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Strategic Plan Document for Next Five Years the Department of AIDS Department of AIDS Control - Strategic Plan Document Strategic Plan Document for Next Five Years The Department of AIDS Control Ministry of Health & Family Welfare Government of India Department of AIDS Control - Strategic Plan Document Department of AIDS Control adopts a robust evidence-based approach for development of strategy and implementation plan for prevention and control of HIV/AIDS in the country. National AIDS Control Programme (NACP) Phase-III (2007-12) was developed over a period of 2 years through dedicated Working Groups on each technical area, several consultations with stakeholders, reviews, special studies and consolidating evidence on the issues to be addressed as well as the interventions to be put in place. Being in the last year of NACP-III, NACO has already initiated a similar robust exercise for consolidating the evidence on achievements made till now, effectiveness of current strategies, need for strengthening ongoing interventions and identifying the important programme gaps where the next phase of NACP should focus upon. This exercise shall also examine the need for new strategies, new models of implementation as well as innovative approaches to achieve prevention and control of HIV/AIDS in India through universal access to prevention and care, treatment services. Since the exact strategy and implementation plan for next five years is in the process of development, this document outlines the broad strategy and plan adopted during NACP-III, strategies rolled out recently and the issues that are important for the next plan. 2 | P a g e Department of AIDS Control - Strategic Plan Document SECTION 1: Vision, Mission, Objectives and Functions Vision: The Department of AIDS Control envisions preventing and reducing HIV burden in India. Mission: The mission is to reduce HIV prevalence in population groups at risk of HIV/AIDS by an integrated prevention, care and support programme. Objective: The National AIDS Control Programme Phase-III (NACP-III) has the goal of halting and reversing the HIV epidemic in India over the five years (2007-12) by integrating programmes for prevention, care and support and treatment. This will be achieved through a four-pronged strategy: Prevention of infections through saturation of coverage of high-risk groups with targeted interventions (TIs) and scaled up interventions in the general population; Provision of greater care, support and treatment to larger number of people living with HIV/AIDS (PLHA); Strengthening the infrastructure, systems and human resources in prevention, care, support and treatment programmes at district, state and national levels; and Strengthening the nationwide Strategic Information Management System. Functions: Targeted Interventions Link Worker Scheme Management of Sexually Transmitted Infection / Reproductive Tract Infection Promotion of Condom use Blood Safety including promotion of Voluntary Blood Donation Integrated Counseling and Testing, and Prevention of Parent to Child Transmission services Information Education and Communication, and Social Mobilisation including mainstreaming Care, Support and Treatment including Antiretroviral therapy (ART) services and Treatment of Opportunistic Infections, HIV-TB Cross Referral and Community Care services for PLHA. Strategic Information Management including Monitoring & Evaluation, Surveillance and Research 3 | P a g e Department of AIDS Control - Strategic Plan Document SECTION 2: Assessment of the situation An estimated 23.9 lakh Indians are infected with HIV with an estimated adult HIV prevalence of 0.31% in an epidemic that is concentrated in high-risk populations, such as sex workers, men who have sex with men, transgender, injecting drug users, and clients of sex workers. Since the first HIV case was identified in India in 1986, the Government of India has worked to contain and prevent the spread of HIV and to provide care, support, and treatment for those already infected. In 1992, the National AIDS Control Organisation (NACO) was created by the Government of India, to prevent and contain the HIV epidemic through the three successive phases of National AIDS Control Programme (NACP-I, II and III). Overview of the HIV epidemic in India HIV epidemic in India is concentrated in nature. The HIV prevalence among the High Risk Groups i.e. Female Sex Workers, Injecting Drug Users, Men who have Sex with Men and Transgender is about 20 times higher than the general population. Based on HIV Sentinel Surveillance 2008-09, it is estimated that 23.9 lakh people are infected with HIV in India, of which, 39% are female and 3.5% are children. The estimates highlight an overall reduction in adult HIV prevalence and HIV incidence (new infections) in India. Adult HIV prevalence at national level has declined from 0.41% in 2000 to 0.31% in 2009. The estimated number of new annual HIV infections has declined by more than 50% over the past decade from 2.7 lakh new infections in 2000 to 1.2 lakh in 2009. The epidemic is concentrated with high prevalence among the High Risk Groups (HRGs) – Injecting Drug Users (IDUs) (9.2%), Men who have sex with men (MSM) (7.3%), Females Sex Workers (FSW) (4.9%) and Sexually Transmitted Infection clinic attendees (2.5%). Compared to this the prevalence among Antenatal Clinic attendees (pregnant women- proxy for general population) is much lower (0.49%). 