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HIV/AIDS in India

HIV/AIDS in India.

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HIV/AIDS in India

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  1. HIV/AIDS in India A presentation by Dr. Kakrani to the workshop held Jan. 1 & 2, 2010 at the Pune Union of Working Journalists Hall in Navi Peth sponsored by the University of Miami and Indiana University titled, “Strengthening Media Professionalism and the NGO-Media Interface in India, and Sri Lanka for HIV/AIDS Coverage

  2. Dr.A.L.Kakrani, MD Dean, Faculty of Medicine Dr DY Patil University & Professor & Head, Department of Medicine Dr D Y Patil Medical College, Hospital & Research Centre Pimpri, Pune 411018 Phone: College & Hospital : 91-20-27423690/27420307 Ext 185 Residence: 91-20-25880873 Mobile: 09823972424 e-mail: kakrani@hotmail.com Res Address: 201,Vishakha,DSK Akashganga, New DP Road, Aundh, Pune 411007

  3. Probable Sources of Transmission in AIDS Cases in India (July, ’05)

  4. Transition Map of HIV prevalenceEvolution of HIV from 1986 to 2002 5.13 Million Indians Living with HIV/AIDS

  5. Decline in HIV incidence • According to NACO's newer estimates, the prevalence of HIV/AIDS in India has to be scaled down from about 0.9 per cent to one in 300 or 0.36 per cent, or to 2-3.1 million with an average of 2.5 millions from the government's 2006 estimate of 5.2 million. • Why are these numbers more accurate? The credibility of the new HIV prevalence figures is very high because they are derived from not one but three authoritative sources. Additional 'sentinel' surveys sites, NHFC-3 & NBSS & IBBAS

  6. Times of India LEADER ARTICLE: Don't Be Misled On AIDS 10 Jul 2007, Pallava Bagla • It may be premature to start celebrating that number of people infected with HIV has come down by half to 2.47 million as per the latest estimate released by the government. • The government went in for a different approach in 2006. Earlier, it would restrict itself to 'sentinel' surveys, This time, the government decided to supplement these surveys with community data. • Prabhat Jha of the Center for Global Health Research, Toronto, says, "It is hard to know how much of this drop is due to a new computer programme rather than the efforts of the AIDS control programme".

  7. Start of National AIDS Control Programme (NACP) was first step towards the control of HIV spread in India

  8. NACP Phase I Started in 1992 with Emphasis on • Epidemic monitoring by surveillance • Awareness generation through information , education & communication • Ensuring blood safety This led to a firm footing for NACP Phase II

  9. Objectives of NACP Phase II(1999-2004-extendable) • Reduce the rate of growth of HIV infection in India • Strengthen India’s capacity to respond to HIV/AIDS

  10. NACP-III2007 till date • Prevent infection through coverage of high-risk groups with targeted interventions and scaled up interventions in the general population. • Provide greater care, support and treatment to larger number of PLHA. • Strengthen the infrastructure, systems and human resources in prevention, care, support and treatment programmes at district, state and national levels. • Strengthen the nationwide Strategic Information Management System.

  11. NACP III Expenditure

  12. Antiretroviral Therapy Till date the only hope for long term survival of HIV AIDS patients is use of Antiretroviral Therapy

  13. Antiretroviral Therapy (ART) ART for HIV disease has transformed the common perception about HIV from being a rapidly fatal disease to some what more manageable chronic disease Risk of Opportunistic Infections is minimized & many non- infectious complications are reduced

  14. Global Response on HIV AIDS • Millennium Development Goal (MDG) By 2015: halt and begin to reverse the spread of HIV/AIDS. • June 2001: UN General Assembly Special Session “call to action” HIV/AIDS is a global emergency, it undermines socio-economic development& poses a challenge to full enjoyment of human rights

  15. Global Response on ART • April 2002:WHO released guidelines for ART in resource limited settings, includes 10 ART drugs in the list of “ Essential Medicines” for all countries, put pressure on Pharma Industries for cost reduction • Sept 03: WHO/UNAIDS: lack of ARV access is “Global Health Emergency” • 1st December 2003: WHO/UNAIDS revised “3 by 5” Initiative launched • 1st Dec 2003, GOI announced free ART from 1/4/04

  16. In February 2004,NACO has prepared the document for ART Guidelines in consultation with clinicians in public & private sector , technical experts from GOI,DGHS, WHO,UNAIDS, donors, CII, Pharma industry, network of HIV Positive, paramedical groups & NGOs. The document will be reviewed from time to time

  17. ART Programme in India Started after 3x5 initiative by WHO in 2003 Govt of India decided to provide free access to ART for 100,000 PLHA by 2005 but only 33000 could be enrolled GOI plans to expand the program up to district level to cover 3 lac PLHA by 2012 through 250 centres across India Program is largely supported by GFATM (Global Fund for AIDS,TB & Malaria ) Public Private Partnership is encouraged

  18. Pressures To Increase The Enrollments For ART Are Inevitable & May Interfere With The Rationale Use & Cause Gaps in Drug Delivery

