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Introduction to elm presented at National Sensitization workshop for Industreis on ELM April 2015


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National Sensitisation workshop for Industries on Employer Led Model
29th April 2015
Silver Oak, Habitat World, India Habitat Center,
Lodhi Road, New Delhi

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Introduction to elm presented at National Sensitization workshop for Industreis on ELM April 2015

  1. 1. Introduction to India HIV /AIDS program and Employer Led Model
  2. 2. Killer Diseases… Cardiovascular disease (17 m) Malaria (500 m people fall severely ill) Diarrhea related diseases (2.2 m) then why HIV/AIDS? 25/9/2017 NW on EKM
  3. 3. Because… • HIV/AIDS affects the most productive age group of 15-49 years • HIV infections can be prevented • It is never possible to get the exact magnitude of the HIV • Impact beyond health – socio economic • Key challenges in HIV prevention: • There are no immediate and exclusive symptoms of HIV • Discussion on sexual issues is a taboo • High levels of stigma and discrimination 35/9/2017 NW on EKM
  4. 4. HIV/AIDS Status in India • 3rd largest no. of People Living with HIV - 21 lakh • Low adult HIV prevalence : 0.27% • HIV is concentrated among : o High Risk Groups (FSW, MSM, TG, IDU) o Bridge Groups (Migrants & Truckers) • 2 Key Strategies: i) Prevention ii) ii) Care, Support & Treatment • Programme implemented through State AIDS Control Societies under the State Govts 5/9/2017 NW on EKM 4
  5. 5. Number of PLHIV – Top Ten Countries 61 34 21 16 16 15 15 14 11 11 0 10 20 30 40 50 60 70 South Africa Nigeria India Kenya Mozambique Uganda Tanzania Zimbabwe Malawi Zambia No. of PLHIV (Lakhs) Globally, 353 lakh persons estimated to be living with HIV 5/9/2017 NW on EKM 5
  6. 6. HIV Concentrated among Key Risk Groups High risk groups (FSW, MSM, IDU, TG) Bridge Population (Migrant workers & Truckers) General Population (Low risk Men & Women) New born Children FSW: Female Sex Workers; MSM: Men who have sex with Men; IDU: Injecting Drug Users; TG: Transgender/ Hijras 5/9/2017 NW on EKM 6
  7. 7. Routes of HIV Transmission Heterosexual, 88.2% Parent to child, 5.0%Not Specified , 2.7% Homosexual, 1.5% Infected Syringe and Needles, 1.7% Blood and Blood Products, 1.0% 5/9/2017 NW on EKM 7
  8. 8. NACP I (1994- 1999) Initial interventions NACP II (1999- 2006) - Decentralisation to states - Limited coverage of services NACP III (2007- 2012) Massive scale up with quality assurance mechanisms >50% reduction in new infections achieved NACP IV (2012-17) Consolidate gains, focus on emerging vulnerabilities, Balance with growing treatment needs, Quality assurance 5/9/2017 NW on EKM 8
  9. 9. Key Achievements in HIV/AIDS Control Programme • Low adult HIV prevalence : 0.27% • 3rd largest no. of People Living with HIV - 21 lakh • Substantial reduction in adult HIV prevalence from 0.41% (2001) to 0.27% (2011) • 57% reduction in annual new HIV infections among adults, from 2.74 lakh (2000) to 1.16 lakh (2011) • 29% reduction in annual AIDS-related deaths from 2.07 lakh (2007) to 1.48 lakh (2011) • Over 1.5 lakh lives saved due to free testing & treatment till 2011 5/9/2017 NW on EKM 9
  10. 10. Why NACO needs partnership with other Public & Private sector ? • Increasing HIV in low prevalence states of North India due to migrant labor • Rise in HIV among Injecting Drug Users in some States: Punjab, Delhi, etc. • Emerging epidemics to be addressed through effective & customized region-specific prevention strategies • Ensure treatment requirements are fully met without sacrificing the needs of prevention • Integration with larger health system including private to ensure sustainability • Access to social protection schemes for people infected and affected with HIV/AIDS through mainstreaming of HIV/AIDS with other ministries • Alleviating stigma and discrimination 5/9/2017 NW on EKM 10
  11. 11. Rationale for ELM
  12. 12. Increasing Informalisation of work • “More than 90% of the workforce and 50% of the domestic product are accounted for by the informal economy” • Faster and inclusive growth needs special attention to informal economy. Formal Sector Formal Jobs, 4.4 Formal Sector Informal Jobs, 10.9 Informal Sector Formal Jobs, 0.1Informal Sector Informal Jobs, 84.6 Percent Distribution of Formal and Informal Sector Jobs, India (2004-05) Source: National Statistical Commission, 2012 5/9/2017 NW on EKM 12
