Divorced Unknown 15 0.98 - 17214 10323 10961 12557 33841 4070 2012 1.18 2.10 1.70 2.13 0.19 1.25 800 2 * * : 97.4% ------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. Year: NA) Size Est., (Mapping, Typology Program Coverage No. episodes treated % Total HRG % Syphilis positivity % Total Pop. Program Target % Married % <25 yrs. based-NA; based-NA; based-NA HRG Size Brothel Home Street 2004 0.06 FSW 570 100 2009 NA 456 3 ------

- 300,HSS-HRG/STD ≥ STI/RTI Panthi - 2005 Double Kothi - decker MSM - Na NA; Na; 1 4 NA ------2010 1434 ------Non daily Injectors- Injectors- 2006 Programme Response Daily 1 2 8 ------NA; IDU NA NA 2011 3865 ------0.41 Vulnerabilities 187,ICTC ≥ 2007 12 1 1 2 ------migration % total pop. % of male migration No. out- Wayanad, Kerala 2012 7122 0.29 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 19 1 1 1 2 1 ------Male Migration, 2001 Census Overall 22919 4.68 100 - 2009 21 1 1 1 1 ------900 and BB and 900 ≥ Inter- State 2.34 0.11 537 - 2010 21 1 1 2 1 2 1 1 ------900);≥ 13671 59.65 Intra- state 2.79 2011 - 23 1 1 2 1 2 1 1 1 - - - - - 4 percent = PP district 38.01 Intra- 8711 1.78 2012 31 - 1 1 3 1 2 1 1 1 - - - - -

District HIV/AIDS Epidemiological Profiles : Karnataka | 25 Chikmagalur

Background: Chikmagalur district of Karnataka borders Shimoga to Chickmagalur District the north, Davangere to the north-east, Chitradurga and Tumkur districts to the east, Hassan to the south, Dakshina Kannada to the south-west and Udupi to the west. Chikmagalur has a population of 11.37 lakhs, a sex ratio of 1,005 females for every 1,000 males, and a female literacy rate of 72.88% with an overall literacy rate of 79.24% (Census 2011). Agriculture, especially coffee cultivation is the economical backbone of Chikkamagaluru district. It is a popular tourist destination due to the mountains, which are a part of the Western Ghats and are the source of rivers like Tunga and Bhadra. Mullayanagiri, which is the highest peak in Karnataka, is located in the district. Wildlife enthusiasts are also attracted to the district for the Kudremukh National Park and Bhadra Wildlife Sanctuary. Chikmagalur is well connected to other districts in the state by railways as well as by National highway 206.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV positivity was low at 0.38% among the ANC attendees, with a declining trend. • According to 2012 PPTCT data, the level of HIV positivity was low at 0.26% among the PPTCT attendees, with a stable trend in the last three years. • According to 2012 Blood Bank data, the level of HIV positivity was low at 0.18% among the Blood Bank attendees, with a stable trend in the last three years. • As per 2012 ICTC data, the level of HIV positivity was low among male (2.59%) and female (2.66%) attendees, as well as among referred (2.51%) and direct walk-in (2.04%) attendees. An overall decreasing trend was exhibited among the district’s ICTC attendees. • According to 2009 HRG mapping data, FSW (1,360; 76.66%of total HRG) was the largest HRG in the district, followed by MSM (414; 23.34% of total HRG). • In 2012, 6,974 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.67%. • According to 2001 census, 6.79% of the males were migrants, among them 2.66% migrated to other states and 59.64% migrated to other districts within the state. • The top two destinations for inter-state out-migration were Mumbai and Thane, Maharashtra. • According to DLHS-III data, HIV and RTI/STI awareness rate among women was 92.3% and 39.3%, respectively. • In 2012, a total of three TI sites (two for FSWs and one for MSM) were operational in the district. Key Recommendations: • A sustained approach is needed to check the incidence of HIV infection, since understanding the trends are difficult with the reported positivity levels, focused approach to strengthen programs and data is required. • Strengthen outreach programme through awareness campaigns around source and transit points like railway stations and bus stands, considering most of the out-migration was to districts in a high HIV prevalent state. • Assess the size and profile of FSWs client population to better understand district vulnerabilities and strengthen TI interventions for FSW population.

26 | District HIV/AIDS Epidemiological Profiles : Karnataka * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 11,37,753 (1.86% of Karnataka Population); Female Literacy Chikmaglur positive, NT = number tested; ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=491) % of Total FSW No. HRG- MSM No. HRG- No. HRG- IDU % Pos; ICTC PPTCT % Pos; DLN (NA) ART (6336) 5

agalooru, 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 Chikm 0.7 4 4 % On ART - - - - 92.26 33 - 15.28 15.57 18.72 13.78 2136 2005 1258 0.37 0.88 288 970 438 820 800 ------Kadur, 5 0.9 General clients & pregnant women. - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 15.33 11.97 11.76 13.00 1091 2006 1144 0.55 1.50 150 994 544 600 800 0.20 % 15-24 yrs ------Koppa, 0.8 - - - - HIV Levels and Trends 6 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 11.68 10.99 10.13 11.76 3203 1855 2075 2904 5813 2007 9743 0.41 0.74 2.38 Mudigere, 728 800 ------Transfusion 0.4 - - - - Blood 0 % Ill., Prim. Edu. 17600 1271 6906 3955 4211 1383 9434 2008 9.76 5.82 5.23 7.58 0.22 0.60 0.75 NR Pura, 800 2 ------Source: DLHS III;Source:DLHS 0.2 63 - - - - - 3 Needle/ Syringe 3264 1935 1849 2932 3602 2009 7386 9.81 4.44 4.19 6.22 0.41 0.50 Sringeri, 520 0 0 - - - - 1 % Married : 72.88%; 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 Tharikere, 15342 10689 13516 33485 4627 9280 4118 2010 3.16 2.76 2.86 2.84 0.12 0.26 0.38 38 800 - Parent to ------0.2 - - - - Child 3.26 20476 12215 13519 16290 42024 5258 4570 2011 2.24 2.03 2.14 2.01 0.22 0.19 - - - - - % Widowed or Divorced Unknown 13 4.28 - 16623 10300 12610 32805 2 3572 9895 5092 2012 2.04 2.51 2.26 2.59 0.18 0.26 0.38 : 92.9% 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. Year: NA) Size Est., (Mapping, Typology Program Coverage No. episodes treated % Total HRG % Syphilis positivity % Total Pop. Program Target % Married % <25 yrs. based-NA; based-NA; based-NA HRG Size Brothel 76.66 Home Street 2004 1360 0.12 FSW 2009 1756 NA 3 3 ------

- 300,HSS-HRG/STD ≥ STI/RTI Panthi - 2005 Double Kothi - decker 23.34 MSM 0.04 - Na 414 NA; Na; 1 1 3 3 NA ------2010 5003 0.56 - - - Non daily Injectors- Injectors- 2006 Programme Response Daily 1 1 3 6 ------NA; IDU NA NA 2011 5801 ------0.95 Vulnerabilities 187,ICTC ≥ 2007 13 1 1 3 (Suburban), ------Maharash - migration % total pop. % of male migration No. out- Mumbai 2012 6974 0.67 tra 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 14 1 1 1 1 3 1 1 ------Maharash Thane, Thane, Male Migration, 2001 Census Overall 38968 tra 6.79 100 2009 23 1 1 1 1 3 1 1 ------900 and BB and 900 ≥ - 1037 Inter- State 2.66 0.18 - 2010 40 1 1 3 1 1 3 1 1 - - - - - 900);≥ 23242 59.64 Intra- state 4.05 2011 - 48 1 1 3 1 1 3 1 2 - - - - - 4 percent = PP district 14689 37.70 Intra- 2.56 2012 66 - 1 1 5 1 1 3 1 2 - - - - -

District HIV/AIDS Epidemiological Profiles : Karnataka | 27 Chitradurga

Background: Chitradurga is an administrative district of Karnataka Chitradurga District andlies in the valley of the Vedavati River, with the Tungabhadra River flowing in the northwest. Tumkur borders the district to the southeast and south, Chikmagalur to the southwest, Davanagere to the west, Bellary to the north, and Anantapur of Andhra Pradesh state to the east. Chitradurga has a population of 16.60 lakhs, a sex ratio of 969 females to every 1,000 males, anda female literacy rate of 66.05% withan overall literacy rate of 73.82% (Census 2011). The district has many historical landmarks, forts, and a hill station, which attract numerous tourists every year. The district has a distinctly agrarian economy complemented by industries related to its rich mineral deposits. However, in 2006, the Ministry of Panchayati Raj named Chitradurga one of the country’s 250 most backward districts; it is one of the five districts in Karnataka currently receiving funds from the Backward Regions Grant Fund Programme (BRGF). Chitradurga is well connected to other districts in Karnataka by way of rail and road, including National Highways 4 and 13, which pass through the district.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV positivity was moderate at 0.88% among the ANC attendees with a fluctuating trend. • According to 2012 PPTCT data, the level of HIV positivity was low at 0.26% among the PPTCT attendees, with a fluctuating trend. • According to 2012 Blood Bank data, the level of HIV positivity was low at 0.18% among the Blood bank attendees, with a stable trend. • Based on 2010 HSS-FSW data, HIV prevalence was moderate at 9.20% among the FSWs, however, due to lack of previous year’s data, a trend could not be determined. • As per 2012 ICTC data, the level of HIV positivity was low among male (3.44%) and female (2.89%) attendees, as well as among referred (3.31%) and direct walk-in (2.77%) attendees. An overall decreasing trend was exhibited among the district’s ICTC attendees. • According to 2009 HRG mapping data, FSW (1,890; 85.91% of total HRG) was the largest HRG in the district, followed by MSM (310; 14.09% of total HRG). • In 2012, 14,348 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.09%. • According to 2001 census, 7.29% of the males were migrants, among them 3.07% migrated to other states and 49.70% migrated to other districts within the state. • The top destination for inter-state out-migration was Anantapur, Andhra Pradesh. • According to DLHS-III data, HIV and RTI/STI awareness rate among women was 89.3% and 42.6%, respectively. • In 2012, a total of three TI sites (two for FSWs and one for MSM) were operational in the district. Key Recommendations: • Conduct socio-demographic analysis of ANC data to ascertain risk factors, considering fluctuating prevalence among the ANC attendees. • Strengthen TI interventions for FSWs, as the percentage of HIV positivity was nearing high. • Strengthen outreach programmes through awareness campaigns around truck halting points and highways, around migrant’s source and transit points and during tourist season in the district. • Analyze risk factors and client profiles among FSWs as they were the largest HRG in the district. As well as focus on hard to reach sub groups like home-based FSWs.

28 | District HIV/AIDS Epidemiological Profiles : Karnataka positive, NT = number tested; * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 16,60,378 (3% of Karnataka Population); Female Literacy Chitradurga ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=689) % of Total FSW No. HRG- MSM No. HRG- IDU No. HRG- ICTC % Pos; PPTCT % Pos; DLN (NA) ART (2862) 5

Challakere,

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 0.33 4 4 % On ART - - - - 95.65 47 - 25.40 10.17 17.40 1210 2384 2005 1458 8.66 0.42 0.63 248 774 684 799 Chitradur - - - ga, 0.33 ------5 General clients & pregnant women. - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 - 32.76 13.15 19.40 11.71 1589 1282 2006 1821 0.23 0.25 232 933 888 800 0.87 % 15-24 yrs ------Hiriyur, 0.46 - - - - HIV Levels and Trends 9 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 19.62 13.18 15.31 16.40 3346 3391 2007 4401 0.15 1.70 0.25 Holalkere, 418 592 516 494 800 ------Transfusion 0.31 - - - - Blood 0 % Ill., Prim. Edu. 15181 22432 11.04 1730 5521 3497 3754 2734 2008 6.29 6.89 7.91 1.50 0.30 0.50 Hosadur 800 ga, 0.25 2 ------Source: DLHS III;Source:DLHS 92 ------3 Needle/ Syringe 11912 mur, 0.39 1379 3306 2616 2068 4783 Molakal - 7228 2009 6.60 4.33 3.52 6.82 0.20 0 0 - - - - 1 : 66.05%; 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 18580 31619 3648 9391 5822 7217 6202 2010 6.09 4.40 4.77 4.95 9.20 0.13 0.42 1.25 62 250 799 - Parent to ------Child 3.34 17243 10515 12829 23318 46662 6101 6871 2011 3.29 2.78 2.80 3.02 0.10 0.18 - - - - - % Widowed or Divorced Unknown 2 24 0.15 : 81.1% - 16291 10476 11234 19434 41144 5419 9294 2012 2.77 3.31 2.89 3.44 0.18 0.26 0.88 800 ------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. Year: NA) Size Est., (Mapping, % Married % <25 yrs. Typology Program Coverage No. episodes treated % Total HRG % Syphilis positivity % Total Pop. Program Target based-0%; 62.90%; 37.10% HRG Size Brothel based- based- 53.80 28.10 85.91 Home Street 2004 1890 0.11 FSW 2009 2805 NA 3 2 1 ------

- 300,HSS-HRG/STD ≥ STI/RTI 33.70%; 61.80% decker- 2005 Double Panthi- Kothi- 65.20 14.09 MSM 4.50 0.02 310 NA; 1 1 3 2 1 NA ------2010 9916 -

- Non daily Injectors- Injectors- 2006 Programme Response Daily 1 1 3 2 1 1 ------NA; IDU NA NA 14224 2011 ------0.12 Vulnerabilities 187,ICTC ≥ 2007 16 1 1 3 1 1 ------Anantapur, migration % total pop. % of male migration No. out- Pradesh Andhra 14348 2012 0.09 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 16 1 1 1 3 1 1 ------Male Migration, 2001 Census Overall 56328 7.29 100 - 2009 35 1 1 1 1 3 1 1 ------900 and BB and 900 ≥ 1727 Inter- State 3.07 0.22 - 2010 35 1 1 2 1 1 3 1 1 - - - - - 900);≥ 27994 49.70 Intra- state 3.62 2011 - 37 1 4 1 1 3 1 2 ------ 4

PP = percent = PP district 26607 47.24 Intra- 3.44 2012 35 - 1 5 1 1 3 1 2 ------

District HIV/AIDS Epidemiological Profiles : Karnataka | 29 Dakshina Kannada

Background: Dakshina Kannada, also known as South Kanara, is a coastal Dakshina Kannada District district in the state of Karnataka in India. It is bordered by Udupi to the north, Chikkamagaluru to the northeast, Hassan district to the east, Kodagu to the southeast, and Kasaragod in Kerala to the south; the Arabian Sea bounds it on the west. The district has a population of 20.83 lakhs, a sex ratio of 1,018 females for every 1,000 males, and a female literacy rate of 84.04% with an overall literacy rate of 88.62% (Census 2011). The coastal tract is the most thickly populated part of the district, as the land is fertile and there are trading facilities. The middle belt consists of hills and dales and forms into an undulating terrain. Dakshina Kannada is well connected to other states and districts within Karnataka by way of National Highways 17 and 48, roads and railways.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was moderate at 0.50% among the ANC attendees, with a fluctuating trend. • According to 2012 PPTCT data, the level of HIV positivity was low at 0.11% among the PPTCT attendees, with a stable trend. • According to 2012 Blood Bank data, the level of HIV positivity was low at 0.24% among the Blood Bank attendees, with a stable trend. • Based on 2010 HSS-FSW data, HIV positivity was low at 3.60% among the FSWs, with a declining trend over the past four recorded years. • Based on 2010 HSS-MSM data, HIV positivity was low at 2.81% among the MSM, although due to lack of previous data a trend analysis could not be conducted. • According to 2012 ICTC data, HIV positivity was low among male (2.53%) and female (2.15%) attendees, as well as among referred (2.76%) and direct walk-in (1.52%) attendees. The positivity levels showed an overall declining trend among all the ICTC attendees. • According to 2009 HRG size mapping data, FSW (1,992;100% of total HRG) was the only HRG in the district. • In 2012, 20,300 STI/RTI episodes were treated the syphilis positivity rate among STI clinic attendees was 0.58%. • According to 2001 census, 14.24% of the males were migrants, among them 14.79% migrated to other states and 20.31% migrated to other districts within the state. • The top two destinations for out-of-state migration were Mumbai (Suburban) and Thane in Maharashtra. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 93.8 % and 73.9%, respectively. • In 2012, a total of three TI sites (two for FSWs and one for MSM) were operational in the district. Key Recommendations: • Carryout disaggregated analysis of ANC data to identify risk factors responsible for the fluctuation in the HIV epidemic among general population. • Though HIV prevalence has declined from high to low levels among ICTC attendees, sustenance of HIV prevention strategies is suggested to maintain HIV prevalence at low levels in the district. • Assess of the size and profile of FSWs client population including migrants and truckers, for better understanding of district vulnerabilities. • Strengthen outreach activities for migrants at source and transit points as the top two destinations for inter-state migration were to a high prevalent state.