  19. National ART DataNovember 2009

  20. Second line Anti-retroviral Therapy • Second line anti-retroviral therapy (ART) was rolled out under the National ART Programme on January 1, 2008 on a pilot basis at the JJ Hospital, Mumbai and GHTM, Tambaram. • Its access has expanded to 10 Centres of Excellence which have necessary expertise and laboratory facilities to initiate and monitor it. • Out of 687 patients who were evaluated, 274 were put on second line ART & 49 counselled

  21. Link ART Centres • Link ART Centres help decongest big ART centres & reduce patient's time & costs • It is planned to have 650 LACs under NACP-III. & A total of 334 LACs were sanctioned of which 68 are functional with 170 trained staff members

  22. Thailand Vaccine trial • For the first time a vaccine against AIDS has shown efficacy in humans. Although modest, it is very encouraging for the scientific community. • With one third of protected persons only, “this vaccine will not allow us to control the AIDS epidemic, But it is a very strong signal to the scientific community: it shows that we can vaccinate against HIV no vaccine against AIDS has so far shown efficacy in humans.

  23. Types of HIV Counselling • Prevention • Risk reduction, behavior change • VCT: Pre-test/Post-test • ART • ART readiness • Adherence • Crisis intervention • Grief and bereavement • Peer counselling

  24. Median Survival after AIDS Diagnosis in Brazil (1989-2001) Introduction of universal access to HAART in Brazil Chequer et al, 1992; Marins et al. 2002

  25. Number of AIDS deaths (registered and estimated) considering the actions of National AIDS Program Brazil, 1989 to 2002 Thousand 35 30 1994-2002: 90,962 avoided deaths 25 20 Projected without NAP actions 15 10 Registered with NAP actions 5 0 89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 Year of Death 1 Registered* Estimative without NAP actions * Estimated deaths after 1999, using real trend

  26. Source, ILO New Delhi, 2003

  27. Stigma and discrimination In Health Care System • Confidentiality breach • Mandatory testing – pre operative, ANC • Refusal of invasive procedures or surgery, when needed including elective caesarian section • Refusal of treatment for PLHA In Employment • Due to misconceptions, risk of frequent absence In Educational institutes

  28. HIV TB Co-Infection • HIV infection is the most powerful risk factor for progression from TB infection to disease. • An individual with dual infection of HIV-TB has more than 50% lifetime risk of developing TB as compared to 10% in TB infected person without HIV infection. • The rate of progression of TB is also 30 times more rapid in an HIV infected person. • TB accelerates the progression of HIV by causing a six-seven-fold increase in viral load. • It shortens the survival period of an HIV infected individual and is a cause of death for one in three cases of AIDS.

  29. HIV AIDS Bill 2005 • The HIV/AIDS bill, aimed at preventing discrimination and protecting the rights of people living with the disease, is 'under finalisation', union Health and Family Welfare Minister Ghulam Nabi Azad said on Tuesday 2009 • 'The draft of the bill on HIV/AIDS is at present under finalisation. However, no firm date can be indicated at this stage,' he said in a written reply to a question on when the bill was going to be introduced in parliament.

  30. Indian Estimates • India had an estimated 1.8 – 2.9 million HIV positive persons in 2007, with an estimated adult HIV prevalence of 0.34%(Males 0.43% & females 0.29% • HIV Prevalence among the high risk groups (HRG) is very high compared to that among the general population, India continues to be in the category of concentrated epidemic.

  31. Indian Estimates • 47 districts (48 sites) have shown >5% HIV Prevalence among FSW, which also include FSW sites in low prevalence states namely West Bengal, Bihar and Gujarat FSW sites • in Pune, Mumbai and Thane have shown > 30% HIV prevalence among FSW. Among FSW, there is a decline in South Indian States reflecting the impact of interventions

  32. Indian Estimates • Except Andhra Pradesh with HIV Prevalence of 1%, all other states have shown < 1% Prevalence among ANC Clinic attendees. 10 districts have shown a very high prevalence of 3% among ANC clinic attendees. • Expanded surveillance among MSM has revealed more than 5% HIV prevalence in Karnataka (17.6%), Andhra Pradesh (17%), Manipur (16.4%), Maharashtra (11.8%), Delhi (11.7%), Gujarat (8.4%), Goa (7.9%), Orissa (7.4%), Tamil Nadu (6.6%) and West Bengal (5.6%).

  33. The Red Ribbon Express Project is the world’s largest mass mobilization campaign on HIV/AIDS. covering 27000 kms & 6.2 million people from Dec 07 to Dec 08

  34. Maharashtra DataNovember 2009 • Total VCTCs 606 Reactivity Rate 0.54% (old data 0.1.09%) Total +ve reported cases 421578 • Total ART Centres 41 On ART 68460 (Pediatric cases 4967) • Total CD4 machines 22 • Total Blood Banks 307

  35. http://www.nacoonline.org Quick links-publications-news letter, this is available in English & Hindi • http://www.mahasacs.org Nirdhar in Marathi news letter on web site • International information is available on Unaids, WHO & UNICEF websites

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