1.2.5 KARNATAKA STATE AIDS PREVENTION SOCIETY: Karnataka State AIDS Prevention Society (KSAPS) was registered as a Society on 9th December 1997; it is an autonomous institution and the highest policy-making structure with respect to HIV/AIDS in Karnataka. The Governing council is headed by the Chief Minister and the Vice chairman is the Minister for Health and Family Welfare Services.

The Chairman of Executive Committee is Secretary to Government Health & Family Welfare Department. As per NACO, high prevalent states in are Nagaland, Mizoram, Tripura, Manipur and Meghalaya. KSAPS is implementing National AIDS Control Programme (NACP IV). Karnataka has 30 Category “A” districts.

KSAPS is implementing NACP IV funded by National AIDS Control Organization (NACO), :

Karnataka has been conducting HIV Sentinel Surveillance since 1998. Surveillance is carried out annually by testing for HIV at designated sentinel sites and now the annual frequency of HSS was shifted to biennial (once in two years). The prevalence among antenatal clinic (ANC) attendees as per HSS 2012-13 was 0.53%. This is close to the NFHS-3 estimate of 0.69% in 2006. HIV prevalence among ANC attendees indicates decline in adult HIV prevalence in the state from 1.5% in 2004 to 0.38% in 2016-17. In 2018-19 16th round of HIV Sentinel Surveillance has been conducted at ANC sites where HIV prevalence among ANC attendees is 0.22% and in 2016-17 HRG HSS of FSW is 3.33% MSM is 5.40% in Karnataka. Presently 17th round of HSS activity is going on in all NACO designated ANC/HRG sites.

Declining trend among ANC attendees-Karnataka

1.6 1.5 1.4 1.3 1.2 1.1 1

0.86 0.89 0.8 0.69 0.6 0.53 0.4 0.36 0.38

0.2 0.22

0 2004 2005 2006 2007 2008 2010 2012 2014-15 2016-17 2018-19

Karnataka State AIDS Prevention Society Programmes:

1. Targeted Intervention:

Response from Karnataka State AIDS Prevention Society (KSAPS) has been to saturate targeted interventions (TIs) in Karnataka under the thrust area of NACP -IV.

I. Core TI (FSW, MSM, TG & IDU):

This saturation currently covers around 84248 Female Sex Workers (FSWs) under targeted interventions and 27107 Men who have sex with Men (MSM), 2282 transgender are covered under this programme. This programme is funded by NACO through KSAPS.

1 TI is implementing Injecting Drug User (IDU) programme of which is in Kolar covering 1097 IDUs. 2 Opioid Substitution Therapy (OST) centers 1 in Bangalore and 1 in Kolar covers intravenous drug user population.

II. Bridge TI (Migrant & Truckers):

8 TI projects in Karnataka covers 1,42,000 destination migrants. 4 truckers TIs cover a population of 80,000 long distance male truckers. The Truckers program is implemented at Trans- shipment locations.

Under this program, registration of HRGs for HIV prevention program takes place. Supply of free condoms, STI drugs, needles and syringes for IDUs. Constant follow up of all registered HRGs for regular medical check up for STI management (once in 3 months) and HIV testing (Once in 6 months). Linkages to ART and other care and support services for HIV positive HRGs. Mainstreaming through linkages to social welfare schemes of central and state government.

2. HIV Counselling & Testing Centres:

In Karnataka Total 473 Stand-alone ICTCs and 2896 FICTC centres are functioning.

• An integrated counselling and testing centre is a place where a person is counselled and tested and checked for HIV, Tuberculosis, ANC and postnatal follow up on his own free will or as advised by a medical provider. • An ICTC shall be located in health facilities owned by the government, in the private/not for- profit sector, in public sector organizations/other government departments such as the Railways, Employees' State Insurance Department (ESID), etc. and in sectors where nongovernmental organizations (NGOs) have a presence.

ICTCs can be classified into two types: Stand alone Integrated Counselling and Testing Centres and Facility-integrated Counselling and Testing Centres

Fixed-facility ICTCs are those that are located within an existing health-care facility/ hospital/centre.

