HIV/AIDS IN GOA Situation and Response GOA STATE AIDS CONTROL SOCIETY

Transcription

1 HIV/AIDS IN GOA 2009 Situation and Response GOA STATE AIDS CONTROL SOCIETY 0

2 Shri. Digambar Kamat, Hon. Chief Minister inaugurating Red Ribbon Clubs. Shri. Vishwajeet Rane, Hon. Minister for Health addressing during Voluntary Blood Donation Day 1 st October

3 HIV/AIDS IN GOA Situation and Response 2009 GOA STATE AIDS CONTROL SOCIETY 1 st Floor, Dayanand Smruti Building, Swami Vivekanand Road, Panaji, Goa Ph: / / Fax: Website: goaaids@gmail.com goaaids@dataone.in 2

4 Shri. Digambar V. Kamat Hon. Chief Minister, Goa Shri. Vishwajeet P. Rane Hon. Minister for Health, Goa Sanjay K Srivastava Chief Secretary/Chairperson of Governing Body, Goa SACS Shri. Shri Rajeev Verma Health Secretary/Chairperson of Executive Committee, Goa SACS Dr. Pramod Salgaocar Chairperson of Core Committee, Goa SACS Dr. Pradeep Padwal Project Director, Goa SACS 3

5 The Governing Body of Goa State AIDS Control Society 1) Chief Secretary --- Chairman 2) Commissioner Finance --- Member 3) Secretary (Health) --- Member 4) Secretary, Planning Department --- Member 5) Secretary, Social Welfare Department --- Member 6) Secretary, Education Department --- Member 7) Secretary (Industry) --- Member 8) Secretary, Women and Child Welfare Department --- Member 9) Secretary, Labour --- Member 10) Secretary, Urban Development Department --- Member 11) Secretary, Transport Department --- Member 12) Secretary, Tourism --- Member 13) Dean, Goa Medical College --- Member 14) Director of Health Services --- Member 15) Director, Information and Publicity --- Member 16) Station Director, All India Radio --- Member 17) Director, Sports & Youth Affairs --- Member 18) N.S.S. Coordinator, Goa University --- Member 19) Station Director, Doordarshan --- Member 20) Representative of UNICEF/WHO --- Member 21) Representative of NACO --- Member 22) Director of Tourism Department --- Member 23) Project Director --- Member Secretary 4

6 Executive Committee of Goa State AIDS Control Society 1. Secretary (Health), Chairman. 2. Dean, Goa Medical College Vice Chairman. 3. Director of Health Services Vice-Chairman. 4. Director of Education Member. 5. Director of the Women & Child Welfare Dept Member. 6. Joint Secretary, Finance Department, Member. 7. Director of Tourism Member. 8. Coordinator, NSS Goa University Member. 9. Director of Social Welfare, Member 10. Mrs. Toshi Mallik, Kripa Foundation, NGO Member 11. Mr. Azad Sheikh, Zindagi, NGO Member 12. Mrs. Denise Monteiro, Rishta, NGO Member 13. Prof & Head Department of Microbiology Member 14. Chairperson of Social Advisory Board Member 15. HOD, Department of PSM, GMC. Member 16. President of Goa Psychiatric Society Member 17. Project Director, GSACS Member Secretary 5

7 Core Committee of Goa State AIDS Control Society 1) Dr Pramod Salgaonkar Chairperson 2) Mrs Anisha Mendes Vice Chairperson 3) Dean, Goa Medical College Member 4) Dr. Virendra Gaonkar Member 5) Dr. Wisemen Pinto Member 6) Director of Health Services Member 7) Joint Secretary (Health) Member 8) Project Director, Goa SACS Member Secretary 6