30 | District HIV/AIDS Epidemiological Profiles : Karnataka * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 20,83,625 (3.41% of Karnataka Population); Female Literacy Dakshina Kannada positive, NT = number tested; ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=866) % of Total FSW No. HRG- MSM No. HRG- IDU No. HRG- ICTC % Pos; PPTCT % Pos; DLN (NA) ART (2388) 5

Bantwal, 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 0.2 4 4 % On ART - - - - 90.88 43 - 34126 25.86 24.14 13.54 2358 1578 3124 2005 3936 8.95 4.00 0.48 0.38 812 250 800 Belthang ------adi, 0.3 5 General clients & pregnant women. - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 13609 17.48 12.05 12.35 13.79 3087 1620 2285 2006 3905 6.64 3.60 0.27 0.75 818 256 250 800 1.27 lore, 0.3 % 15-24 yrs Manga ------HIV Levels and Trends 8 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 30711 12769 20255 13.38 15.53 14.24 14.50 4670 2916 2872 4614 2007 5.20 3.04 0.17 0.55 0.13 250 230 800 Puttur, - - - - Transfusion 0.1 - - - - Blood 0.58 % Ill., Prim. Edu. 19718 20616 36880 9330 6944 7101 9163 2008 7.34 7.10 6.10 8.13 3.74 5.94 0.17 0.30 0.75 214 202 800 Sulya, 2 - - - - Source: DLHS III;Source:DLHS 0.3 84 - - - - - 3 Needle/ Syringe 0.12 43200 11058 3085 2083 1946 3222 5890 2009 6.16 7.83 6.83 6.83 0.25 0.25 - - - - - 1 % Married : 84.04%; 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 11961 17717 11024 18654 62582 23589 53267 2010 2.37 3.89 3.21 3.31 2.81 3.60 0.16 0.20 0.25 64 249 250 800 - Parent to ------Child 3.93 14987 19885 13174 21698 47211 26607 61479 2011 1.54 3.32 2.43 2.62 0.18 0.15 - - - - - % Widowed or Divorced Unknown 21 3.23 - 11499 25011 15028 21482 43056 21863 58373 2 2012 1.52 2.76 2.15 2.53 0.24 0.11 0.50 : 97% 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. Year: NA) Size Est., (Mapping, Typology Program Coverage No. episodes treated % Total HRG % Syphilis positivity % Total Pop. % Married % <25 yrs. Program Target HRG Size Brothel based- based- based- Home Street 2004 1992 0.10 FSW 100 NA; NA; 2009 3762 NA NA 11 1 3 ------

- 300,HSS-HRG/STD ≥ STI/RTI Kothi-NA; decker- 2005 Double Panthi- MSM 11 NA; 1 1 5 NA NA ------2010 8025 ------

- Non daily Injectors- Injectors- 2006 Programme Response 11 15 Daily 1 1 1 ------NA; IDU NA NA 14378 2011 ------1.08 Vulnerabilities 187,ICTC ≥ 2007 12 18 2 1 1 1 (Suburban), ------Maharash - migration % total pop. % of male migration No. out- Mumbai 20300 2012 0.58 tra 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 12 19 2 1 1 1 1 1 2 - - - - - Maharash Thane, Thane, Male Migration, 2001 Census 133568 Overall 14.24 tra 100 2009 12 27 2 1 3 1 1 1 2 - - - - - 900 and BB and 900 ≥ - Kasaragod, Kerala 19749 14.79 Inter- State 2.11 2010 11 33 2 1 3 1 1 1 2 - - - - - Maharash - 900);≥ Mumbai, 27134 20.31 Intra- state 2.89 tra 2011 13 41 1 1 3 1 1 1 2 - - - - - 4 percent = PP Maharash - district 86685 64.90 Pune, Intra- 9.24 2012 tra 13 48 1 1 4 2 1 1 2 - - - - -

District HIV/AIDS Epidemiological Profiles : Karnataka | 31 Davanagere

Background: Davanagere is a district located in Karnataka, it was carved Davanagere District out of the erstwhile three districts namely Chitradurga, Shimoga and Bellary in the year 1997. It is bordered by Shivamogga and Haveri on the west, Chitradurga on the east, Bellary on the north and Chikmagalur on the south. Davanagere has a population of 19.46, a sex ratio of 967 females out of 1,000 males, and a female literacy rate of 69.39% with an overall literacy rate of 76.30% (Census 2011). The district’s economy is predominantly based on agriculture. In 2006, the Ministry of Panchayati Raj named Davanagere one of the country’s 250 most backward districts. Davanagere is one of the five districts in Karnataka currently receiving funds from the Backward Regions Grant Fund Programme (BRGF). National Highway 4, state road and railways connect Davanagere with the rest of Karnataka.

HIV Epidemic Profle: • As per 2010 HSS-ANC data, HIV positivity was moderate at 0.75% among the ANC attendees, with a fluctuating trend. • According to 2012 PPTCT data, the level of HIV positivity was low at 0.18% among the PPTCT attendees, with a stable trend. • According to 2012 Blood Bank data, the level of HIV positivity was low at 0.29% among the Blood Bank attendees, with a stable trend. • Based on 2010 HSS-FSW data, HIV prevalence was moderate at 5.60% among the FSWs; however due to lack of previous data a trend could not be determined. • As per 2012 ICTC data, the level of HIV positivity was low among male (4.44%) and female (3.29%) attendees. It was also low for referred (4.25%) and direct walk-in (2.27%) attendees. An overall declining trend was exhibited among all the ICTC attendees. • According to 2009 HRG mapping size data, FSW (1,365; 77.03% of total HRG) was the largest HRG in the district, followed by MSM (407; 22.97% of total HRG). • In 2012,10,589 STI/RTI episodes were treated. • According to 2001 census, 5.98% of the males were migrants, among them 1.75% migrated to other states and 50.48% migrated to other districts within the state. • The top destinations for inter-state out-migration were South and North Goa. • According to DLHS-III data, HIV and RTI/STI awareness rate among women was 84.80% and 34.60%, respectively. • In 2012, a total of three TI sites (two for FSWs and one for MSM) were operational in the district. Key Recommendations: • Conduct socio-demographic analysis of HSS-ANC data to understand risk factors for HIV epidemic among general population. • Strengthen TI interventions for FSWs, as the percentage of HIV positivity was notable among them. • Increase availability of typology data for FSWs to improve analysis of risk factors and better understand the district’s vulnerabilities. • Increase availability of data regarding profile and pattern of migration and truckers, to gain better insight to district HIV vulnerabilities.

32 | District HIV/AIDS Epidemiological Profiles : Karnataka * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 19,46,905 (3.18% of Karnataka Population); Female Literacy Davanagere positive, NT = number tested; ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=1020) % of Total FSW No. HRG- MSM No. HRG- IDU No. HRG- ICTC % Pos; PPTCT % Pos; ART (8936) DLN (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 - - - - - 94.02 32 - 16116 43.66 31.47 36.44 34.48 2508 5529 3246 4791 2005 8037 0.56 1.38 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 53.31 17.27 25.16 25.40 1345 4691 2587 3449 9969 2006 6036 0.38 1.38 800 0.39 % 15-24 yrs ------10 HIV Levels and Trends - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 16944 12404 39.90 32.61 36.68 35.31 2113 2530 2091 2552 7761 2007 0.34 1.02 0.75 800 ------Transfusion - - - - - Blood 0.29 % Ill., Prim. Edu. 11893 20166 33118 19.81 18.15 15.47 23.17 5678 7278 7221 5731 2008 0.41 0.40 2.00 800 2 ------Source: DLHS III;Source:DLHS 88 ------3 Needle/ Syringe 27784 12060 20.80 15.53 14.12 20.99 1548 3116 2515 2149 7396 2009 0.24 0.20 0 - - - - - 1 % Married : 69.39%; 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 17855 12817 11053 30523 24721 48591 6015 2010 5.87 4.96 4.46 6.04 5.60 0.23 0.14 0.75 63 250 800 - Parent to ------Child 3.82 21934 16182 15226 28819 31488 62896 9474 2011 2.48 3.76 3.00 3.78 0.23 0.17 - - - - - % Widowed or Divorced Unknown 20 1.47 - 20804 14634 12083 20118 27580 54297 2 5913 2012 2.27 4.25 3.29 4.44 0.29 0.18 : 82.9% ------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. Year: NA) Size Est., (Mapping, Typology Program Coverage No. episodes treated % Total HRG % Syphilis positivity % Total Pop. % Married % <25 yrs. Program Target HRG Size Brothel based- based- based- 77.03 Home Street 2004 1365 0.07 FSW NA; NA; 2009 1810 NA NA 12 1 3 1 ------

- 300,HSS-HRG/STD ≥ STI/RTI decker- 2005 Double Panthi- Kothi- 22.97 MSM 13 0.02 407 NA; NA; 1 1 3 1 NA NA ------2010 7796 - - -

- Non daily Injectors- Injectors- 2006 Programme Response 10 Daily 1 1 1 3 1 1 ------NA; IDU NA NA 2011 8415 ------Vulnerabilities 0 187,ICTC ≥ 2007 12 1 1 1 1 3 1 1 ------migration % total pop. % of male migration No. out- 10589 South 2012 Goa 0 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 17 1 1 1 1 5 1 1 ------Male Migration, 2001 Census North North Overall 54880 Goa 5.98 100 2009 45 1 1 2 1 1 5 1 1 -

- - - - 900 and BB and 900 ≥ Inter- State 1.75 0.10 961 - 2010 54 1 1 4 1 1 5 1 1 - - - - - 900);≥ 27704 50.48 Intra- state 3.02 2011 - 56 1 1 4 2 1 5 1 1 - - - - - 4 percent = PP district 26215 47.77 Intra- 2.86 2012 55 - 1 1 5 2 1 5 1 2 - - - - -

District HIV/AIDS Epidemiological Profiles : Karnataka | 33 Dharwad

Background: Dharwad is bordered on the north by Belgaum, on the Dharwad District east by Gadag, on the south by Haveri and on the west by Uttara Kannada. It has a population of 18.46 lakhs, a sex ratio of 967 females per 1,000 males, and a female literacy rate of 73.57% with an overall literacy rate of 80.30%. Dharwad has been a renowned centre of learning, with many famous high schools, colleges and universities. Hubli in Dharwad, is an important industrial centre, with the presence of more than 1,000 allied small and medium industries. There are industries for machine tools, electronics, steel furniture, food products, rubber, leather and tanning. People are also involved in agriculture and other commercial activities. The district is well connected via roads and railway, and National Highways 67 and 4 connects it to the rest of the districts of the state.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, positivity was low at 0.13% among the ANC attendees, with a declining trend. • According to 2012 PPTCT data, the level of HIV positivity was low at 0.23% among the PPTCT attendees, with a declining trend. • According to 2012 Blood Bank data, the level of HIV positivity was low at 0.28% among the Blood Bank attendees, with a stable trend. • According to 2010 HSS-FSW data, the HIV positivity was nearing high (9.60%) among FSWs, but a trend analysis could not be conducted due to lack of historical data. • Based on 2010 HSS-MSM data, HIV prevalence was moderate (8.81%) among MSM, however, due to lack of previous data points a trend could not be determined. • As per 2012 ICTC data, the level of HIV positivity was near moderate among male (4.82%) but low among female (3.96%) attendees. It was near moderate among referred (4.90%) but low among direct walk-in (3.32%) attendees. A decreasing trend was seen among all the ICTC attendees. • According to 2009 HRG mapping size data, FSW (2,602; 56.69% of total HRG) was the largest HRG in the district, followed by MSM (1,757; 40.31% of total HRG). • In 2012,10,105 STI/RTI episodes were treated the syphilis positivity rate among STI clinic attendees was 0.11%. • According to 2001 census, 10.46% of the males were migrants, among them 13.71% migrated to other states and 46.82% migrated to other districts within the state. • The top two destinations for inter-state out-migration were South Goa and North Goa. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 90.30% and 43.60%, respectively. • In 2012, a total of three TI sites (two for FSWs and one for MSM) were operational in the district. Key Recommendations: • Carryout disaggregated analysis of HSS-FSW and HSS-MSM data to find out HIV risk factors in the district, as the level positivity was moderate among them. • Sustenance of HIV prevention strategies is suggested to maintain HIV prevalence at low levels in the district. • Assess the size and profile of FSW’s client populations, including migrants and truckers, to provide better insights into district vulnerabilities. • Analysis of typology would also help to analyze risk factors, since the largest HRG wasFSW.