1. “Stand-alone Integrated Counselling and Testing Centres”: SICTC having a full-time counsellor and laboratory technician who undertake HIV counselling and testing. Such facilities exist in medical colleges and district hospitals, and in some sub district hospitals.

2. “Facility- integrated Counselling and Testing Centres”: FICTC which does not have full-time staff and provides HIV counselling and testing as a service along with other services. Existing staff such as the auxiliary nurse midwife (ANM)/staff nurse/health visitor/laboratory technician (LT)/pharmacist are expected to undertake HIV counselling and testing. Such ICTCs will usually be established in facilities that do not have a very large client load and where it would be uneconomical to establish a stand-alone ICTC

Such facilities are 24-hour PHCs as well as private sector/not-for-profit hospitals, private laboratories, public sector organization-run hospitals or facilities, and in the NGO sector.

HIV Cases Tested and found Positive in ICTC General clients ANC Achievement Achievement Year Achieve Target Positivity Target Achievement Positivity Tested ment +ve Tested +ve % % % % 2013-14 1467137 1664848 113.48 29473 1.77 1292519 1178907 91.21 1445 0.12

2014-15 1540494 1906237 123.74 26509 1.39 1253456 1232862 98.36 1295 0.11

2015-16 1617519 1945282 120.26 21989 1.13 1287757 1280862 99.46 1034 0.08

2016-17 1698395 1940589 114.3 20004 1.03 1287757 1321668 103 856 0.06

2017-18 1973772 2220292 112.49 18862 0.85 1315595 1418176 74.09. 891 0.06

2018-19 2225423 2473845 111.16 18143 0.73 1315595 1423045 108.17 776 0.05 2019-20 2634744 2578245 97.85 15685 0.60 1381375 1447231 104.72 623 0.04

2020-21 2634744 1629561 61.85 9504 0.58 1209010 1209938 100.0 580 0.05

3. Care Support & Treatment:

During 2020-21, 68 ART centers and 305 Link ART Centers are functioning. The cumulative number of HIV cases registered at ART Centers till March 21 are 3,55,945 out of which, 1,69,830 cases are alive and on ART. The progress of ART centers is given in Table 12.61. Table 12.61. Cumulative Status report on ART (till March - 2021)

Adult Child Child Indicator Adult Female TS/TG Total Male Male Female

Pre ART-Registration 171835 164507 933 10211 8459 355945

Ever Started on ART 137879 135113 715 7848 6415 287970

Alive on ART 69965 89111 429 5610 4715 169830

Reported on ART Death 50398 30726 162 1470 1079 83835

State is following "Treat All" policy since 14th June 2017 which mandates free ART treatment initiation irrespective of CD4 count & WHO staging.

4. STI/RTI (SEXUALLY TRANSMITTED INFECTIONS / REPRODUCTIVE TRACT INFECTIONS): Major route of transmission of HIV in Karnataka in unprotected sexual intercourse and HIV is primarily considered to be a sexually transmitted infection. A person with STI/RTI is 2 to 9 times prone to get HIV. HIV positive patients with STI are more likely to acquire HIV. Hence, control of STIs contributes significantly to the reduction in HIV transmission. Up to 40% of HIV transmission can be cut down by treating STI, hence STI control could be considered as the most cost-effective programme. There are 54 Designated STI/RTI Clinics (DSRCs) and 2 State Reference Centres (SRCs) in Karnataka, The DSRCs are located in all District Hospitals and some Taluka Hospitals. SRC is located in Bengaluru Urban District and Hubli, Dharwad District. DSRC - Physical and Financial Achievement

Physical Year Target Achievement 2018-19 413384 277184 (67%) 2019-20 420808 288971 (69%) 2020-21 428042 183400(42.8%)

5. Information Education Communication, Youth and Mainstreaming.

Under IEC, awareness will be created through various medias like mass media, folk media, outdoor media, print media, Trainings, Through clubs creating of awareness on prevention of HIV/AIDS, available Government services and schemes for PLHIV, Adolescent Health Education Programme, HIV and AIDS (Prevention and Control) Act 2017, creating awareness to youth, women and general population regarding Care and Support, reduction of Stigma and discrimination .