8 Preface AIDS is one of the greatest challenges facing our generation. AIDS is a new type of emergency an unprecedented threat to human development requiring sustained action and commitment over the long term. AIDS has been with us for more than two decades. It will continue to challenge us for many decades to come but how far it spreads and how much damage it does, is entirely up to us. Today around 33 million people are living with HIV/AIDS throughout the world. This number increases in every region every day. As per the latest estimates of UNAIDS, in India alone 2.3 million people are living with HIV/AIDS. Ignorance and prejudice are fuelling the spread of a preventive disease. In Goa the estimated number of people living with HIV/AIDS is about 16,000. The year 2009 is a year to look back. It was exactly 28 years ago that HIV/AIDS made its appearance on the world stage. HIV/AIDS epidemic is nearly 22 years old in Goa. Now it is time to sit up and take stock. Goa SACS and its partners have a lot of introspection to do. Some inroads have been made but a lot more needs to be done. We need to take lessons from the past and plan effective strategies for the future. The most important lesson we have learnt so far is that we can make a difference. We can prevent new infections and we can improve the quality of care and treatment for People Living with HIV/AIDS. Now we know what works and need to find answers to what more can be done to halt and reverse the trends of this epidemic. How to contain the spread of HIV/AIDS from high risk groups to the general population and from urban to rural areas? How to make youth and women less vulnerable? How to ensure accessibility to various services such as ICTCs, ART, PPTCT, STDs, condom promotion, etc. made available by the government for the prevention and control of HIV/AIDS? How to improve the quality of services that are being provided? HIV/AIDS is still in early stages in Goa and effective responses are possible now. Unless more is done today not only do more but also do it better it is sure to cause devastation on an unprecedented scale and would reverse the achievements of the last few decades. In Goa HIV prevalence rate is less than 1%. Government of Goa is fully committed to prevent the spread of HIV/AIDS at the initial stage itself. But Government alone cannot do it. It is everyone s responsibility. It s up to you, me and us to stop the spread of HIV and end prejudice. People need to respond effectively to the threat that the community is facing. Prevention is important. We must never lose sight of doing everything we can do to prevent people from becoming infected in the 7

9 first place. While keeping the spirit of international theme for the AIDS campaign for this year, Stop AIDS Keep the Promise, we need to focus on youth and women by calling upon them to take charge of their lives to fight AIDS. Further we need to address stigma and discrimination through all communication channels, as they are the main barriers of AIDS prevention and control efforts and need to be prioritized. Goa resolves to defeat HIV/AIDS by creating total awareness on transmission & prevention, by holding extensive youth education campaigns and curriculum based school AIDS education programme, by creating a partnership across all stakeholders, by saturating targeted intervention in high risk groups, by providing care & support to people living with HIV/AIDS, by removing stigma & discrimination, by providing voluntary counseling & testing facilities at peripheral levels, by providing Anti Retroviral Therapy for PLHAs and by organizing mass mobilization campaigns across Goa. We must acknowledge that the battle against AIDS is poised at a challenging level. If we join hands we can triumph and if we don t, the grim scenario can well be envisaged. We can and we must overcome this crisis. This is the revised edition of the eighth publication compiled by Shri. H. K. Ravinder, Ex. Monitoring & Evaluation Officer. The other publications being Containing HIV/AIDS , AIDS in Women and Children , Bailo ani AIDS , Containing HIV/AIDS and Mandatory HIV Testing and Situation and Response I would like to place on record my sincere appreciation of the efforts made by Dr. Y. Durga Prasad, M & E Officer bringing out these revised publication. The updation is made by Shri. Narayan Zuwarkar, Statistical Officer. The secretarial assistance provided by Shri. Sandesh Bhagat, Computer Literate Steno and Ms. Shantagauri Kandolkar, M & E Assistant in bringing out this brochure is also acknowledged. Place: Panaji Date: 01/12/2009 Project Director, Goa SACS 8

10 List of tables. List of Charts. Table of contents Page No. Figures at a Glance Overview of the AIDS epidemic 1.1. HIV/AIDS Global Scenario HIV/AIDS in India Situation in Goa Goa s Response to HIV/AIDS 2.1. Introduction Blood Safety STD Control Programme STD Surveillance Prevention of Parent to Child Transmission CD4/CD8 Count facility Antiretroviral Treatment Community Care Centre Integrated Counselling and Testing Centre Information, Education, Communication (IEC) 46 & Social Mobilization Targetted Intervention Workplace Intervention Training Toll Free AIDS helpline Free drugs for OIs and PEP Condom Promotion Website Conclusion Success stories of NGOs 68 9

