Hiv general (30 august 2007)

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Hiv general (30 august 2007)

  1. 1. HIV in India UNAIDS India
  2. 2. Modes of transmission of HIV <ul><li>Sex </li></ul><ul><ul><li>Any unprotected sexual intercourse with an infected partner </li></ul></ul><ul><li>Blood – through micro or macro transfusion </li></ul><ul><ul><li>Macro transfusion: transfusion of contaminated blood </li></ul></ul><ul><ul><li>Micro transfusion: </li></ul></ul><ul><ul><ul><li>Sharing of needles and syringes among drug users </li></ul></ul></ul><ul><ul><ul><li>Accidental infection with (re) use of non sterile equipment – injection, razors, tatooing, piercing, etc. </li></ul></ul></ul><ul><li>Mother to child </li></ul><ul><ul><li>During pregnancy, birth or breastfeeding </li></ul></ul>
  3. 3. How HIV is not transmitted <ul><li>HIV transmission never happens in daily non-intimate </li></ul><ul><li>contacts. In particular: </li></ul><ul><ul><li>Every day contact at work, at school, at home, in public places, in swimming pools, etc. </li></ul></ul><ul><ul><li>Sharing of food, clothes, telephone sets, toilets, etc. </li></ul></ul><ul><ul><li>Normal bodily contacts: shaking hands, hugging, kissing </li></ul></ul><ul><ul><li>Mosquito bites </li></ul></ul><ul><li>HIV transmission requires exchange of bodily fluids </li></ul>
  4. 4. Evolution to AIDS <ul><li>7 to 10 years after infection </li></ul><ul><li>Progressive degradation of the immune system </li></ul><ul><li>AIDS is characterized by either: </li></ul><ul><ul><li>Specific opportunistic infections </li></ul></ul><ul><ul><li>CD4 count less than 200/microliter </li></ul></ul><ul><li>There is no cure for AIDS </li></ul><ul><li>With antiretroviral treatment, patients can live a normal life for several years. </li></ul>
  5. 5. In India Sexual Transmission Accounts for most of HIV infections <ul><li>Modes of HIV transmission </li></ul><ul><li>Sexual </li></ul><ul><ul><li>Unprotected Sex </li></ul></ul><ul><li>Parenteral </li></ul><ul><ul><li>IV drug use </li></ul></ul><ul><ul><li>Blood products </li></ul></ul><ul><li>Parental to child transmission (PTCT) </li></ul><ul><ul><li>Before birth </li></ul></ul><ul><ul><li>During birth </li></ul></ul><ul><ul><li>After birth during breastfeeding </li></ul></ul>
  6. 6. Approaches to preventing blood transmission in medical settings are well defined <ul><li>Ensure Safe Blood Products </li></ul><ul><li>Transfusion Guidelines to avoid unnecessary transfusions </li></ul><ul><li>Donor selection criteria </li></ul><ul><ul><li>Voluntary donor pool </li></ul></ul><ul><li>HIV (and other infectious disease) screening. </li></ul><ul><li>Single-use supplies </li></ul><ul><li>Institute “Universal Precautions </li></ul><ul><li>Adequate funding for supplies for universal precautions </li></ul><ul><li>Post Exposure Prophylaxis drugs and protocol in place </li></ul>
  7. 7. Multiple partners at the same time increase risk of HIV transmission <ul><li>Structure of sexual partnerships influences transmission </li></ul><ul><ul><li>Concurrent partnerships (partners at the same time) </li></ul></ul><ul><ul><li>Serial partnerships </li></ul></ul><ul><li>Researchers have shown that without differences in numbers of partners, HIV transmission 10-fold greater with concurrent partnerships </li></ul><ul><li>Multiple concurrent sexual partners common in </li></ul><ul><ul><li>Sex workers – male and female </li></ul></ul><ul><ul><li>Men who have sex with men on pleasure circuit </li></ul></ul>
  8. 8. Global HIV Epidemic, 2006 Source: 2006 Report on Global AIDS Epidemic, UNAIDS
  9. 9. About 11 000 new HIV infections a day in 2006 <ul><li>More than 95% are in low and middle income countries </li></ul><ul><li>Almost 2000 are in children under 15 years of age </li></ul><ul><li>About 9 000 are in persons aged 15 to 49 years, of whom: </li></ul><ul><ul><li>almost 50% are women </li></ul></ul><ul><ul><li>about 50% are 15–24 year olds </li></ul></ul>Source: 2006 Report on Global AIDS Epidemic, UNAIDS
  10. 10. > 1 % antenatal women HIV Prevalence reaches over 5% amongst high risk group in Maharashtra and Manipur First case of HIV detected in Chennai 1986 1990 1994 > 5 % high risk groups < 5 % high risk groups 2.5 m. adult Indians living with HIV 1998 2001 2006