11th five year plan document on health prepared by Planning Commission of India suggest that during the Eleventh Five Year Plan, the NACP goal is to halt and reverse the epidemic in India over the next five years by integrating programmes for prevention, care, support, and treatment and also addressing the human rights issues specific to people living with HIV/AIDS (PLHA). The specific objectives are to reduce new infections by 60% in high prevalence States so as to obtain reversal of the epidemic and by 40% in the vulnerable States so as to stabilize the epidemic this objective is in consonance with the objective NACP-III Based on Programme data, unprotected sex (87.1% heterosexual and 1.5% homosexual) is the major route of HIV transmission, followed by transmission from Parent to Child which is 5.4% and use of infected blood and blood products is 1.1%. While Injecting Drug Use is the predominant route of transmission in north eastern states, it accounts for 1.7% of HIV infections. 4 | P a g e Department of AIDS Control - Strategic Plan Document Fig1: Routes of HIV Transmission 2009-10: HIV Incidence HIV Sentinel Surveillance 2008-09 revealed that the number of new annual HIV infections has declined by more than 50% during the last decade. This is one of the most important evidence on the impact of the various interventions under National AIDS Control Programme and scaled-up prevention strategies. It is estimated that India had approximately 1.2 lakh new HIV infections in 2009, as against 2.7 lakh in 2000. While this trend is evident in most states, some low prevalence states have shown a slight increase in the number of new infections over the past two years that underscores the need for the programme to focus more on these states with low prevalence, but high vulnerability. Of the 1.2 lakh estimated new infections in 2009, the six high prevalence states account for only 39% of the cases, while the states of Orissa, Bihar, West Bengal, Uttar Pradesh, Rajasthan, Madhya Pradesh and Gujarat account for 41% of new infections. HIV prevalence There was a gradual scale up of the HIV Sentinel Survey (HSS) by an increase in the number of sites from 176 in 1998 to 1215 in HSS 2008/09 across the country. Technical changes were made to the recruitment strategy and the sample collection method for testing at HRG sites. Operational changes were also made by establishing an effective and structured training programme and institutionalizing a strong monitoring and supervision system. While an overall decline in HIV prevalence among antenatal care clinic (ANC) attendees is noted especially in high prevalence states; however, there is an increase in some low and moderate prevalence states. While there is a decline in the epidemic among FSW in south Indian states, rising trends are evident in the North East where the epidemic is increasingly driven both by IDU and sexual transmission. 5 | P a g e Department of AIDS Control - Strategic Plan Document Fig2: Declining Trends among FSW Stable to Rising Trends among IDU & MSM Source: HIV Sentinel Surveillance, 2003-09 A steady decline in HIV prevalence amongst FSW has been noted, resulting it may be argued, from focused government and stakeholder interventions. HIV prevalence among MSM is stable. A varied trend in prevalence has emerged among IDU however. The estimated adult HIV prevalence in India was 0.32% (0.26% – 0.41%) in 2008 and 0.31% (0.25% – 0.39%) in 2009(Source: HSS 2008-09), the adult prevalence is 0.26% among women and 0.38% among men in 2008, and 0.25% among women and 0.36% among men in 2009. Among the states, Manipur has shown the highest estimated adult HIV prevalence of 1.40%, followed by Andhra Pradesh (0.90%), Mizoram (0.81%), Nagaland (0.78%), Karnataka (0.63%) and Maharashtra (0.55%). Besides these states, Goa, Chandigarh, Gujarat, Punjab and Tamil Nadu have shown estimated adult HIV prevalence greater than national prevalence (0.31%), while Delhi, Orissa, West Bengal, Chhattisgarh & Puducherry have shown estimated adult HIV prevalence of 0.28-0.30%. All other states/UTs have lower levels of HIV. Trends of Adult HIV Prevalence The adult HIV prevalence at national level has continued its steady decline from estimated level of 0.41% in 2000 through 0.36% in 2006 to 0.31% in 2009. All the high prevalence states show a clear declining trend in adult HIV prevalence. HIV has declined notably in Tamil Nadu to reach 0.33% in 2009.
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