The following IEC activities undertaken from April 2020 till March 2021:

1. Broadcast of Radio spots of 30 secs each on blood donation through 3 private radio channels (Big FM, Radio City and Radio Mirchi ) from 12.8.2020 to 21.8.2020, 8 spots per day totally 240 spots on eve of International Youth Day. 2. Broadcast of Radio spots of 30 secs from 28.8.2020 to 18.9.2020 6 spots per day (State hook, FM and Vivid Bharathi) totally 180 spots through All India Radio, Bengaluru. 3. Broadcast of 15 mins long format – 10 programmes (one programme per week) and 40 spots of 30 secs on blood donation through All India Radio, Dharwad from 15.9.2020. 4. Broadcast of 230 spots through Pvt FM Radio channels on eve of National Voluntary Blood Donation Day. 5. Broadcast of 240 spots through 3 pvt FM Radio channels and 210 spots through AIR and 2 phone in programme on eve of World AIDS Day. 6. Telecast of TV 220 spots through Pvt TV channels and also through Doordarshan 120 spots and 2 panel discussion. 7. Publishing of message through leading newspaper on eve of WAD. 8. Broadcast of 28512 audio spots at 198 Bus stations across the State from 16.9.2020 to 10.10.2020. 9. Observation of State level and district level World AIDS Day. 10. District, State and Regional level quiz competition for Red Ribbon Clubs colleges. 11. IEC materials like Sunboards, pamplets and posters and various themes like Suraksha clinic and STI, ART, Blood Donation, Condom usage, Social protection, HIV Act, Adolescent Education Programme, Red Ribbon Clubs, Basics of HIV and PPTCT, Nutrition food and good health were printed and supplied to all districts across the State. 12. Wall paintings on HIV/AIDS at 10 districts (Bellari, Chikkabalapura, Mysuru, Ramanagar, Chitradurga, Davangere, Shivamogga, Dharwad, Yadgir and Bengaluru (Urban). 13. Display of messages at the 20 bus shelters. 14. Broadcast of audio spots at 198 Bus stations across the State from 28.12.2020 to 9.12.2020 -14256 spots on eve of WAD. 15. Branding of 166 buses across the State for one month from 12.9.2020 to 11.10.2020. 16. On the eve of International Youth Day, Karnataka State AIDS Prevention Society organized online Quiz competition on HIV/AIDS for college students. 17. Celebration of National Youth Day at district level. 18. Wall painting was done across the State on various themes - Social protection schemes. HIV and AIDS Act, National helpline 1097. 19. To create awareness on HIV/AIDS, Blood Donation, Social schemes, HIV and AIDS Act, Adolescent Education Programme, Red Ribbon Clubs, PPTCT among the general population Door to Door campaign was conducted in 23 districts. 20. Messages on Blood Donation, Social Protection Schemes, HIV and AIDS Act, National Helpline 1097 were printed on sunboards and displayed in the premises of 736 colleges across the State. 21. Messages on HIV/AIDS, Suraksha Clinic, STI, Blood donation, Social protection schemes, HIV and AID Act, Adolscent Education Programme, Red Ribbon clubs, PPTCT, Nutrition were posted through twitter, facebook, whatsapp, Instagram to create awareness through social media. 22. International Womens Day was celebrated on 8.3.2021 and on occasion on this message of EMTCT was printed on the postal covers and released on this day. 23. Under Mainstreaming training, 45185 members of various departments, institutions are sensitized at district level from April – 2020 till March - 2021.