34 | District HIV/AIDS Epidemiological Profiles : Karnataka * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 18,46,993(3.02% of Karnataka Population); Female Literacy Dharwad positive, NT = number tested; ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=1614) % of Total FSW No. HRG- MSM No. HRG- IDU No. HRG- % Pos; ICTC PPTCT % Pos; DLN (NA) ART (16191) 5

Dharwad, 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 0.8 4 4 % On ART - - - - 93.80 22 - 14893 43.66 31.47 36.44 34.48 30.40 2508 5529 3246 4791 2005 8037 0.38 6.75 250 800 ------Hubali, 5 1.24 General clients & pregnant women. - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 53.31 17.27 25.16 25.40 13.60 1345 4691 2587 3449 9174 2006 6036 0.26 0.88 250 800 0.37 Kalaghat - % 15-24 yrs gi, 0.45 ------HIV Levels and Trends 9 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 18311 13701 39.90 32.61 36.68 35.31 2113 2530 2091 2552 9058 2007 8.40 0.29 1.20 0.38 Kundagol, 250 800 ------Transfusion 0.41 - - - - Blood 0.68 % Ill., Prim. Edu. 22059 35011 19.81 18.15 15.47 23.17 15.20 5678 7278 7221 5731 9307 2008 gund, 0.5 0.12 0.90 0.63 250 800 Naval - 2 ------Source: DLHS III;Source:DLHS 44 - - - - - 3 Needle/ Syringe 0.31 21171 14033 20.80 15.53 14.12 20.99 1548 3116 2515 2149 9369 2009 0.21 0.60 - - - - - 1 % Married : 73.57%; 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 17000 12352 11038 23798 26865 50255 6390 2010 9.86 6.54 6.44 8.57 8.81 9.60 0.26 0.52 0.50 38 227 250 799 - Parent to ------Child 3.59 11030 19787 14954 15863 27698 33275 64092 2011 5.55 5.62 5.20 5.98 0.23 0.27 - - - - - % Widowed or Divorced Unknown 18 1.24 - 2 11731 24974 18160 18545 18924 32252 68957 : 81% 2012 3.32 4.90 3.96 4.82 0.28 0.23 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. Year: NA) Size Est., (Mapping, Typology Program Coverage No. episodes treated % Total HRG % Syphilis positivity % Total Pop. % Married % <25 yrs. Program Target HRG Size Brothel based- based- based- 17.20 59.69 Home Street 2004 2602 0.14 FSW NA; NA; 2009 1583 NA NA 18 1 7 1 ------

- 300,HSS-HRG/STD ≥ STI/RTI 22.68%; decker- 2005 Double Panthi- Kothi- 28.50 40.31 1757 MSM 18 0.10 NA; 1 1 2 7 1 NA NA ------50 2010 8157 0.89 -

Non daily Injectors- Injectors- 2006 Programme Response 18 Daily 1 1 2 7 1 1 ------NA; IDU NA NA 2011 9536 ------0.07 Vulnerabilities 187,ICTC ≥ 2007 18 1 1 2 6 1 1 ------migration % total pop. % of male migration No. out- 10105 South 2012 0.11 Goa 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 18 1 1 1 2 8 1 1 ------Male Migration, 2001 Census North North Overall 86136 Goa 10.46 100 2009 18 1 1 3 1 2 7 1 1 -

- - - - 900 and BB and 900 ≥ Maharash - Pune, 11812 13.71 Inter- State 1.43 tra 2010 49 1 1 3 2 2 8 1 1 - - - - - Maharash - 900);≥ Mumbai, 40327 46.82 Intra- state 4.90 tra 2011 10 49 1 3 2 2 2 2 ------4 percent = PP Maharash - Thane, district 33997 39.47 Intra- 4.13 2012 tra 10 41 1 3 2 2 1 2 ------

District HIV/AIDS Epidemiological Profiles : Karnataka | 35 Gadag

Background: Gadag was formed in the year 1997, when it was split Gadag District off from Dharwad district. Gadag borders Bagalkot on the north, Koppal on the east, Bellary on the southeast, Haveri on the southwest, Dharwad on the west, and Belgaum on the northwest.Gadag has a population of 10.65 lakhs, a sex ratio of 978 females per 1,000 males, and a female literacy rate of 65.29% with an overall literacy rate of 75.18% (Census 2011). The district has many historical sites and temples which attracts tourism. Agriculture, however, is the primary source of economy in Gadag. The district is well connected via roads and railway; National Highway 67 connects Gadag to other districts of the state.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, the level of positivity was low at 0.38% among the ANC attendees, with a fluctuating trend. • According to 2012 PPTCT data, the level of HIV positivity was low at 0.30% among the PPTCT attendees, with a declining trend. • According to 2012 Blood Bank data, the level of HIV positivity was low at 0.15% among the Blood bank attendees, with a stable trend. • Based on 2010 HSS-FSW data, HIV prevalence was moderate at 7.63% among the FSWs, however, due to lack of previous year’s data, a trend could not be determined. • As per 2012 ICTC data, the level of HIV positivity was low among male (4.75%) and female (4.58%) attendees, as well as among referred (3.99%) and direct walk-in (7.95%) attendees. An overall decreasing trend was exhibited among the district’s ICTC attendees. • According to 2009 HRG mapping data, FSW (1,304; 88.89% of total HRG) was the largest HRG in the district, followed by MSM (432; 55.56% of total HRG). • In 2012, 8,657 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.19%. • According to 2001 census, 10.99% of the males were migrants, among them 4.46% migrated to other states and 48.12% migrated to other districts within the state. • The top two destinations for inter-state out-migration were North and South Goa. • According to DLHS-III data, HIV and RTI/STI awareness rate among women was 85.3% and 39.9%, respectively. • In 2012, a total of three TI sites were operational in the district. • In 2012, there was one blood bank, one STI clinic and one ART center. The district also had six link ART centers, one PLHIV network and one community care center. Key Recommendations: • Conduct disaggregated analysis of HSS-ANC data to identify risk factors responsible for the stable HIV epidemic among the general population. • Strengthen and improve quality of outreach program for FSWs and MSM due to its substantial presence in the district. . The typology of HRG would help to analyze risk factors among these group. • Analyze the risk profile of positive individuals to determine associated factors due to the moderate HIV prevalence among all the ICTC attendees. • Strengthen routine programme data from district for completeness and accuracy, and examine it regularly to understand HIV transmission dynamics in district. • 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.

36 | District HIV/AIDS Epidemiological Profiles : Karnataka * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 10,65,235 (% of Karnataka Population); Female Literacy Gadag positive, NT = number tested; ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=909) % of Total FSW No. HRG- MSM No. HRG- IDU No. HRG- % Pos; ICTC PPTCT % Pos; DLN (NA) ART (4064) 5

Hetero-sexual NT PP Gadag, NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 1.25 4 4 % On ART - - - - 94.50 49 - 23.77 29.55 27.48 27.67 1039 1341 2005 1569 0.45 1.13 530 604 965 800 Mundargi, ------5 0.8 General clients & pregnant women. - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 19.81 15.22 15.96 15.75 1334 2006 1546 0.20 0.88 212 727 819 981 Naragund, 800 0.55 % 15-24 yrs ------0.9 - - - - HIV Levels and Trends 9 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 20.84 27.84 25.13 25.28 1003 1674 1174 1503 1957 3882 2007 6559 0.41 1.00 0.50 800 ------Transfusion 0.36 Ron, - - - - Blood 0.11 % Ill., Prim. Edu. 11754 17498 15.58 15.01 15.24 15.23 Shirahatti, 2234 3510 2737 3007 2008 0.33 0.90 0.50 903 800 2 ------0.44 Source: DLHS III;Source:DLHS 86 - - - - - 3 Needle/ Syringe 10.66 12.44 12.05 11.79 1712 1187 1247 1907 5288 2009 7722 0.21 0.50 722 0 1 - : 65.29%; 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 19289 32505 3628 9588 6816 6400 2477 2010 8.71 7.81 7.32 8.84 7.63 0.04 0.54 1.13 54 249 800 - Parent to ------Child 4.84 15278 23750 42888 3860 9385 9753 2590 2011 5.39 5.91 5.64 5.97 0.15 0.24 - - - - - % Widowed or Divorced 2 Unknown : 80.6% 29 - 16192 10220 22296 41795 0 3307 9279 2713 2012 7.95 3.99 4.58 4.75 0.15 0.30 0.38 800 ------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. Year: NA) Size Est., (Mapping, Typology Program Coverage No. episodes treated % Total HRG % Syphilis positivity % Total Pop. % Married % <25 yrs. Program Target HRG Size Brothel based- based- based- 88.89 Home Street 2004 1304 7.06 FSW NA; NA; 2009 1318 NA NA 1 2 3 1 ------

- 300,HSS-HRG/STD ≥ STI/RTI decker- 2005 Double Panthi- Kothi- 55.56 MSM 2.34 432 NA; NA; 1 1 2 3 1 NA NA ------2010 6639 - - -

- Non daily Injectors- Injectors- 2006 Programme Response Daily 1 1 1 2 6 1 1 ------NA; IDU NA NA 2011 5569 ------Vulnerabilities 0 187,ICTC ≥ 2007 11 1 1 1 2 1 1 ------migration % total pop. % of male migration No. out- North North 2012 8657 0.19 Goa 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008

11 1 1 1 2 1 1 ------Male Migration, 2001 Census South South Overall 54280 Goa 10.99 100 2009 11 1 1 1 1 2 1 1 ------900 and BB and 900 ≥ Maharash - Pune, 2422 Inter- State 4.46 0.49 tra 2010 25 1 1 3 1 1 2 1 1 - - - - - Maharash - 900);≥ Kolhapur, 26118 48.12 Intra- state 5.29 tra 2011 28 1 1 4 1 1 1 1 2 - - - - - 4 percent = PP Maharash - Ratnagiri, district 25740 47.42 Intra- 5.21 2012 tra 30 1 1 6 1 1 1 1 2 - - - - -

District HIV/AIDS Epidemiological Profiles : Karnataka | 37 Gulbarga

Background: Gulbarga district is located in the northern part of Gulbarga District Karnataka. It is one of the three districts that were transferred from Hyderabad to Karnataka at the time of re- organization of the states in the year 1956. The district has a population of 25.64 lakhs, a sex ratio of 962 females for every 1,000 males, and a female literacy rate of 55.87% with an overall literacy rate of 65.65% (Census 2011). Gulbarga is bordered on the west by Bijapur district of Karnataka and Sholapur district of Maharashtra, on the west by Bijapur district of Andhra Pradesh, on the north by Bidar district of and Osmanabad district of Maharashtra and on the south by Richur district of Karnataka. Gulbarga district has an agrarian economy supplemented by a handful of cement, textile, leather and chemical industries.Tourism is also a significant revenue-generating sector in Gulbarga; there are many temples, mosques, and historical sites that bring tourists to the district. Gulbarga is well connected to its surrounding districts and other states by railways and state highways.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was low at 0.38% among the ANC attendees, with a fluctuating trend. • According to 2012 PPTCT data, HIV positivity was low at 0.17% among the attendees, with a stable trend in the last three years. • According to 2012 Blood Bank data, HIV positivity was low at 0.22% among the attendees, with a declining trend. • As per 2010 HSS-FSW data, HIV positivity was moderate at 5.63% among the FSWs, but a trend analysis could not be conducted due to lack of historical data. • Based on 2010 HSS-MSM data, HIV positivity was low at 3.61% among the MSM. A trend could not be determined due to lack of data from previous years. • According to 2012 ICTC data, HIV positivity among was low among male (3.76%) and female (2.08%) attendees, as well as among referred (3.08%) and direct walk-in (0.59%) attendees. The positivity levels showed a declining trend among all the ICTC attendees. • According to 2009 HRG size mapping data, FSW (3,212; 73.74% of total HRG) was the largest HRG in the district followed by MSM (1,144; 26.26% of total HRG). The only typology of FSWs was street-based (100%). • In 2012, 24,419 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.11%. • According to 2001 census, 6.34% of the males were migrants, among them 46.91% migrated to other states and 22.44% migrated to other districts within the state. • The top two destinations for out-of-state migration were Pune and Thane, Maharashtra. • According to 2012 data, HIV transmission through parent to child accounted for 6.94% of the total HIV transmissions in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 71 % and 27%, respectively. • In 2012, a total of three TI sites (two for FSWs and one for MSM)were operational in the district. Key Recommendations: • Increase the number of TIs in the district in order to support the large number of HRGs. • Sustained approach is needed to limit the spread of the infection, though HIV prevalence has declined from high to low levels among both, ANC and ICTC attendees. • Conduct in-depth analysis of ICTC data to understand the profile of attendees, as the parent to child HIV transmission rate was notable. • Considering high number of FSWs and MSM in the district, assessment of the size and profile of their client including migrants and truckers, will help in better understanding of district vulnerabilities. • Considering high rate of migration to high HIV prevalent districts, strengthen outreach programs through awareness campaigns among women and around truck halting points and highways in the district.

38 | District HIV/AIDS Epidemiological Profiles : Karnataka * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 25,64,892 (4.19% of Karnataka’s Population); Female Literacy Gulbarga positive, NT = number tested; ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=1715) % of Total FSW No. HRG- MSM No. HRG- IDU No. HRG- % Pos; ICTC PPTCT % Pos; ART (10614) DLN (NA) 5

Afzalpur, 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 0.6 4 4 % On ART - - - - 90.44 28 - 22.43 17.33 15.84 21.34 20.40 1725 1111 1354 7137 2005 2465 0.55 2.63 740 250 800 ------Aland, 5 0.5 General clients & pregnant women. - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 22.52 18.04 17.90 19.74 1580 1135 1468 2006 1984 7.57 0.75 0.88 404 849 251 800 0.70 Chincholi, % 15-24 yrs ------0.28 - - - - 12 HIV Levels and Trends - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 28.61 26.69 27.01 27.79 1031 1742 1355 1418 4892 5405 2007 8178 5.20 0.57 1.17 2.74 Chittapur, 250 802 ------Transfusion 0.57 - - - - Blood 0.17 % Ill., Prim. Edu. 25244 37916 15.85 13.42 11.32 17.98 3780 8898 7323 5349 2008 Gulbarga, 5.62 0.70 1.25 249 846 798 0 2 ------0.95 Source: DLHS III;Source:DLHS 34 - - - - - 3 Needle/ Syringe 0.17 13766 19694 12.58 10.01 14.71 1095 4834 3385 2543 5822 2009 9.68 0.10 0.40 Jevargi, 0.45 - - - - % Married 1 3 : 55.87%; ANC Utilization Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 108894 45571 29589 23226 14005 56079 7244 2010 4.38 4.38 3.57 5.40 Sedam, 3.61 5.63 0.35 0.29 0.25 40 249 231 800 - 0.22 Parent to ------Child 6.94 148080 Shahpur, 54420 36764 26823 12911 84493 9167 2011 2.98 3.38 2.61 4.34 0.15 0.19 0.51 - - - - % Widowed or Divorced Unknown 15 1.57 - 126051 54100 37422 24836 11367 63793 2 8158 2012 0.59 3.08 2.08 3.76 0.22 0.17 0.38 : 65.4% 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. Year: NA) Size Est., (Mapping, % Married % <25 yrs. Typology Program Coverage No. episodes treated % Total HRG % Syphilis positivity % Total Pop. Program Target HRG Size Brothel based- based- based- 100% 62.90 36.20 73.74 Home Street 2004 3212 0.13 FSW 0%; 0%; 2009 3116 NA 4 4 1 ------

- 300,HSS-HRG/STD ≥ STI/RTI 91.35%; decker- 2005 Double Panthi- 8.65% Kothi- 19.80 30.80 26.26 1144 MSM 0.04 16491 NA; 1 2 4 5 1 NA ------2010 -

- Non daily Injectors- Injectors- 2006 Programme Response 12 Daily 1 1 2 4 1 1 ------NA; IDU NA NA 21226 2011 ------0.14 Vulnerabilities 187,ICTC ≥ 2007 27 1 2 2 4 1 1 ------Maharash migration % total pop. % of male migration No. out- 24419 Pune, Pune, 2012 0.11 tra 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 30 1 1 2 2 3 1 1 ------Maharash Thane, Thane, Male Migration, 2001 Census 100954 Overall tra 6.34 100 2009 36 1 1 2 2 1 4 1 1 - - - - - 900 and BB and 900 ≥ - (Suburban) Mumbai , Maha - rashtra 47361 46.91 Inter- State 2.98 2010 101 1 1 4 2 2 4 1 1 - - - - - Maharash - 900);≥ Raigarh, 22655 22.44 Intra- state 1.42 tra 2011 71 1 1 6 2 1 4 1 2 - - - - - 4 percent = PP Maharash - Mumbai, district 30938 30.65 Intra- 1.94 2012 107 tra 1 1 6 2 1 4 1 2 - - - - -