11 List of Tables Table No. Particular Page No. 1. Global Summary of the HIV/AIDS epidemic, Dec Age/sex wise distribution of AIDS cases reported in India, 1986 to May Proportion of reported AIDS cases by sex/age groups in India, 1986 to May Distribution of HIV/ AIDS cases by route of transmission, 1986 to May Total Number of tested conducted for HIV/AIDS testing from in Goa, 1986 to Taluka wise distribution of HIV cases detected in Goa, 1998 to Taluka wise percentage distribution of HIV cases detected in Goa, 1998 to Age /sex wise distribution of HIV cases detected in Goa, 1999 to Proportion (%) of HIV cases by sex in different age groups 1999 to Proportion of female infected to total HIV cases detected in Goa, 1987 to Route of Transmission of sero positive cases detected in Goa, 1999 to Sentinel Surveillance for HIV infection in Goa Proportion of direct walk in to total person tested at ICTC, Proportion of females and those in the age group total walk in clients Number of persons counseled at ICTCs, 2002 to Sex wise particulars of tested at ICTCs, 2002 to Reported no. of AIDS deaths in Goa, 2002 to No. of Units of Blood Screened for HIV in State Govt. Blood Banks, 2000 to No. of units of Blood screened for other transfusion related diseases in 34 state Govt. Blood Banks, 2000 to Blood Bank wise no. of blood units collected during HIV Positivity profile among STD patients in Goa 1994 to Details of STD detected in Govt. STD Clinics in Goa, 2008 to Data on PPTCT programme April 03 to Sept Year wise cases of CD4/CD8 count, 2001 to Number of patients screened /treated at ART Centre April 05 to Sept Taluka wise AIDS patient treated at ART Centre April 05 to Sept Activities of Community Care Centre 2008 to Grants released to NGOs by Goa State AIDS Control Society, Number of Project funded by Goa SACS, Grants released to NGOs by Goa State AIDS Control Society, Family Health Awareness Campaign in Goa,

12 List of Charts Chart No. Particular Page No. 1. Estimate of HIV infection in India, Proportion (%) of reported AIDS Cases by sex/age group 8 in India 86 to May Probable source of infection among AIDS Cases in India, 1986 to Trend in number of HIV cases detected in Goa, 1986 to HIV positivity rate in Goa, 1986 to Taluka wise distribution of HIV cases detected in Goa, 2005 to Taluka wise percentage of HIV cases detected in Goa, 1998 to Taluka wise proportion (%) of HIV cases detected in Goa, Proportion of HIV cases detected in different age groups by sex, Proportion of female to total HIV cases detected in Goa, 1995 to Route of Transmission of sero positive cases detected in Goa, Proportion of direct walk in to total person tested Trend in number of AIDS Cases in Goa, 1989 to Reported number of AIDS Deaths in Goa 2000 to HIV positivity rate among STD patients in Goa,