  11. 11. There are pockets of high prevalence even in low prevalence states From 1 case in 1986 to 2.5 million in 2006 Deeper shade of Blue indicates higher prevalence Source: NACO’s Sentinel Surveillance data: ANC sites (2001, 2003)
  12. 12. Key Points About the Epidemic in India <ul><li>India HIV epidemic – HIV and AIDS found throughout India, in every region </li></ul><ul><li>We may still be in the epidemic’s early phase </li></ul><ul><li>Mainly driven by core groups and bridge population </li></ul>
  13. 13. HIV Situation in India <ul><li>2.5 million Indians are living with HIV in India – and most of them do not know their status. </li></ul><ul><li>India HIV epidemic – HIV and AIDS found throughout India, in every region </li></ul><ul><li>We may still be in the epidemic’s early phase </li></ul><ul><li>Mainly driven by core groups and bridge population </li></ul><ul><li>Nearly 90% not aware of their status. </li></ul>
  14. 14. Routes of HIV Transmission, 2006
  15. 15. <ul><li>To halt and reverse the epidemic in India </li></ul><ul><li>over the next five years </li></ul><ul><li>Objectives: </li></ul><ul><li>Prevention of new infections (saturation of HRG coverage and scale up of interventions for General population) </li></ul><ul><li>Increased proportion of PLHA receiving care, support and treatment </li></ul><ul><li>Strengthening capacities at district, state and national levels </li></ul><ul><li>Building Strategic information management systems </li></ul>NACP III: Goal
  16. 16. Key Features of NACP III <ul><li>Continued emphasis on Prevention </li></ul><ul><li>Significant up-scaling of activities (increased targets) to achieve MDG </li></ul><ul><li>Classification of districts by risk category </li></ul><ul><ul><li>A (163) B (59) C (278) D (111) </li></ul></ul><ul><li>TIs more focused approach (Sex workers, MSM and IDU interventions) </li></ul><ul><li>Empowering and capacity strengthening of CBOs to manage TIs </li></ul><ul><li>Introduction of Link Workers in A and B districts (more focus on IPC) </li></ul><ul><li>Focused efforts on women, youth and children </li></ul>
  17. 17. Key Features of NACP III (Contd…) <ul><li>Emphasis on quality of care </li></ul><ul><li>Increased access to ART, including resistance surveillance </li></ul><ul><li>Increased focus of pediatric ART care </li></ul><ul><li>Special efforts to address GIPA, impact mitigation </li></ul><ul><li>Mainstreaming and partnerships with private sector </li></ul><ul><li>Leveraging resources for sustainable response </li></ul><ul><li>Performance Oriented Programme Management </li></ul>
  18. 18. NACP III: Targets <ul><li>Saturation of HRG (1 million sex workers, 1.15M MSM and 0.19M IDU) through Targeted Interventions (TIs) </li></ul><ul><li>Focus on bridge population (truckers, migrants): 3M </li></ul><ul><li>Reach out to cover rural population(15-49 yrs): 280 M </li></ul><ul><li>PPTCT : 10.8 million and ICTC : 22 million tests </li></ul><ul><li>Blood Units: 8.5 million </li></ul><ul><li>STD : 30 million (50% to be covered) </li></ul><ul><li>Condom : 3.5 billion per year </li></ul><ul><li>Provision of ART (3,00,000) and community care centers (350) and their effective linkages with TIs </li></ul><ul><li>Expansion of HIV Sentinel surveillance (1200 sites) </li></ul><ul><li>M&E at district, state and national levels to be established </li></ul>
  19. 19. Estimated Financial Requirements 100.0 2633 Total 5.0 131 Contingency 3.0 82 SIM 7.9 207 Capacity Building and Program mgmt. 16.9 444 Care, Support and Treatment 67.2 1770 Prevention Percentage to Total Amount (USD Millions) Programme Component
  20. 20. Proportionate Requirement - NACP II vs. III <ul><li>NACP II (Rs. 2066 cr) </li></ul><ul><li>TI for HRG (16.26%) </li></ul><ul><li>Preventive Intervention for general community (56.57%) </li></ul><ul><li>Low cost AIDS care (4.39%) </li></ul><ul><li>Institutional strengthening (21.86%) </li></ul><ul><li>Inter-sector Collaboration (0.77%) </li></ul><ul><li>NACP III (Rs. 11585 cr.) </li></ul><ul><li>Prevention (67%) </li></ul><ul><li>Care, support & treatment (17%) </li></ul><ul><li>Capacity Building (7%) </li></ul><ul><li>Strategic Information Management (4%) </li></ul><ul><li>Contingency (5%) </li></ul>

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