District HIV/AIDS Epidemiological Profiles : Karnataka | 39 Hassan

Background: Hassan is a district located in the southwestern part of Hassan District Karnataka. The district is surrounded by Chikmagalur to the north west, Chitradurga to the north, Tumkur to the east, Mandya to the south east, Mysore to the south, Kodagu to the south west and Dakshina Kannada to the west. Hassan has a population of 17.76 lakhs, a sex ratio of 1,005 females for every 1,000 males, and a female literacy rate of 68.30% with an overall literacy rate of 75.89% (Census 2011). Tourism and agriculture, specifically coffee, are the two main sources of income of that make up Hassan’s economy. Hassan is easily accessed by National Highway 48, as well as by state railways and roadways.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, positivity was low at 0.68% among the ANC attendees, with a declining trend. • According to 2012 PPTCT data, HIV positivity was low at 0.12% among the attendees, with a decreasing trend. • According to 2012 Blood Bank data, HIV positivity was low at 0.09% among the attendees, with a stable trend. • Based on 2010 HSS-FSW data, HIV prevalence was moderate at 0.80% among FSWs, but a trend could not be determined due to lack of previous data. • As per 2012 ICTC data, the level of HIV positivity was low among male (1.99%) and female (1.75%) attendees. It was also low for referred (1.83%) and direct walk-in (2.16 %) attendees. An overall decreasing trend was exhibited among all the ICTC attendees. • According to the HRG mapping size data, FSW (1,420; 100% of total HRG) was the only HRG in the district. The major typology for FSWs was home-based (93.47%). • In 2012,11,071 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 1.02%. • According to 2001 census, 9.06% of the males were migrants, among them 2.08% migrated to other states and 49.21% migrated to other districts within the state. • The top two destinations for inter-state out-migration were Mumbai (suburban) and Thane, Maharashtra. • According to DLHS-III data, HIV and RTI/STI awareness rate among women was 83.80% and 53%, respectively. • In 2012, a total of two TI sites, one each for FSWs and MSM, were operational in the district. • In 2012, there were two blood banks, one STI clinic and one ART center. The district also had six link ART centers and one PLHIV network.

Key Recommendations: • Increase the number of TIs in the district in order to support the large number of HRGs. • Sustained approach is needed to limit the spread of the infection, though HIV prevalence has declined from high to low levels among both, ANC and ICTC attendees. • Assess the size and profile of FSW’s client, including migrants and truckers, to better understand district vulnerabilities. • Considering high number of home based sex workers, the prevention program should be customized to reach this hard to reach population • Considering high rate of migration to high HIV prevalent districts, strengthen outreach programs through awareness campaigns among women and around truck halting points and highways in the district.

40 | District HIV/AIDS Epidemiological Profiles : Karnataka * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 17,76,221 (2.90% of Karnataka Population); Female Literacy Hassan positive, NT = number tested; ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=1715) % of Total FSW No. HRG- MSM No. HRG- IDU No. HRG- % Pos; ICTC PPTCT % Pos; 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 Alur 0.3 4 4 % On ART - - - - 94.57 - - 19.61 12.53 11.97 16.21 1349 1104 5670 2005 1864 0.23 1.38 515 760 800 Arakalgud ------5 0.4 General clients & pregnant women. - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 18.10 11.51 1248 2676 2006 1596 7.85 8.50 0.19 2.38 348 753 843 800 0.58 Arasikere % 15-24 yrs ------0.1 - - - - HIV Levels and Trends - - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 10.48 1615 1579 1620 1574 7136 5703 2007 8897 9.35 6.97 5.93 0.18 0.79 1.25 800 ------Transfusion Belur 0.8 - - - - Blood 0.12 % Ill., Prim. Edu. 14973 31143 apatna 1.1 Chanaray - 6651 9521 7812 8358 3751 2008 5.37 5.75 5.01 6.13 0.21 0.50 0.88 800 2 ------Source: DLHS III;Source:DLHS ------3 Needle/ Syringe 0.00 13495 2682 5109 4015 3776 8092 5704 2009 5.07 4.64 4.28 5.32 0.10 0.50 Hassan 0.8 - - - - 1 % Married : 68.30%; 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 sipura 0.2 Holenara - 20684 14046 15648 18419 48113 9010 8654 2010 3.44 2.59 2.48 3.18 0.80 0.17 0.23 0.75 250 800 - - Parent to ------Child 3.00 Sakalesh - 33435 20327 23082 25726 69135 pur 0.3 9974 8876 2011 2.11 2.11 1.90 2.30 0.10 0.19 - - - - % Widowed or Divorced Unknown 1.73 - - 38271 21009 24993 22731 68733 2 7731 8124 2012 2.16 1.83 1.75 1.99 0.09 0.12 0.63 : 94% 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. Year: NA) Size Est., (Mapping, Typology Program Coverage No. episodes treated % Total HRG % Married % <25 yrs. % Syphilis positivity % Total Pop. Program Target 93.47%; HRG Size 1.17%; Brothel 5.36% based- based- based- 78.00 Home Street 2004 1420 5.10 0.08 FSW 100 2009 1904 NA 2 4 ------

- 300,HSS-HRG/STD ≥ STI/RTI decker- 2005 Double Panthi- Kothi- MSM NA; NA; 1 1 2 6 NA NA ------2010 5865 ------

- Non daily Injectors- Injectors- 2006 Programme Response Daily 1 1 2 7 ------NA; IDU NA NA 11126 2011 ------0.21 Vulnerabilities 187,ICTC ≥ 2007 1 1 1 2 8 ------migration % total pop. % of male migration No. out- ban), Ma ban), harashtra Mumbai Mumbai (Subur 11071 2012 1.02 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 - - 1 1 1 2 8 1 1 ------Maharash Thane, Thane, Male Migration, 2001 Census Overall 77810 tra 9.06 100 2009 1 1 1 1 2 9 1 1 ------900 and BB and 900 ≥ - Maharash - Mumbai, 1621 Inter- State 2.08 0.19 tra 2010 48 1 1 1 2 1 1 ------900);≥ 38287 49.21 Intra- state 4.46 2011 - 54 1 5 1 1 2 1 1 ------4 percent = PP district 37902 48.71 Intra- 4.41 2012 54 - 1 9 1 1 2 1 1 ------

District HIV/AIDS Epidemiological Profiles : Karnataka | 41 Haveri

Background: Haveri is bordered by Dharwad on the north, by Gadag in Haveri District the northeast, by Bellary on the east, by Davangere on the south, by Shimoga in the southwest and by Uttar Kannada on the west and northwest. It has a population of 15.98 lakhs, a sex ratio of 951 females per 1,000 males, and a female literacy rate of 70.65% with an overall literacy rate of 77.60% (Census 2011). The local residents reap crops and indulge in industrial enterprises and other allied ventures to earn their living. The district is also trying to exploit its gold and silver deposits in order to earn revenue. Haveri’s tourism industry is dependent on the majestic and revered shrines at Byadgi, Rannibennur and Savanur. It is well connected via roads and railway, and National Highway 4 connects it to other districts within the state.

HIV Epidemic Profle: • As per 2012 ANC data, HIV prevalence was low at 0.13% among the ANC attendees, with a declining trend. • According to 2012 PPTCT data, HIV positivity was low at 0.11% among the attendees, with a stable trend. • According to 2012 Blood Bank data, HIV positivity was low at 0.11% among the attendees, with a declining trend in the last three years. • Based on 2010 HSS-FSW data, the level of HIV positivity was low (2.80%) among FSWs. • According to 2012 ICTC data, the level of HIV positivity was low among male (2.71%) and female (2.54%) attendees. It was low among referred (2.78%) and direct walk-in attendees (1.59%). A decreasing trend was encountered among all the ICTC attendees. • According to 2009 HRG mapping size data, FSW (1,079; 71.13% of total HRG) was the largest HRG in the district, followed by MSM (438; 28.87% of total HRG). Out of FSWs, the majority were home-based (54.80%). • In 2012, 6,549 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.62%. • According to 2001 census, 8.40% of the males were migrants, among them 3.54% migrated to other states and 44.58% migrated to other districts within the state. • The top two destinations for inter-state out-migration were North and South Goa. • According to 2012 ICTC data, HIV transmissions though parent to child accounted for about 6.50% of the district’s total HIV transmissions. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 74.70% and 47.60%, respectively. • In 2012, a total of three TI sites were operational in the district. • In 2012, there was one blood bank, one STI clinic and one ART center. It also had 10 link ART centers, one PLHIV network and one community care center. Key Recommendations: • Sustained HIV prevention strategy is required to keep HIV prevalence at check. • Increase the number of TIs, considering the large number of FSWs and MSM population. • Conduct in-depth analysis of ICTC data to understand the profile of attendees, as the parent to child HIV transmission rate was notable. • Assess the size and profile of FSWs clients including migrants and truckers, to better understand district vulnerabilities. • Focus on hard to reach sub-groups like home-based FSWs, as they were the largest typology in the district. Prevention program should be customized to benefit them. • Considering high rate of migration to high HIV prevalent districts, strengthen outreach through awareness campaigns around tourist areas, truck halting points and highways in the district.

42 | District HIV/AIDS Epidemiological Profiles : Karnataka * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 15,98,506 (2.61% of Karnataka Population); Female Literacy Haveri positive, NT = number tested; ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=600) % of Total FSW No. HRG- MSM No. HRG- IDU No. HRG- % Pos; ICTC PPTCT % Pos; ART (4403) DLN (NA) 5

Byadagi, 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 0.66 4 4 % On ART - - - - 92.17 42 - 28.48 12.96 17.87 17.18 1088 2005 1534 0.38 446 649 885 800 ------Hangal, 5 0.29 General clients & pregnant women. - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 19.51 11.07 11.50 1168 2006 1414 9.59 0.63 246 605 809 800 0.50 % 15-24 yrs ------Haveri, 0.79 - - - - 10 HIV Levels and Trends - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 15.65 13.09 12.51 15.16 2322 1647 1557 6717 2007 9921 0.67 0.25 882 800 Hirekerur 56 0 ------Transfusion 0.34 - - - - Blood 0 % Ill., Prim. Edu. 15553 23229 12.50 11.06 1856 5820 4305 3371 2008 Raneben - 7.61 7.02 0.50 0.63 nur, 0.47 800 77 0 2 ------Source: DLHS III;Source:DLHS 84 - - - - - 3 Needle/ Syringe 0.50 12621 15470 12.75 11.28 2237 1643 1206 2009 8.14 7.55 Savanur, 0.20 612 253 0 0.47 - - - - 1 % Married : 70.65%; 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 Shiggaon, 16211 28342 46908 2355 9592 8974 2010 8.87 4.62 5.03 5.30 2.80 0.60 0.25 0.13 55 250 335 800 - 0.18 Parent to ------Child 6.50 20186 12184 11847 28823 52854 3845 2011 2.18 3.76 3.18 3.86 0.38 0.18 527 - - - - - % Widowed or Divorced Unknown 27 0.33 - 19796 11666 11214 26566 49446 2 3084 2012 1.59 2.78 2.54 2.71 0.11 0.13 : 89.4% 509 800 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. Year: NA) Size Est., (Mapping, % Married % <25 yrs. Typology Program Coverage No. episodes treated % Total HRG % Syphilis positivity % Total Pop. Program Target 54.80%; 45.20% HRG Size Brothel based- based- based- 59.50 11.90 71.13 Home Street 2004 1079 0.07 FSW 0%; 2009 1004 NA 4 1 ------

- 300,HSS-HRG/STD ≥ STI/RTI 38.34%; 61.66% decker- 2005 Double Panthi- Kothi- 40.50 28.87 MSM 0.03 438 NA; 1 1 5 1 NA ------2010 5287 0 -

- Non daily Injectors- Injectors- 2006 Programme Response Daily 1 1 8 1 1 ------NA; IDU NA NA 2011 7556 ------4.92 Vulnerabilities 187,ICTC ≥ 2007 13 1 1 1 1 1 ------migration % total pop. % of male migration No. out- North North 2012 6549 0.62 Goa 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008

13 1 1 1 1 1 1 ------Male Migration, 2001 Census South South Overall 62198 Goa Goa 8.40 100 2009 13 1 1 1 1 1 1 ------900 and BB and 900 ≥ West Delhi North 2204 Inter- State 3.54 0.30 2010 25 1 1 3 1 1 1 1 1 - - - - - 900);≥ 27725 44.58 Intra- state 3.75 2011 - 28 1 1 6 1 1 1 1 2 - - - - - 4 percent = PP district 32269 51.88 Intra- 4.36 2012 10 34 - 1 1 1 1 1 1 2 - - - - -

District HIV/AIDS Epidemiological Profiles : Karnataka | 43 Kodagu

Background: Kodagu, also known by its anglicized former name of Coorg, Kodagu District is the least populous district in Karnataka. The district is bordered by Dakshina Kannada to the Northwest, Hassan to the North, Mysore to the East, Kannur district of Kerala to the Southwest, and the Wayanad district of Kerala to the South. It has a population of 5.54 lakhs, a sex ratio of 1,019 females for every 1,000 males, and a female literacy rate of 77.91% with an overall literacy rate of 82.52% (Census 2011). Kodagu is a rural region with most of the economy based on agriculture, plantations and forestry, as well as one of the more prosperous parts of Karnataka. Due to coffee production and other plantation crops; coffee processing is also becoming a major economic contributor. The district attracts lot of tourist due to its scenic beauty. Eco-tourism, such as walking and trekking tours, bring multitudes of tourist into the district each year. Kodagu is connected to other districts in Karnataka by way of state highways.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV positivity was moderate at 0.50% among the ANC attendees, with a decreasing trend. • According to 2012 PPTCT data, HIV positivity was low at 0.14% among the attendees, with a stable trend. • According to 2012 Blood Bank data, HIV positivity was low among the attendees, with a stable trend. • According to 2012 ICTC data, HIV positivity was low among male (1.21%) and female (1.36%) attendees.It was also low among referred (1.42%) and direct walk-in (0.92%) attendees.There had been an overall declining trend observed over the past five years. • According to HRG size mapping data, FSW (499; 66.71% of total HRG) was the largest HRG in the district followed by MSM (249; 33.29% of total HRG). • In 2012, 6,218 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.19%. • According to 2001 census, 12.05% of males were migrants, among them 8.38% migrated to other states and 35.87% migrated to other districts within the state. • The top two destinations for out-of-state migration were Wayanad and Kannur, Kerala. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 86.9 % and 27.8%, respectively. • In 2012, one composite TI site was operational in the district. • In 2012, a total of 21 ICTCs were operational, which tested a total of 23,988 attendees for HIV in the district. • In 2012, there were one blood bank, one STI clinic and one ART center. The district also had three link ART centers and one PLHIV network. Key Recommendations: • Conduct socio-economic analysis of HIV positive people to understand the reasons for HIV positivity among ANC attendees. • Increase the number of TIs in the district in order to support the large number of HRGs. • Assess the size and profile of the clients of FSWs and MSM, including migrants and truckers, to help in better understanding of district vulnerabilities. • Information on typology of HRG population will help to appropriately design the prevention program for these vulnerable population. • Considering high rate of migration to high HIV prevalent districts, strengthen outreach programs through awareness campaigns among women and around truck halting points and highways in the district.