Government facilities available to HIV infected and affected persons April 2020 to March 2021 Sl. Name of the Concerned Beneficia To whom Benefit No. scheme Dept ries Anthyodaya Food & civil Supply 1 HIV infected Family 35 Kgs food grains 453 Yogana Dept CABA Rs. 1000/- will be (Children HIV infected & Women & Child 2 credited directly to their 1458 affected by affected children Welfare Dept bank account AIDS) Rajiv Gandhi Rural Rajiv Gandhi issuing of constructed 3 HIV infected person Development 19 housing house corporation Mythree Rs 600 pension per Revenue 4 Scheme for TS/TG 1 Yogana month Department for those who are TA for ART Dept. of Health & 5 taking Second line 3519 treatment family welfare ART treatment Free testing and HIV infected and HIV people get free Dept. of Health & 6 36360 treatment affected people Testing and Treatment family welfare Education HIV infected & free admissions inprivate Dept. of Primary 7 22 under RTE affected Child schools Education 1) 50,000/- Loan to FSW community, 2) ) in this loan only Women & Child Chetana 8 Sex workers 50% is subsidy development 2442 Scheme repay back to WCD corporation dept minimal interest Higher in this scheme get free HIV infected and Dept. of Higher 9 education and higher education & 37 affected children education scholarship scholarship Under this scheme get benefit to PLHIV women Rs 50,000 Loan Rs, 25000 subsidy and This scheme Dhana Shree repayment of remaining Women & Child 10 particularly HIV 182 yojana Rs. 25,000 monthly Welfare Corporation positive women only instalment with minimal interest return to Women & Child Development Corporation . Unmarried women monthly get Rs 600 Women & child 11 Manaswini 0 above 45 years pension Welfare Dept Free legal Karnataka State 12 PLHAs free legal services 55 services Legal authority

6.Blood Safety:

State Blood Council was established in Karnataka during 1996-97 to provide adequate and safe blood and blood products at reasonable rates. At present there are 230 registered blood banks in Karnataka of which 66 are supported by NACO. Out of 230 blood banks, 43 are in Governments Sectors (State Govt. - 40, Central Govt.- 3), IRCS blood banks are - 8, Voluntary/Charitable blood banks-66 and 113 are in private sector (108 private Hospital Blood Banks & 5 are Private Stand Alone Blood Banks)

Blood Safety Indicators (2014-15 to 2020-21)

2015- Indicator 2014-15 2016-17 2017-18 2018-19 2019-20 2020-21 16 Total blood units collection 694151 754485 746716 787330 844419 877654 625062 Blood units collected from VBD 408974 519260 539878 593108 657612 766860 536744

7. Programme Component wise expenditure of KSAPS Budget

Year 2020-21 (31.03.2021) Total Grants Expenditure Approved Sl. received/availabl by Programme Budget for Expenditure(i No. e for the year Programme 2020-21 n Lakhs) 2020-21 ( in on total grant (in Lakhs) Lakhs) (%) 1 2443.85 1646.22 1948.26 118.35 Targeted Interventions

1.1 182.69 132.93 131.51 Link Worker Scheme 98.93 Sexually Transmitted 2 Infection / Reproductive 136.22 80.22 132.37 165.01 Tract Infections Services 3 Blood Safety 479.79 369.45 363.60 98.42 4 Lab Services 209.47 184.32 102.73 55.73 5 ICTC/HI-TB/PPTCT 3529.59 3673.72 3579.01 97.42 Information, Education & 6 Communication 387.25 338.85 301.58 89.00 7 ART/CCC 3481.54 2281.79 2288.12 100.28 8 Institutional Strengthening 1185.00 1183.78 824.59 69.66 Strategic Information 9 Management System 75.35 42.96 26.16 60.89 10 UNICEF 0 0 0 0 11 State Fund 2210-06-101-7-15-103 Grant 11a in Aid Salary 800.00 800.00 105.82 13.23 2210-06-101-7-15-100 11b Reimbursement of Travel 264.00 264.00 40.00 15.15 cost to HIV patient 2210-06-101-7-15-059 LWS 11c programme 100.00 100.00 111.20 111.20 89.70 13274.75 11098.24 9954.95 Total