  13. 13. 13 Challenges 5/9/2017 NW on EKM
  14. 14. 5/9/2017 NW on EKM 14 Migrant Labor show HIV risk States with higher vulnerability due to Migration Source: NACO HIV Sentinel Surveillance 2010-11 – Provisional Findings; Source: Population Council Study -- Reference: Saggurti N, Mahapatra BB, Swain SN, Jain AK. Male out-migration and sexual risk behavior in India: Is the place of origin critical for HIV prevention programs?. BMC Public Health. 2011. 11:S6; Higher HIV Prevalence among Pregnant Women with a Migrant Spouse Migrants over-represented (80%) among HIV+ men (Ganjam) 0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.13 0.39 Migrant Non-Migrant 19.7 55.6 52.8 18.7 27.6 25.7 0% 20% 40% 60% 80% 100% HIV Positive Cases HIV Negative Controls Non-Migrants Returned Migrants Active Migrants Role of Migration -Low HIV among High risk groups in source states -Higher HIV in rural than urban -Higher HIV in spouses of migrants than non-migrants
  15. 15. Risky sexual behavior of male workers by the nature of their occupation % men reported sex outside marriage by their occupation % reported consistent condom use in sex outside marriage by their occupation 14 16 12 13 20 30 12 18 23 20 12 21 29 19 0 50 100 Construction workers (N=2426) Hamalis (N=582) Daily wage workers (N=1343) Small Scale Industry laborers (N=3813) Stone cutters and others (N=538) Fishermen (N=891) Others (N=1626) Sex with non-spousal unpaid females Sex with sex worker 62 64 50 68 61 56 69 20 24 15 24 19 27 11 0 50 100 Construction workers Hamalis Daily wage workers Small scale industry workers Stone cutters and others Fishermen Others Condom use in sex with non-spousal unpaid females Condom use in sex with sex worker Source: Population Council, 2008 5/9/2017 NW on EKM 15
  16. 16. Goal To help prospective employers to implement a comprehensive program on HIV/AIDS prevention to care, by integrating awareness, service delivery with existing systems, structures and resources, within their business and training agenda. 5/9/2017 NW on EKM 16
  17. 17. Objectives • Increase awareness and access to HIV/AIDS services for the informal workers • To create enabling environment by reducing stigma and discrimination against PLHIV • To encourage and help prospective employers to integrate and sustain the HIV and AIDS Intervention Program within existing systems and structures 5/9/2017 NW on EKM 17
  18. 18. Strategic Approach • Evidence based prioritization for Intervention • Focus on vulnerable and at risk workers • Enhance access to awareness and services for HIV/AIDS/STI • No incremental cost : Integrating in existing structures and resources for implementation 5/9/2017 NW on EKM 18
  19. 19. Expectations through ELM • Integration of HIV/AIDS/STI Services in existing health set ups – Integrating STI Management within the TATA main hospital, mobile medical units – Integrating ICTC/PPTCT Services within the TATA main hospital, mobile medical units – Integrating ART and care and treatment services • Ongoing awareness for vulnerable workers and communities – Integrating within the health & safety programs – Training of medical staff, para medical staff at MMU – Employee volunteers for conducting awareness • Increasing access to condoms – Making the supply chain responsible for implementing HIV/AIDS program for their workers 5/9/2017 NW on EKM 19
  20. 20. The Cost and Benefit 20 STI PPTCT / ICTC Condom Promotion HIV/AIDS Awareness to Workers HIV-TB Benefit to Family Social benefit Treatment of OIs First & Second Line ART The return on investment in the prevention of HIV far exceeds that of standard capital investments. Studies have indicated that these returns, in terms of cost savings through preventing HIV, are as much as 3.5 to 7.5 times the cost of intervention Per Unit cost at Industry Level • Comprehensive HIV/AIDS program – INR 33 • HIV prevention program – INR 13 • Care and Treatment per PLHA– INR 6,500 5/9/2017 NW on EKM
  21. 21. Indirect Benefits 21 •Being responsible corporate citizen : To be good corporate citizens, extending welfare for contract workers and communities •For a positive image among workers : have both economic and social returns •Activities can be included as sustainability reporting as part of Corporate Social Responsibility (Schedule VII of Company Bill, 2012) •Contributor to National Program and Millennium Development Goal (MDG) 5/9/2017 NW on EKM
  22. 22. Thank You 5/9/2017 NW on EKM 22