44 | District HIV/AIDS Epidemiological Profiles : Karnataka * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 5,54,762 (0.91% of Karnataka Population); Female Literacy Kodagu positive, NT = number tested; ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=169) % of Total FSW No. HRG- MSM No. HRG- No. HRG- IDU % Pos; ICTC PPTCT % Pos; ART(903) DLN (NA) 5

Madikeri, 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 0.1 4 4 % On ART - - - - 96.45 44 - 14.91 10.22 1144 2005 1258 4.81 3.84 0.51 0.75 114 886 372 783 800 pete, 0.3 ------Somvar 5 General clients & pregnant women. - - - - Homo-sexual - Route of HIV Transmission, ICTC 2012 23.53 12.22 1405 2006 1473 6.69 4.44 0.46 0.50 900 573 647 800 68 Virajpete, % 15-24 yrs ------0 0.4 - - - - 10 HIV Levels and Trends - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 3316 2269 1833 1349 2963 2007 7065 7.63 5.28 4.50 7.26 0.30 0.47 0.75 786 800 ------Transfusion - - - - - Blood 0 % Ill., Prim. Edu. 13205 1147 5089 2975 3261 6969 2008 4.62 3.87 3.97 4.05 0.37 0.30 2.63 538 799 2 ------Source: DLHS III;Source:DLHS 92 ------3 Needle/ Syringe 1550 1222 1232 2882 2009 4880 4.91 2.84 3.35 3.27 0.08 0.60 448 776 0 - - - - - 1 : 77.91%; 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 22430 5233 8533 5229 8537 1578 8664 2010 1.32 2.14 2.22 1.59 0.27 0.63 63 800 - 0 Parent to ------Child 3.55 10083 23988 4810 5512 9381 1643 9095 2011 1.08 1.60 1.40 1.46 0.12 0.09 - - - - - % Widowed or Divorced Unknown 19 - 2 : 94.5% 21199 0 4040 9294 5217 8117 1558 7865 2012 0.92 1.42 1.36 1.21 0.14 0.50 800 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. Year: NA) Size Est., (Mapping, Typology Program Coverage No. episodes treated % Total HRG % Syphilis positivity % Total Pop. % Married % <25 yrs. Program Target HRG Size Brothel based- based- based- 66.71 Home Street 2004 0.09 FSW 499 NA; NA; 2009 NA NA 502 1 4 ------

- 300,HSS-HRG/STD ≥ STI/RTI decker- 2005 Double Panthi- Kothi- 33.29 MSM 0.04 249 NA; NA; 1 1 4 NA NA ------2010 2421 - - -

- Non daily Injectors- Injectors- 2006 Programme Response Daily 1 1 6 ------NA; IDU NA NA 2011 5645 ------0.10 Vulnerabilities 187,ICTC ≥ 2007 10 1 1 ------Wayanad, Wayanad, migration % total pop. % of male migration No. out- Kerala 2012 6218 0.19 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 10 1 1 1 ------Kannur, Kannur, Kerala Male Migration, 2001 Census Overall 32919 12.05 100 2009 17 1 0 1 1 ------900 and BB and 900 ≥ Kasaragod, Kerala 2758 Inter- State 8.38 1.01 2010 17 1 1 1 1 1 ------900);≥ Chandi - digarh, Chan - 11809 35.87 Intra- garh state 4.32 2011 21 1 2 1 1 1 1 ------4 percent = PP Ludhiana, Punjab district 18352 55.75 Intra- 6.72 2012 28 1 3 1 1 1 1 ------

District HIV/AIDS Epidemiological Profiles : Karnataka | 45 Kolar

Background: Kolar is located in the southern region of Karnataka and Kolar District is the eastern-most district of the Karnataka. The district is bordered by Bangalore Rural in the west, Chikballapur in the north, Chittoor district of Andhra Pradesh in the east and on the south by Krishnagiri and Vellore district of Tamil Nadu. The population of Kolar is 15.40 lakhs, a sex ratio of 976 females for every 1,000 males, and a female literacy rate of 66.56% with an overall literacy rate of 74.33% (Census 2011). The major sources of employment are agriculture, dairy and sericulture, floriculture hence, it is popularly known as the land of “Silk, Milk and Gold”. The gold mines until recently supplied the major portion of gold for India; the economy of Kolar also depends on silk farming and wool spinning. The district is well connected to other parts of the state by railways, roadways, as well as National Highways 4 and 234.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was low at 0.25% among the ANC clients, with a declining trend. • According to 2012 PPTCT data, HIV positivity was low at 0.17% among the attendees, with a stable trend. • According to 2012 Blood Bank data, HIV positivity was low at 0.28% among the attendees, with a declining trend. • As per 2010 HSS-FSW data, HIV positivity was low at 3.20% among FSWs, but a trend could not be determined due on lack of data. • According to 2012 data, HIV positivity among ICTC attendees was low among male (2.18%) and female (1.88%) attendees, as well as among referred (2.08%) and direct walk-in (1.87%) attendees. The positivity levels showed a declining trend among all the ICTC attendees. • According to 2009 HRG size mapping data, FSW (2,228; 73.36% of total HRG) was the largest HRG in the district followed by MSM (809; 26.64% of total HRG). • In 2012, 21,912 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.31%. • According to 2001 census, 5.25% of the males were migrants, among them 6.48% migrated to other states and 46.25% migrated to other districts within the state. • The top two destinations for out-of-state migration were Chittoor and Anantapur, Andhra Pradesh. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 68.4 % and 14.5%, respectively. • In 2012, a total of three TI sites, one each for FSW, MSM and IDUs were operational in the district. • In 2012, there were five blood banks, two STI clinic and one ART centers. The district also had three link ART center. 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 and diverse HRGs in the area. • A sustained approach for HIV prevention programs is needed to keep a check on HIV prevalence in the district. • Assess the size and profile of FSWs clients’ population and MSM and their partners, to help in understanding the district vulnerabilities. • Considering high rate of migration to high HIV prevalent districts, strengthen outreach programs through awareness campaigns among women and around truck halting points and highways in the district.

46 | District HIV/AIDS Epidemiological Profiles : Karnataka * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 15,40,231 (2.52% of Uttar Pradesh Population); Female Literacy Kolar positive, NT = number tested; ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=1059) % of Total FSW No. HRG- MSM No. HRG- No. HRG- IDU % Pos; ICTC PPTCT % Pos; ART(4921) DLN (NA) 5

Bangarpet,

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 0.3 4 4 % On ART - - - - 94.71 32 - 20.09 13.32 13.92 20.73 1125 1135 5769 2005 2071 0.71 1.00 946 936 400 Kolar, 0.5 ------5 General clients & pregnant women. - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 15.97 13.43 1071 2435 2006 1672 9.24 9.74 0.37 1.50 601 801 871 400 1.23 % 15-24 yrs ------Malur, 0.73 - - - - 14 HIV Levels and Trends - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 10180 16.45 12.15 11.29 1356 2612 1638 2330 7204 6212 2007 9.15 Mulabagi - 0.24 0.80 0.25 400 lu, 0.05 ------Transfusion - - - - Blood 0.38 % Ill., Prim. Edu. 10418 16998 33919 6533 9603 7318 2896 2008 6.12 3.81 3.48 6.31 0.17 0.40 0.50 799 vaspura, Shrini - 2 ------0.32 Source: DLHS III;Source:DLHS 95 - - - - - 3 Needle/ Syringe 0.19 13397 1795 4476 3567 2704 7861 7126 2009 6.13 3.93 3.45 6.03 0.33 0.40 - - - - - % Married 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 30394 20803 19555 39254 79612 1 9964 8200 2010 3.28 2.61 2.34 3.24 3.20 0.22 0.25 0.25 73 : 66.56%; ANC Utilization 250 800 - Parent to ------Child 1.89 104671 15885 39309 27537 27657 49477 9473 2011 2.13 2.32 1.97 2.57 0.10 0.23 - - - - - % Widowed or Divorced Unknown 16 1.61 - 12302 39637 25801 26138 14457 35243 87182 2012 1.87 2.08 1.88 2.18 0.28 0.17 0.25 800 ------2 : 92.5% 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. Year: NA) Size Est., (Mapping, Typology Program Coverage No. episodes treated % Total HRG % Married % <25 yrs. % Syphilis positivity % Total Pop. Program Target HRG Size Brothel based- based- based- 73.36 Home Street 2004 2228 0.14 FSW NA; NA; 2009 7821 NA NA 3 2 ------

- 300,HSS-HRG/STD ≥ STI/RTI 28.20%; 67.50% decker- 2005 Double Panthi- Kothi- 15.70 30.50 26.64 MSM 0.05 809 17140 NA; 1 2 3 2 NA ------2010 -

- Non daily Injectors- Injectors- 2006 Programme Response Daily 1 1 2 3 8 ------NA; IDU NA NA 19948 2011 ------0.31 Vulnerabilities 187,ICTC ≥ 2007 17 1 1 2 3 ------migration % total pop. % of male migration No. out- Chittoor, Chittoor, Pradesh Andhra Andhra 21912 2012 0.31 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 16 1 1 1 2 5 1 ------Anantapur, Anantapur, Pradesh Andhra Andhra Male Migration, 2001 Census Overall 67207 5.25 100 2009 33 1 1 1 2 4 1 ------900 and BB and 900 ≥ Tamil Nadu Dharma - puri, 4356 Inter- State 6.48 0.34 2010 37 1 1 1 2 4 1 ------Tamil Nadu 900);≥ Vellore, 31085 46.25 Intra- state 2.43 2011 54 1 1 2 1 2 4 1 1 1 - - - - 4 percent = PP (Suburban) Mumbai , Maha - rashtra district 31766 47.27 Intra- 2.48 2012 70 1 1 3 1 2 5 1 1 1 - - - -

District HIV/AIDS Epidemiological Profiles : Karnataka | 47 Koppal

Background: Koppal, previously referred to as ‘Kopana Nagara’, Koppal District was formed after the split of Raichur district. It has a population of 13.91 lakhs, a sex ratio of 983 female per 1,000 males, and a female literacy rate of 56.22% with an overall literacy rate of 67.28% (Census 2011). Agriculture and industries of this district comprises the economy of the district. Koppal, now a district headquarters is ancient Kopana, a major holy place of the Jainas. Koppal district is surrounded by Raichur district in the east, Gadag district in the West, Bagalkot district in the north, Bellary district in the south. Koppal district headquarters is closest to the world heritage Hampi which attracts numerous tourist and pilgrims each year to the district. District is well-known for its iron, steel, tourism, and artisan industries. It is well connected via roads and railway, National Highways 13 and 63 connects it to other districts of the sate.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, positivity was low at 0.38% among the ANC attendees, with a fluctuating trend. • According to 2012 PPTCT data, HIV positivity was low at 0.29% among the attendees, with a stable trend in the last three years. • According to 2012 Blood Bank data, HIV positivity was low at 0.16% among the attendees, with a declining trend in the last three years. • Based on 2010 HSS-FSW data, HIV positivity was low at 3.61% among the attendees. Although, due to lack of historical data a trend could not be determined. • According to 2012 ICTC data, the level of positivity was low among male (4.82%) and female (4.50%) attendees. It was near moderate for referred (4.89%) attendees and low among direct walk-ins (3.83%). An overall decreasing trend was observed among all the ICTC attendees. • According to 2009 HRG mapping size data, FSW (1,500; 66.96% of total HRG) was the largest HRG in the district, followed by MSM (740; 33.04% of total HRG). • In 2012, 10,162 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.10%. • According to 2001 census, 5.15% of the males were migrants, among them 5.44% migrated to other states and 50.14% migrated to other districts within the state. • The top two inter-state out-migration destinations were Ratnagiri, Maharashtra and North Goa. • According to 2012 ICTC data, HIV infections though parent to child accounted for 8.16% of the district’s total HIV transmissions. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 62% and 18.30%, respectively. • In 2012, a total of three TI sites one each for FSW, MSM and IDUs were operational in the district. • In 2012, there were one blood banks, two STI clinic and one ART center. The district also had nine link ART centers. Key Recommendations: • Increase the number of TI sites in the district as to accommodate the presence of a large number of diverse HRGs. • Carryout disaggregated analysis of HSS-ANC data to identify risk factors responsible for the HIV epidemic among general population. • Conduct socio-economic analysis of ICTC data to understand the profile of attendees, as the parent to child HIV transmission rate was quite notable. • Assess the size and profile of FSW’s client including migrants and truckers, to better understand district vulnerabilities. • Availability of data on typology of HRGs would help to analyze risk factors, so that appropriate intervention can be planned. • Strengthen outreach programmes through awareness campaigns for STI for women, migrants and around truck halting points and highways in the district.

48 | District HIV/AIDS Epidemiological Profiles : Karnataka * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 13,91,292 (2.27% of Karnataka Population); Female Literacy Koppal positive, NT = number tested; ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=1385) % of Total FSW No. HRG- MSM No. HRG- No. HRG- IDU % Pos; ICTC PPTCT % Pos; DLN (NA) ART(7633) 5

Hetero-sexual NT Ganga - PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP vathi, 1.16 4 4 % On ART - - - - 90.40 43 - 49.46 22.33 38.88 34.27 1388 2005 1069 2.88 427 642 800 93 ------Koppal, 5 0.88 General clients & pregnant women. - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 48.10 29.21 23.59 20.79 1010 2006 1073 1.63 462 611 800 79 Kushtagi, % 15-24 yrs ------0 0.83 - - - - HIV Levels and Trends 8 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 45.89 34.84 35.44 39.22 1053 1719 2007 3720 1.28 1.25 231 976 948 800 Yelburga, ------Transfusion 0.3 - - - - Blood 0 % Ill., Prim. Edu. 16735 28.29 19.92 21.69 25.24 1209 3918 3606 9211 2008 0.84 994 800 0 2 ------Source: DLHS III;Source:DLHS 77 ------3 Needle/ Syringe 11292 21.30 36.33 18.23 19.57 1770 1624 1691 7977 2009 0.65 277 0 ------1 % Married : 56.22%; 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 21055 34083 13.30 22.45 10.56 1647 6315 6714 6314 2611 2010 9.35 3.61 0.46 0.39 0.63 51 249 800 - Parent to ------Child 8.16 22350 13919 12532 31478 57929 4101 3305 2011 5.29 4.57 4.38 5.02 0.21 0.33 - - - - - % Widowed or Divorced Unknown 25 1.44 - 23130 15551 14218 26594 56363 2 6639 3844 2012 3.83 4.89 4.50 4.82 0.16 0.29 0.38 : 65.7% 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. Year: NA) Size Est., (Mapping, Typology Program Coverage No. episodes treated % Total HRG % Syphilis positivity % Total Pop. % Married % <25 yrs. Program Target HRG Size Brothel based- based- based- 66.96 Home Street 2004 1500 0.11 FSW NA; NA; 2009 NA NA 798 1 ------

- 300,HSS-HRG/STD ≥ STI/RTI decker- 2005 Double Panthi- Kothi- 33.04 MSM 0.05 740 NA; NA; 1 2 1 NA NA ------2010 5406 - - -

- Non daily Injectors- Injectors- 2006 Programme Response Daily 1 1 1 ------NA; IDU NA NA 2011 8965 ------Vulnerabilities 0 187,ICTC ≥ 2007 1 1 2 8 ------Maharash migration % total pop. % of male migration No. out- Ratnagiri, Ratnagiri, 10162 2012 0.10 tra 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 14 1 1 1 2 1 1 ------North North Goa, Male Migration, 2001 Census Overall 30980 Goa 5.15 100 2009 41 1 1 3 1 1 1 1 ------900 and BB and 900 ≥ South Goa, Goa 1686 Inter- State 5.44 0.28 2010 42 1 1 4 1 2 1 1 1 - - - - - 900);≥ 15532 50.14 Intra- state 2.58 2011 - 60 1 1 5 1 2 1 1 1 - - - - - 4 percent = PP district 13762 44.42 Intra- 2.29 2012 58 - 1 1 9 1 2 1 1 1 1 - - - -

District HIV/AIDS Epidemiological Profiles : Karnataka | 49 Mandya

Background: Mandya is an administrative district of Karnataka and Mandya District Hassan borders it on the north and Tumkur on the east, by Tumkur and Bangalore on the south by Mysore and on the west by the districts of Hassan and Mysore. The district has a population of 18.08 lakhs, a sex ration of 989 females for every 1,000 males, and a female literacy rate of 62.10% with an overall literacy rate of 70.14% (Census 2011). Since Mandya is located on the banks of the river Cauvery, agriculture is the main occupation and is the single largest contributor to its economy. The district is well connected with rail and road network which connects it to other districts of the state. The National Highways 48 and 209 passes through this district.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV positivity was high at 1.13% among the ANC attendees, with an increasing trend. • According to 2012 PPTCT data, HIV positivity was low (0.22%) among the PPTCT attendees, with a stable trend. • According to 2012 Blood Bank data, HIV positivity was low (0.21%) among the Blood Bank attendees, with a stable trend. • As per 2012 ICTC data, HIV positivity was low among male (2.49%) and female (3.31%) attendees. It was also low for referred (2.70%) and direct walk-ins (3.12%) attendees. An overall decreasing trend was exhibited among all the ICTC attendees. • According to the 2009 HRG mapping size data, FSW (810; 82.91% of total HRG) was the largest HRG in the district, followed by MSM (167; 17.09% of total HRG). • In 2012,16,266 STI/RTI episodes were treated the syphilis positivity rate among STI attendees was 2.29%. • According to 2001 census, 8.16% of the males were migrants, among them 1.93% migrated to other states and 49.73% migrated to other districts within the state. • The top two destinations for inter-state out-migration were Mumbai (suburban) and Mumbai, Maharashtra. • According to DLHS-III data, HIV and RTI/STI awareness rate among women was 85% and 27.2%, respectively. • In 2012, two TIs, one for FSWs and one for MSM, were operational in the district. • In 2012, there were three blood banks, one STI clinic and one ART center. The district also had eight link ART centers. Key Recommendations: • Increase the number of TIs in the district in order to support the large number and diverse HRGs. • Carryout disaggregated analysis of HSS-ANC data to identify the factors the high HIV prevalence among the general population. • Assess the size and profile of FSW’s client including migrants and truckers, to better understand district vulnerabilities. • Availability of data on HRGs typology will help to understand the district’s vulnerability. • Considering high rate of migration to high HIV prevalent districts, strengthen outreach programs through awareness campaigns among women and around truck halting points and highways in the district.

50 | District HIV/AIDS Epidemiological Profiles : Karnataka * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 18,08,680 (2.96% of Karnataka Population); Female Literacy Mandya positive, NT = number tested; ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=852) % of Total FSW No. HRG- MSM No. HRG- No. HRG- IDU % Pos; ICTC PPTCT % Pos; DLN (NA) ART(4127) 5

Hetero-sexual K.R.Pet, NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP 0.46 4 4 % On ART - - - - 96.95 49 - 27.58 13.59 18.39 17.27 1714 1529 5643 2005 2421 0.48 1.00 707 892 800 ------Maddur, 5 1.88 General clients & pregnant women. - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 25.46 11.90 15.30 18.22 3985 2006 1327 0.50 0.25 487 840 608 719 800 0.82 Malavalli, % 15-24 yrs ------1.14 - - - - HIV Levels and Trends 9 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 14746 17225 18.44 11.45 13.06 13.21 1877 1514 7493 2007 0.52 0.82 1.25 602 965 800 Mandya, ------Transfusion 0.35 - - - - Blood 0.47 % Ill., Prim. Edu. 16583 30192 Nagaman - gala, 0.38 3585 9986 4833 8776 3895 2008 7.31 7.12 8.36 6.51 0.36 0.30 0.13 799 2 ------Source: DLHS III;Source:DLHS 91 - - - - - 3 Needle/ Syringe 0.35 10433 davapura, 1425 3233 1733 2925 8527 5775 2009 8.00 7.11 8.37 6.84 0.25 0.40 0.19 Pan - - - - - 1 % Married : 62.10%; 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 gapattana 15792 15883 11255 18681 42590 8117 8026 2010 Shriran - 3.76 4.39 5.36 3.58 0.24 0.31 0.50 61 800 - Parent to ------0.4 - - - - Child 0.23 20179 18158 11344 22595 50557 7783 9804 2011 2.48 3.04 3.38 2.61 0.26 0.23 - - - - - % Widowed or Divorced Unknown 23 1.17 - 24223 11338 19191 19380 49909 2 6306 9464 2012 3.12 2.70 3.31 2.49 0.21 0.22 1.13 : 97.2% 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. Year: NA) Size Est., (Mapping, Typology Program Coverage No. episodes treated % Total HRG % Syphilis positivity % Total Pop. % Married % <25 yrs. Program Target HRG Size Brothel based- based- based- 82.91 Home Street 2004 0.04 FSW 810 NA; NA; 2009 NA NA 968 3 3 1 ------

- 300,HSS-HRG/STD ≥ STI/RTI decker- 2005 Double Panthi- Kothi- 17.09 MSM 0.01 167 NA; NA; 1 1 3 5 1 NA NA ------2010 4771 - - -

- Non daily Injectors- Injectors- 2006 Programme Response 11 Daily 1 1 3 1 ------NA; IDU NA NA 13411 2011 0 0 0 - - - 2.29 Vulnerabilities 187,ICTC ≥ 2007 17 1 1 3 1 ------migration % total pop. % of male migration No. out- ban), Ma ban), harashtra Mumbai Mumbai (Subur 16266 2012 0.63 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 - 17 - 1 1 3 1 ------Maharash Mumbai, Mumbai, Male Migration, 2001 Census Overall 72414 tra 8.16 100 2009 17 1 1 2 1 1 3 1 ------900 and BB and 900 ≥ - Maharash - Thane, 1400 Inter- State 1.93 0.16 tra 2010 31 1 1 5 1 1 3 1 ------900);≥ 36012 49.73 Intra- state 4.06 2011 - 36 1 1 6 1 1 3 1 ------4 percent = PP district 35002 48.34 Intra- 3.94 2012 26 - 1 1 8 1 1 3 0 1 1 - - - -

District HIV/AIDS Epidemiological Profiles : Karnataka | 51 Mysore

Background: Mysore is an administrative district located in the southern Mysore District part of Karnataka and is the third most populous district in Karnataka after Bangalore and Belgaum. The district is bordered by Mandya to the North-east, Chamrajanagar to the Southeast, Wayanad (Kerala) to the South, Kodagu to the West, and Hassan to the North. Mysore has a population of 29.94 lakhs, a sex ratio of 982 females for every 1,000 males, and a female literacy rate of 66.59% with an overall literacy rate of 72.56% (Census 2011). The district has multiple monuments and historical sites making it a popular tourist destination. While, tourism is an important industry in Mysore, the economy is based primarily on agriculture. However, there are various large industries in the district. As well, Mysore is proving to be the next IT hub in Karnataka after the phenomenal success of Bangalore. The district is well connected to other districts and states by National Highway 212, as well by state roadways and railways.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV prevalence was moderate at 0.50% among the ANC attendees, with a fluctuating trend. • According to 2012 PPTCT data, HIV positivity was low at 0.16% among the attendees, with a stable trend. • According to 2012 Blood Bank data, HIV positivity was low at 0.21% among the attendees, with a declining trend in the last three years. • According to 2012 ICTC data, HIV positivity was low among male (2.51%) and female (3.34%) attendees. HIV positivity levels were near moderate among referred (4.71%) attendees and low among direct walk-ins (1.65%). For the previous five years there had been an overall declining trend among all the ICTC attendees. • According to 2009 HRG size mapping data, FSW (4,255;100% of total HRG) was the only HRG in the district. Among FSWs, the major typology was home-based (66.67%). • In 2012, 15,825 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.37%. • According to 2001 census, 6.23% of the males were migrants, among them 7.11% migrated to other states and 43.90% migrated to other districts within the state. • The top two destinations for out-of-state migration were Nilgiris, Tamil Nadu and Mumbai (suburban), Maharastra. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 76.2% and 24.9%, respectively. • In 2012, a total of five TI sites (four for FSWs and 1 for MSM) were operational in the district. • In 2012, there were 95 ICTC centers which tested 1,06,569 attendees. There have been consistent increase in number of ICTCs in the district. • In 2012, there were 11 blood banks, one STI clinic and two ART centers. The district also had eight link ART centers. Key Recommendations: • Sustained approach is needed to keep a check on HIV incidence as it has shown a sharp increase in 2012. • Assess of the size and profile of FSWs client’s, including migrants and truckers, to help in better understanding the district’s vulnerabilities. • An up to date information on profile and size of migrants will improve understanding of district vulnerabilities. Strengthen IEC programme for creating awareness on HIV prevention in the district among general population, especially women, considering relatively higher prevalence among ANC attendees.

52 | District HIV/AIDS Epidemiological Profiles : Karnataka * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 29,94,744 (4.50% of Karnataka Population); Female Literacy Mysore positive, NT = number tested; ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=1815) % of Total FSW No. HRG- MSM No. HRG- No. HRG- IDU % Pos; ICTC PPTCT % Pos; ART(19374) DLN (NA) 5

H.D.Kote, 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 0.19 4 4 % On ART - - - - 94.60 37 - 23272 22.52 20.49 23.10 20.36 13.60 2727 4530 2364 4893 2005 7257 0.50 1.13 250 800 ------Hunsur, 5 0.43 General clients & pregnant women. - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 13844 31.49 12.94 16.11 16.83 14.00 3726 1782 2846 2006 4628 0.37 1.00 902 250 800 1.71 % 15-24 yrs ------Nagar, 0.24 K.R. - - - - 11 HIV Levels and Trends -

Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 25725 12086 21348 10.57 15.93 14.87 13.73 10.00 3047 6215 3517 5745 2007 0.39 0.43 0.88 250 800 Mysore, ------Transfusion 0.73 - - - - Blood 0 % Ill., Prim. Edu. 16869 15974 12312 32838 57877 10.94 10.02 8494 9065 2008 8.06 9.09 0.35 0.49 0.88 800 Nanjan - 2 ------0.27 gud, Source: DLHS III;Source:DLHS 77 - - - - - 3 Needle/ Syringe 0.06 27506 10671 20083 10.50 10.68 3016 6399 3061 6351 2009 7.92 9.16 0.34 0.40 Periyap - atna, 0.14 - - - - 1 % Married : 66.59%; 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 10189 25129 10819 24499 33422 36373 71691 TN Pura, 2010 5.33 5.44 6.65 4.86 0.30 0.25 0.13 56 800 - 0.34 Parent to ------Child 2.09 13226 35411 14387 34250 36211 43916 92553 2011 2.63 4.71 5.28 3.64 0.23 0.17 - - - - - % Widowed or Divorced Unknown 15 1.54 - 106569 19886 45462 21376 43972 34630 41221 2 2012 1.65 3.27 3.34 2.51 0.21 0.16 0.50 : 91.5% 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. Year: NA) Size Est., (Mapping, Typology Program Coverage No. episodes treated % Total HRG % Married % <25 yrs. % Syphilis positivity % Total Pop. Program Target 66.67%; 30.46% HRG Size Brothel- 2.87%; based- based- based- Home- Street- 80.00 16.50 2004 4255 0.14 FSW 100 2009 1272 NA 1 9 7 1 ------

- 300,HSS-HRG/STD ≥ STI/RTI decker- 2005 Double Panthi- Kothi- MSM 12 NA; NA; 1 1 1 9 1 NA NA ------2010 9477 ------

- Non daily Injectors- Injectors- 2006 Programme Response 17 Daily 1 1 1 8 1 ------NA; IDU NA NA 15592 2011 ------0.00 Vulnerabilities 187,ICTC ≥ 2007 24 1 1 1 1 9 1 Tamil Nadu ------migration % total pop. % of male migration No. out- Nilgiris, Nilgiris, 15825 2012 0.37 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 12 24 2 1 1 1 1 ------(Suburban) Mumbai Mumbai , Maha rashtra Male Migration, 2001 Census Overall 83172 6.23 100 2009 10 26 - 2 1 1 1 1 1 ------900 and BB and 900 ≥ Tamil Nadu batore, Coim - 5910 Inter- State 7.11 0.44 2010 11 53 2 1 4 2 1 1 ------Wayanad, 900);≥ Kerala 36511 43.90 Intra- state 2.73 2011 11 60 2 1 7 2 1 1 ------4 percent = PP Maharash - Thane, district 40751 49.00 Intra- 3.05 2012 tra 11 95 2 1 8 2 1 1 4 - - - - -

District HIV/AIDS Epidemiological Profiles : Karnataka | 53 Raichur

Background: Raichur is located in the northeast part of the state and Raichur District is bordered by Yadgir in the north, Bijapur and Bagalkot district in the northwest, Koppal in the west, Bellary in the south, Mahabubnagar and Kurnool districts of Andhra Pradesh in the east. It has a population of 19.24 lakhs, a sex ratio of 992 females per 1,000 males, and a female literacy rate of 49.56% with an overall literacy rate of 60.46% (Census 2011). Agriculture is the main source of economy for the district. It also has a good trading market in cotton and oil seeds industry. The district is well connected to the other districts of the state by roads and railways.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV positivity was moderate at 0.50% among the ANC attendees, with a decreasing trend. • According to 2012 PPTCT data, HIV positivity was low at 0.30% among the attendees, with a stable trend. • According to 2012 Blood Bank data, HIV positivity was low at 0.18% among the attendees, with a declining trend. • Based on 2010 HSS-FSW data, HIV positivity was moderate (6.80%) among FSWs. Although, due to lack of previous data points a trend could not be determined. • According to 2012 ICTC data, the level of HIV positivity was low among male (4.64%) and female (4.34%) attendees. It was also low among referred (3.81%) attendees but moderate among direct walk-ins (8.11%).A decreasing trend was seen among all the ICTC attendees. • According to 2009HRG mapping size data, FSW (1,744; 68.82% of total HRG) was the largest HRG in the district, followed by MSM (790; 31.18% of total HRG). Among the FSWs, the majority were home-based (57.90%). • In 2012, 10,018 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.54%. • According to 2001 census, 5.43% of the males were migrants, among them 17.39% migrated to other states and 42.17% migrated to other districts within the state. • The top two destinations for inter-state out-migration were Pune in Maharashtra and Mahbubnagar in Andra Pradesh. • In 2012, HIV transmissions though parent to child accounted for about 6.92% of the district’s total HIV transmissions. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 76.30% and 36.20%, respectively. • In 2012, there were three TIs (two for FSWs and one for MSM) functional in the district. • In 2012, there were 60 ICTCs which tested 59,475 attendees. • In 2012, there were six blood banks, two STI clinic and two ART centers. The district also had four link ART centers. Key Recommendations: • Increase the number of TIs in the district in order to support the large and diverse number of HRGs. • Carry out in-depth analysis of ICTC data to understand the profile of attendees, as the parent to child HIV transmission rate was notable. • Assess the size and profile of FSW’s client including migrants and truckers, to better understand district vulnerabilities. • Prevention program should be focused on hard to reach sub-groups like home-based FSWs. • Considering high rate of migration to high HIV prevalent districts, strengthen outreach programs through awareness campaigns among women and around truck halting points and highways in the district.

54 | District HIV/AIDS Epidemiological Profiles : Karnataka positive, NT = number tested; * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 19,24,773 (% of Uttar Pradesh Population); Female Literacy Raichur ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=1576) % of Total FSW No. HRG- MSM No. HRG- No. HRG- IDU % Pos; ICTC PPTCT % Pos; DLN (NA) ART (9795) 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 durga, Deva - 0.48 4 4 % On ART - - - - 91.69 37 - 14.54 38.66 28.21 27.80 7453 2005 1023 0.58 1.63 454 569 397 626 800 Lingsugar, ------5 0.38 General clients & pregnant women. - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 26.04 11.53 12.46 14.84 1579 1024 6497 2006 1867 0.43 1.38 288 843 800 0.25 % 15-24 yrs ------Manvi, 0.29 - - - - HIV Levels and Trends 8 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 40.27 23.27 28.23 28.42 1356 3197 2044 2509 9818 2391 2007 6944 0.38 5.94 0.50 800 Raichur, ------Transfusion 0.78 - - - - Blood 0.00 % Ill., Prim. Edu. 11283 20102 29.46 14.20 17.31 18.95 2332 6494 3963 4856 4945 2008 Sindhnur, 0.26 0.60 0.50 800 2 ------0.87 Source: DLHS III;Source:DLHS 78 - - - - - 3 Needle/ Syringe 0.19 12394 10481 34.63 14.51 21.38 18.15 2247 1258 1736 7487 2009 0.21 0.60 748 - - - - - 1 : 49.56%; 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 12919 14390 21392 38499 15.78 11.30 10.51 4188 7399 9708 2010 9.25 6.80 0.19 0.49 0.25 54 250 800 - Parent to ------Child 6.92 28031 16171 18009 15747 32206 66386 6149 2011 8.15 4.75 5.26 5.49 0.13 0.35 - - - - - % Widowed or Divorced Unknown 20 0.95 - 2 29416 16368 18648 10846 24459 : 55.7% 59475 5600 2012 8.11 3.81 4.34 4.64 0.18 0.30 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. Year: NA) Size Est., (Mapping, % Married % <25 yrs. Typology Program Coverage No. episodes treated % Total HRG % Syphilis positivity % Total Pop. Program Target 57.90%; 42.10% HRG Size Brothel based- based- based- 15.80 15.80 68.82 Home Street 2004 1744 0.09 FSW 0%; 2009 2209 NA 5 ------

- 300,HSS-HRG/STD ≥ STI/RTI 25.58%; 74.42% decker- 2005 Double Panthi- Kothi- 22.90 33.10 31.18 MSM 0.04 790 NA; 1 1 5 NA ------2010 3585 -

- Non daily Injectors- Injectors- 2006 Programme Response Daily 1 1 2 5 ------NA; IDU NA NA 2011 8221 ------Vulnerabilities - 187,ICTC ≥ 2007 21 1 1 1 5 ------Maharash migration % total pop. % of male migration No. out- 10018 Pune, Pune, 2012 0.54 tra 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 24 1 1 1 1 6 ------Mahbub Pradesh Andhra Andhra nagar, nagar, Male Migration, 2001 Census Overall 45161 5.43 100 2009 43 1 1 4 1 1 6 1 1 ------900 and BB and 900 ≥ (Suburban) Mumbai , Maha - rashtra 17.39 7854 Inter- State 0.94 2010 43 1 1 4 2 1 6 1 1 - - - - - Maharash - 900);≥ Thane, 19287 42.71 Intra- state 2.32 tra 2011 62 1 1 4 2 2 6 1 1 - - - - - 4

PP = percent = PP Kurnool, Pradesh Andhra district 18020 39.90 Intra- 2.16 2012 60 1 1 4 2 2 6 1 2 - - - - -

District HIV/AIDS Epidemiological Profiles : Karnataka | 55 Shimoga

Background: Shimoga is located in the center of Karnataka map. It Shimoga District is the rice bowl of the State. It is bordered by Haveri , Davanagere , Chikmagalur , and Uttara Kannada. It has a population of 17.55 lakhs, a sex ratio of 995 females for every 1,000 males, and a female literacy rate of 74.89% with an overall literacy rate of 80.50% (Census 2011). Foundry, agriculture and animal husbandry are the major contributors to the economy of Shimoga. Shimoga is well connected to other parts of the states by state roadways and broad gauge railways, it also has National Highways 13 and 206 passing through the district.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, positivity was low at 0.25% among the ANC attendees, with a fluctuating trend. • According to 2012 PPTCT data, the level of HIV positivity was low at 0.17% among the PPTCT attendees, with a stable trend. • According to 2012 Blood Bank data, the level of HIV positivity was low at 0.32% among the Blood Bank attendees, with a stable trend. • Based on 2010 HSS-FSW data, HIV prevalence was low (3.20%) among FSWs; however due to lack of previous data a trend could not be determined. • As per 2012 ICTC data, the level of HIV positivity was low among male (1.83%) and female (2.12%) attendees. It was also low for referred (1.91%) and direct walk-in (2.11%) attendees. An overall decreasing trend was exhibited among all the ICTC attendees. • According to the HRG mapping size data, FSW (1,588; 82.02% of total HRG) was the largest HRG in the district followed by MSM (348; 17.98% of total HRG). The major typology for FSWs was home-based (68.80%). • In 2012, 9,515 STI/RTI episodes were treated and the syphilis positivity rate among STI attendees was 0.41%. • According to 2001 census, 8.55% of the males were migrants, among them 2.66% migrated to other states and 53% migrated to other districts within the state. • The top two destinations for inter-state out-migration were Mumbai (suburban) and Thane, Maharashtra. • According to DLHS-III data, HIV and RTI/STI awareness rate among women was 90.20% and 33.90%, respectively. • In 2012, there were three TIs functional in the district. • In 2012, there were 44 ICTCs which tested 54,840 attendees. • In 2012, there were five blood banks, two STI clinics and one ART center. The district also had six link ART centers, one PLHIV network and one community care center. Key Recommendations: • Increase the number of TIs, considering the large and diverse group of HRG population • Assess of the size and profile of FSWs client’s, including migrants and truckers, to help in better understanding the district’s vulnerabilities. • An up to date information on profile and size of migrants will improve understanding of district vulnerabilities. • Considering high number of home based and street based sex workers, the prevention program should be customized to reach this hard to reach population • Considering high rate of migration to high HIV prevalent districts, strengthen outreach programs through awareness campaigns among women and around truck halting points and highways in the district.

56 | District HIV/AIDS Epidemiological Profiles : Karnataka * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 17,55,512 (2.87% of Karnataka Population); Female Literacy Shimoga positive, NT = number tested; ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=668) % of Total FSW No. HRG- MSM No. HRG- No. HRG- IDU % Pos; ICTC PPTCT % Pos; DLN (NA) ART(3444) 5

Hetero-sexual Bhadra - NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP vathi, 0.2 4 4 % On ART - - - - 94.01 44 - 10683 25.13 15.03 21.40 15.92 1091 2005 1485 0.33 0.88 394 486 999 800 ------Hosana - - - 5 gar, 0.2 General clients & pregnant women. - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 29.48 10.13 2017 1056 1290 6373 2006 2346 6.74 9.77 0.64 0.50 329 800 1.05 % 15-24 yrs ------Sagar, 0.5 - - - - HIV Levels and Trends 8 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 13541 10534 15972 10.97 10.12 1630 3818 2513 2925 2007 6.38 9.07 0.31 0.30 0.38 800 Shikar ------Transfusion ipura, 0.3 - - - - Blood 0 - % Ill., Prim. Edu. 10903 17704 32413 3811 6085 8624 5383 2008 6.82 4.66 5.19 5.23 Shimoga, 0.35 0.40 1.00 800 2 ------Source: DLHS III;Source:DLHS 0.4 87 - - - - - 3 Needle/ Syringe Shimogga, 0.15 15336 13447 1661 4775 2386 4050 7011 2009 5.54 4.61 5.41 4.52 0.40 0.48 0.2 - - - - 1 % Married : 74.89%; 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 Thirtahalli, 17173 12598 19459 17564 39925 5188 9763 2010 3.97 2.90 3.22 3.10 3.20 0.41 0.27 57 250 799 - 0 Parent to ------0.3 - - - - Child 4.79 24256 13031 19175 19852 24450 56656 7950 2011 2.47 2.13 2.43 2.06 0.32 0.20 - - - - - % Widowed or Divorced Unknown 23 - 27025 14419 19769 17890 20652 54840 0 2 7163 2012 2.11 1.91 2.12 1.83 0.32 0.17 0.25 : 91.8% 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. Year: NA) Size Est., (Mapping, % Married % <25 yrs. Typology Program Coverage No. episodes treated % Total HRG % Syphilis positivity % Total Pop. Program Target 68.80%; 29.90% HRG Size 1.30%; Brothel based- based- based- 57.10 20.80 82.02 Home Street 2004 1588 0.09 FSW 2009 2630 NA 1 6 4 1 ------

- 300,HSS-HRG/STD ≥ STI/RTI 38.34%; 61.66% decker- 2005 Double Panthi- Kothi- 25.00 17.98 MSM 0.02 348 NA; 1 1 6 0 1 NA ------2010 9366 0 -

- Non daily Injectors- Injectors- 2006 Programme Response 10 Daily 1 1 7 1 1 ------NA; IDU NA NA 2011 7206 ------1.50 Vulnerabilities 187,ICTC ≥ 2007 13 1 1 1 7 1 1 ------Maharash migration % total pop. % of male migration No. out- Mumbai Mumbai (Subur 2012 9515 ban), ban), 0.41 tra 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 - 13 1 1 1 1 6 1 1 ------Maharash Thane, Thane, Male Migration, 2001 Census Overall 70900 tra 8.55 100 2009 14 2 1 1 1 5 1 1 ------900 and BB and 900 ≥ - South Goa, Goa 1887 Inter- State 2.66 0.23 2010 22 1 1 4 1 1 5 1 1 - - - - - North Goa, 900);≥ 37575 53.00 Intra- Goa state 4.53 2011 42 1 1 6 1 1 5 1 1 - - - - - 4 percent = PP Maharash - Kolhapur, district 31438 44.34 Intra- 3.79 2012 tra 44 1 1 6 1 2 5 1 2 - - - - -

District HIV/AIDS Epidemiological Profiles : Karnataka | 57 Tumkur

Background: Tumkur is an administrative district of Karnataka and Tumkur District is only 70 kilometers from the capital city, Bangalore. The district is bound by Chitradurga, Hassan, Mandya, Ramanagara, Bangalore Rural, Chikaballapura, and Anantapur of Andhra Pradesh. It has a population 26.81 lakhs, a sex ratio of 979 females for every 1,000 males, and a female literacy rate of 66.45% with an overall literacy rate of 74.32% (Census 2011). The main source of economy in Tumkur is agriculture. There are, however, medium and large scale industries in the district. Tumkur is also rich in natural resources such as limestone and iron ore. The district also has many historical sites and temples which attracts large number of tourists. The district is well connected by road and Railways. National Highways 4 and 48 pass through Tumkur.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV positivity was moderate at 0.50% among the ANC clients, with a declining trend. • According to 2012 PPTCT data, the level of HIV positivity was low at 0.19% among the PPTCT attendees, with a stable trend. • According to 2012 Blood Bank data, the level of HIV positivity was low 0.19% among the Blood Bank attendees, with a stable trend. • Based on 2010 HSS-FSW data, HIV prevalence was low (4.05%) among FSWs; however due to lack of previous data a trend could not be determined. • As per 2012 ICTC data, the level of HIV positivity was low among male (2.18%) and female (2.10%) attendees. It was also low for referred (1.76%) and for direct walk-in (3.31%) attendees. An overall decreasing trend was exhibited among all the ICTC attendees. • According to the 2009 HRG mapping size data, FSW (1,501; 100% of total HRG) was the only HRG in the district. The major typology for FSWs was home-based (90.70%). • In 2012,14,240 STI/RTI episodes were treated and the syphilis positivity rate among STI attendees was 0.50%. • According to 2001 census, 7.64% of the males were migrants, among them 1.86% migrated to other states and 48.74% migrated to other districts within the state. • The top destination for inter-state out-migration was Anantapur, Andhra Pradesh. • According to DLHS-III data, HIV and RTI/STI awareness rate among women was 82% and 43.8%, respectively. • In 2012, there were three TIs (two for FSWs and one for MSM) functional in the district. • In 2012, there were 98 ICTC centers which tested 97,911 attendees. • In 2012, there were five blood banks, one STI clinic and one ART center. The district also had eight link ART centers, one PLHIV network and one community care center. Key Recommendations: • Carryout disaggregated analysis of HSS-ANC data to understand the profile of people who are infected with HIV. This is important as the prevalence of HIV was relatively higher. • Sustained approach is needed to keep a check on HIV incidence as it has shown a sharp increase in the year 2012 • Assess the size and profile of FSW’s client including migrants and truckers, to better understand district vulnerabilities. • Focus on sub groups like home based FSWs, as they are hard to reach population. An updated estimate would help to design intervention plan appropriately. • Strengthen outreach programs through awareness campaigns around source and transit points like railway stations and bus stands.

58 | District HIV/AIDS Epidemiological Profiles : Karnataka * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 26,81,449 (4.39% of Karnataka Population); Female Literacy Tumkur positive, NT = number tested; No. HRG- MSM ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=1293) % of Total No. HRG- FSW % Pos; PPTCT ART(6233) DLN (NA) No. HRG- IDU % Pos; ICTC 5

kanahalli, Hetero-sexual kanaya - NT PP NT NT NT NT NT NT NT NT NT NT NT PP PP PP PP PP PP PP PP PP PP Chik - 0.63 4 4 % On ART - - - - 92.11 48 - 23.78 11.67 16.34 20.50 1047 1010 6302 2005 1818 0.27 1.00 771 808 800 ------Gubbi, 5 0.48 General clients & pregnant women. - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 27.89 12.37 1099 4335 2006 1601 2.73 8.64 0.12 0.75 502 752 849 800 2.32 % 15-24 yrs ------Korat - agere, 0.26 - - - - 11 HIV Levels and Trends - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 10510 13579 11.98 11.96 2829 2091 2253 2667 8659 2007 9.71 9.90 0.36 0.90 1.13 800 Kunigal, ------Transfusion 0.77 - - - - Blood 0.77 % Ill., Prim. Edu. 12156 12937 11605 13487 24344 49436 Madhugiri, 4210 2008 7.90 5.33 5.93 7.12 0.19 0.49 1.13 800 2 ------0.12 Source: DLHS III;Source:DLHS 79 - - - - - 3 Needle/ Syringe 0.15 11820 Pavagada, 14312 25086 4938 5836 5151 5623 2009 5.91 4.64 5.03 5.41 0.20 0.30 0.57 - - - - 1 % Married : 66.45%; 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 15463 20470 16895 19038 11192 31573 67506 2010 4.86 3.31 3.83 4.11 4.05 0.23 0.34 1.50 57 222 799 - 0.47 Sira, Parent to ------Child 2.24 17916 38471 25667 30720 11577 42785 99172 2011 3.42 2.26 2.64 2.63 0.16 0.22 Tiptur, 0.25 - - - - % Widowed or Divorced Unknown 17 2.40 - 14911 45415 27504 32822 11821 37585 97911 2 2012 3.31 1.76 2.10 2.18 0.19 0.19 0.50 : 93.9% 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. Year: NA) Size Est., (Mapping, Typology Program Coverage No. episodes treated % Total HRG % Married % <25 yrs. % Syphilis positivity % Total Pop. Program Target 94.38%; HRG Size 1.35%; Brothel 4.27% based- based- based- 55.50 Home Street 2004 1501 8.00 0.06 FSW 100 2009 3117 NA 4 4 ------

- 300,HSS-HRG/STD ≥ STI/RTI decker- 2005 Double Panthi- Kothi- MSM NA; NA; 1 1 3 4 NA NA ------2010 9599 ------

- Non daily Injectors- Injectors- 2006 Programme Response 23 Daily 1 1 3 ------NA; IDU NA NA 15506 2011 ------0.00 Vulnerabilities 187,ICTC ≥ 2007 23 1 1 4 Anantapur, Anantapur, ------migration % total pop. % of male migration No. out- Pradesh Andhra Andhra 14240 2012 0.50 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 23 1 1 1 1 5 1 2 ------Male Migration, 2001 Census 100273 Overall 7.64 100 - 2009 47 1 1 1 1 5 1 2 ------900 and BB and 900 ≥ 1864 Inter- State 1.86 0.14 - 2010 74 1 1 4 1 1 5 1 2 - - - - - 900);≥ 48871 48.74 Intra- state 3.73 2011 - 75 1 1 8 1 1 5 1 2 - - - - - 4 percent = PP district 49538 49.40 Intra- 3.78 2012 98 - 1 1 8 1 1 5 1 2 - - - - -

District HIV/AIDS Epidemiological Profiles : Karnataka | 59 Udupi

Background: Udupi District Udupi was created in August 1997. The three northern taluks, Udupi, Kundapur and Karkal, were separated from Dakshina Kannada districtto form Udupi. It is surrounded by Uttara Kannada in the north, Dakshina Kannada in the south. Shimoga borders on northeast side and chikamagalur on the east and the Arabian sea is on the west of Udupi. The district has a population of 11.77 lakhs, a sex ratio of 1,093 females for every 1,000 males, and a female literacy rate of 81.41% with an overall literacy rate of 86.29% (Census 2011). Udupi’s economy depends mainly on agriculture and fishing. Small-scale industries like the cashew, other food items and milk cooperatives are the most prominent. It attracts tourist each year for it’s temples. Udupi district has National Highways 13 and 17 passing through it, making it accessible to other districts within the state, as does state roadways and railways.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV positivity level was low at 0.38% among the ANC attendees, with a declining trend. • According to 2012 PPTCT data, the level of HIV positivity was low at 0.24% among the PPTCT attendees, with a stable trend. • According to 2012 Blood Bank data, the level of HIV positivity was low at 0.08% among the Blood Bank attendees, with a stable trend. • According to 2012 data, HIV positivity among ICTCs attendees was low among male (2.71%) and female (2.52%) attendees, as well as among referred (2.75%) and direct walk-in (2.10%) attendees. Positivity levels showed an overall declining trend among ICTC attendees over the previous five years. • In 2012, 10,664 STI/RTI episodes were treated the and the syphilis positivity rate among STI attendees was 0.33%. • According to 2001 census, 14.86% of the males were migrants, among them 16.06% migrated to other states and 28.38% migrated to other districts within the state. • The top two destinations for inter-state out-migration were Mumbai (suburban) and Thane, Maharashtra. • In 2012, HIV transmissions through unknown routes accounted for 5.30% of all the districts HIV transmissions in the district. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 97% and 43%, respectively. • In 2012, a total of two TI sites (one for FSWs and one for MSM) were operational in the district. • In 2012, there were 37 ICTCs which tested 39,927 attendees. • In 2012, there were two blood banks, one STI clinic and one ART center. The district also had three link ART centers and one PLHIV network. Key Recommendations: • Conduct socio-cultural and economic analysis of ANC data to understand the profile of HIV positive people. This will help to strengthen the prevention plan • Assess the size and profile of FSW’s clients, including migrants and truckers, to better understand district vulnerabilities. • Availability of data on typology of FSWs would help to design appropriate prevention plan for this high risk group. • Focus outreach efforts towards migrants at source and transit sites, as migration to high prevalent districts could be a driver of the HIV epidemic in the state. • Increase the availability of data regarding profile and pattern of migration to gain better insight to district HIV vulnerabilities.

60 | District HIV/AIDS Epidemiological Profiles : Karnataka * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 11,77,908 (1.93% of Uttar Pradesh Population); Female Literacy Udupi positive, NT = number tested; MSM No. HRG- MSM No. HRG- IDU No. HRG- ICTC % Pos; PPTCT % Pos; ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=679) % of Total DLN (NA) ART (3990) 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 - - - - - 90.72 55 - 12225 28.00 11.94 7466 4038 3803 2005 7841 7.67 5.55 0.14 0.63 375 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 43.10 7296 3499 4036 7410 2006 7535 3.74 3.43 6.34 0.13 0.75 239 800 0.74 % 15-24 yrs ------HIV Levels and Trends 5 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 16634 14667 25.97 10.41 13.51 2045 8750 4487 6308 3872 2007 9.01 0.12 1.90 0.13 800 ------Transfusion - - - - - Blood 0.59 % Ill., Prim. Edu. 12065 24650 12.43 3764 6699 9130 8513 8821 2008 6.63 6.40 9.19 0.13 0.49 0.63 800 2 ------Source: DLHS III;Source:DLHS 84 ------3 Needle/ Syringe 18635 12.57 1050 3905 2125 2823 4559 2009 9507 5.89 5.98 8.43 0.11 0.29 0 - - - - - % Married 3 Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 13881 11059 21823 10879 29501 1 4741 7563 2010 5.76 5.40 4.72 6.02 0.10 0.37 0.50 49 : 81.41%; ANC Utilization 800 - Parent to ------Child 2.65 18000 13645 25669 13132 35491 4359 8714 2011 4.06 3.34 3.11 3.73 0.09 0.23 - - - - - % Widowed or Divorced Unknown 21 5.30 - 21718 10548 15886 19957 13493 39927 4716 2012 2.10 2.75 2.52 2.71 0.08 0.24 0.38 800 ------2 : 96.4% 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. Year: NA) Size Est., (Mapping, Typology Program Coverage No. episodes treated % Total HRG % Syphilis positivity % Total Pop. % Married % <25 yrs. Program Target HRG Size Brothel based- based- based- Home Street 2004 0.04 FSW 504 100 NA; NA; 2009 NA NA 823 2 4 ------

- 300,HSS-HRG/STD ≥ STI/RTI decker- 2005 Double Panthi- Kothi- MSM NA; NA; 1 1 2 4 NA NA ------2010 2737 ------

- Non daily Injectors- Injectors- 2006 Programme Response 13 Daily 1 1 2 ------NA; IDU NA NA 2011 5638 ------2.59 Vulnerabilities 187,ICTC ≥ 2007 13 1 1 1 2 ------migration % total pop. % of male migration No. out- ban), Ma ban), harashtra Mumbai Mumbai (Subur 10664 2012 0.33 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 - 13 - 1 1 1 1 2 1 1 ------Maharash Thane, Thane, Male Migration, 2001 Census Overall 77486 14.86 tra 100 2009 13 1 1 1 1 2 1 1 ------900 and BB and 900 ≥ - Maharash - Pune, 12444 16.06 Inter- State 2.39 tra 2010 22 1 1 2 1 1 2 1 1 - - - - - Maharash - 900);≥ Mumbai, 21989 28.38 Intra- state 4.22 tra 2011 26 1 2 1 1 2 1 1 ------4 percent = PP Kannur, district 43053 Kerala 55.56 Intra- 8.25 2012 37 1 3 1 1 2 1 1 ------

District HIV/AIDS Epidemiological Profiles : Karnataka | 61 Uttara Kannada

Background: Uttara Kannada, also known as north Kanada or north Uttara Kannada District Canara, is a Konkan district. It is bordered by the state of Goa and Belgaum district to the north, Dharwad and Haveri to the east, Shimoga and Udupi to the south and Arabian Sea to the west. It has a population of 14.36 lakhs, a sex ratio of 975 females per 1,000 males, and a female literacy rate of 78.21% with an overall literacy rate of 84.03% (Census 2011). The district’s high rainfall supports lush forests, which cover approximately 70% of the district. The main stay of the economy is agriculture but it also has small scale industries. This district is well connected via roads and railway, National Highways 17 and 4A pass through it and connects it to rest of the districts of the state.

HIV Epidemic Profle: • As per 2012 HSS-ANC data, HIV positivity was low (0.25%) among the ANC attendees, with a fluctuating trend. • According to 2012 PPTCT data, the level of HIV positivity was low at 0.16% among the PPTCT attendees, with a stable trend. • According to 2012 Blood Bank data, the level of HIV positivity was low at 0.03% among the Blood Bank attendees, with a stable trend. • Based on 2010 HSS-FSW data, HIV positivity was low at 3.20% among FSWs, however, due to lack of data points a trend could not be determined. • According to 2012 ICTC data, the level of HIV positivity was low among male (1.18%) and female (1.57%) attendees. It was also low among referred (1.47%) and direct walk-in (1%) attendees. A decreasing trend was seen among all the ICTC attendees. • According to the HRG mapping size data, FSW (1,588; 100% of total HRG) was the only HRG in the district. Among FSWs, the majority of typology was street-based (77.10%) followed by home-based (22.90%). • In 2012, 4,537 STI/RTI episodes were treated. • According to 2001 census, 13.74% of the males were migrants, among them 10.55% migrated to other states and 20.14% migrated to other districts within the state. • The top two destinations for inter-state out-migration were South and North Goa. • According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 89.40% and 45%, respectively. • In 2012, a total of two FSW TI sites were operational in the district. • In 2012, there were 34 ICTCs which tested 45,633 attendees. • In 2012, there were five blood banks, two STI clinics and one ART center. The district also had nine link ART centers, one PLHIV network and one community care center. Key Recommendations: • Sustained approach for HIV prevention and treatment program is needed to keep acheck on HIV in the district. • Assess the size and profile of FSW’s clients, including migrants and truckers, to better understand district vulnerabilities. • Focus on sub groups like home based FSWs, as they are hard to reach population. An updated estimate would help to design intervention plan appropriately. • Strengthen outreach programs through awareness campaigns around source and transit points, like railway stations and bus stands, considering significant number of migrant population. • Availability of DLN data would help in better understanding of district vulnerabilities. • Availability of data at the block level would help to understand the spatial distribution of vulnerable and at risk population.

62 | District HIV/AIDS Epidemiological Profiles : Karnataka * Inadequate sample size; - Data not available;not Data size; - sample Inadequate * District Population: 14,36,947 ( 2.35% of Karnataka Population); Female Literacy Uttara Kannada positive, NT = number tested; MSM No. HRG- MSM No. HRG- IDU No. HRG- ICTC % Pos; PPTCT % Pos; ICTCs Total tested at Walk-in ICTC Direct ICTC Referred ICTC Female ICTC Male HSS-IDU HSS-MSM HSS-FSW HSS-STD Blood Bank HSS-ANC PPTCT (N=371) % of Total DLN (NA) ART (2013) 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 - - - - - 92.99 52 - 16.77 2005 8.06 9.23 9.69 0.75 161 794 336 619 955 800 ------5 General clients & pregnant women. - - - - - Homo-sexual Route of HIV Transmission, ICTC 2012 18.00 1134 2006 1234 3.62 3.16 5.91 1.35 100 506 728 816 1.62 % 15-24 yrs ------HIV Levels and Trends 7 - Block-Level Details PLHIV Pro f le, 2012 1 2011 Census;2011 10.65 1103 5771 2007 7180 9.98 5.84 5.89 0.50 0.50 621 788 526 883 800 0 ------Transfusion - - - - - Blood 0.54 % Ill., Prim. Edu. 18650 5087 4743 3490 6339 8821 2008 4.36 4.89 6.16 3.75 0.11 0.50 0.13 926 799 2 ------Source: DLHS III;Source:DLHS 83 ------3 Needle/ Syringe 2032 1977 1467 2542 2343 4559 2009 8568 3.84 5.56 5.52 4.21 0.21 0.30 0 - - - - - % Married 1 3 : 78.21%; ANC Utilization Data presented only for years where sample size is valid (HSS-ANC valid is size sample where years for only presented Data 12029 12260 16409 36215 7777 7546 3065 2010 2.13 3.00 3.39 2.21 3.20 55 0.07 0.16 0.38 250 800 - Parent to ------Child 4.85 12567 17737 12581 17723 20373 50677 3471 2011 1.04 1.60 1.44 1.32 0.17 0.14 - - - - - % Widowed or Divorced Unknown 24 - 20538 11623 15949 18061 45633 0 7034 2878 2012 1.00 1.47 1.57 1.18 0.03 0.16 0.25 2 799 : 91% ------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. Year: NA) Size Est., (Mapping, Typology Program Coverage No. episodes treated % Total HRG % Married % <25 yrs. % Syphilis positivity % Total Pop. Program Target 22.90%; 77.10% HRG Size Brothel based- based- based- 71.40 Home Street 2004 1588 9.50 0.11 FSW 0%; 100 2009 6602 NA 2 1 ------

- 300,HSS-HRG/STD ≥ STI/RTI decker- 2005 Double Panthi- Kothi- MSM NA; NA; 1 2 2 1 NA NA ------2010 8514 ------

- Non daily Injectors- Injectors- 2006 Programme Response Daily 1 2 2 1 ------NA; IDU NA NA 2011 6470 ------0.13 Vulnerabilities 187,ICTC ≥ 2007 1 2 2 1 ------South Goa South migration % total pop. % of male migration No. out- 2012 4537 0 600,PPTCT ≥ Top 5 districts for inter-state out-migration 2008 1 1 1 2 3 1 ------North Goa North Male Migration, 2001 Census Overall 94424 13.74 100 2009 1 1 1 1 3 1 ------900 and BB and 900 ≥ Maharash - Thane, 10.55 9958 Inter- State 1.45 tra 2010 1 1 2 1 2 4 1 ------(Suburban), Maharash - 900);≥ Mumbai 19020 20.14 Intra- state 2.77 tra 2011 1 1 8 1 2 5 2 ------4 percent = PP Maharash - district 65446 69.31 Pune, Intra- 9.53 2012 tra 34 1 1 9 1 2 5 2 ------

District HIV/AIDS Epidemiological Profiles : Karnataka | 63

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