13 A: Global Scenario Figures at a Glance First case detected among homosexuals in USA in Reported number of AIDS cases in 1991was 0.37 million. Estimated number of people living with HIV/AIDS as on Dec was 33 million. People newly infected with HIV in the year 2007 were 2.7 million. Number of children (0-14) infected during the year 2007 was 3.70 lakh which accounts for 11 per cent of the total infected. About half of the new infections occur in young adults before they are 25 years old and who if untreated, will die within 10 years of contracting the infection. Everyday 7400 new infections occur in the world despite the fact more is known than ever before about prevention and control of the epidemic. 96% of all HIV/ AIDS infected people are living in developing countries. HIV /AIDS was considered as a male disease two decade ago. Now it is distributed almost equally among male and female. Worldwide women comprise an increasing number of adults living with HIV/ AIDS. Women accounted for about 50% of the adults infected in In sub-saharan Africa, women represent more than half (60%) of all people living with HIV/ AIDS. HIV/ AIDS has had profound impact on teens and young adults. 45% of new HIV infections and almost one-third of the global total of people living with the disease are aged In certain African countries, HIV infection rates are five times higher among young women than men. Since the onset of epidemic 25 million deaths have occurred all over world. During 2007 alone there were 2.1 million deaths due to AIDS of which 75% occurred in Sub-Saharan Africa. With the current trends life expectancies in many of the highly affected countries may drop below 30 years, reversing the steady gains over the last century. HIV has more than doubled the adult death rate in some countries and is the single biggest cause of adult deaths in many countries. HIV/ AIDS is among the top ten killer world wide and at given current rate of HIV infection it may soon move to the top five. World over the predominant mode of transmission is through sexual intercourse being 75%, followed by injecting drug use (10%), Perinatal (10%) and blood and blood products (5%) 1

14 B: Indian Scenario First case of HIV detected among sex workers in Chennai in Initial cases of HIV/ AIDS were reported among commercial sex workers in Mumbai and Chennai and injecting drug users in Northeastern states of Manipur. As per the latest estimates 2.3 million people are living with HIV/ AIDS in India at the end of year Adult HIV prevalence in India is approximately 0.36 per cent. HIV infection is now prevalent in all parts of the country. Maharashtra, Tamil Nadu, Karnataka, Andhra Pradesh, Manipur and Nagaland are the high prevalent states. Gujarat, Goa and Pondicherry are moderate prevalent states. Remaining states have been classified as low prevalent states. Trends indicate that HIV spreads from urban to rural areas and from high-risk groups (HRG) to low risk group (LRG). The time lag for the infection to spread from HRG to LRG is 3 to 5 years, as the infection will spread from CSWs to their clients that acts as the bridge population and then to wives/ other sexual partners of these clients during the period. However as per today infection among the low risk group is on the rise. In India higher percentage of males have high-risk behaviour and the disease is more common in males than in females. The number of women infected is steadily rising one in every four cases reported is a woman. Almost 89% of the reported cases belong to the age group years i.e. mainly the people who are sexually active and in the economically productive age group. Relatively, the disease affects females of younger age group more than males. About 43% of the females infected belonged to the age group as against 27% for males. The predominant mode of transmission is through heterosexual contacts (85.8%), followed by perinatal (3.8%), IDUs (2.2%) and blood and blood products (2.0%). 2

15 C: Goan Scenario First case of HIV detected in Total number of HIV cases detected in Goa since 1987 up to Sept is 12,432. Total AIDS cases reported to Goa SACS during August is Reported AIDS death 637 upto September 09. Estimated number of people living with HIV/ AIDS in Goa 16,000. HIV infection is now prevalent in all parts of Goa and majority of the cases are reported in the four coastal talukas viz. Salcete (17.1 %), Mormugao (16.4 %) in South Goa District and Tiswadi (11.5%) and Bardez (15.8%) in North Goa District 87% of the cases detected in Goa during 2009 (upto Sept. belong to the age group years. The disease is more common in males than females. Out of every five cases detected three are males. Whereas in 1997 out of four cases detected three were males. While nearly half of the females infected belong to the age group 15-34, more than one-third of the infected males belonged to this age group. Males infected in the age group of were little higher than female i.e. 47.3% male and 37.5% females. Nearly 50% of males detected Cases and 41% of female detected cases were in the age group 50 year and above. During , Sexual route is the predominant mode of transmission is in the range of 83 to 96.0% followed by Perinatal is 4 to 7.6%, Transmission through blood and blood products and infected syringes and needles is negligible in Goa. As per the Sentinel Surveillance Survey 2008, HIV Prevalence rate amongst STD patients was 4.80% MSM 5.60 %, FSW 5.60 % and among antenatal mother was 0.67 %. 3

16 1 - Overview of the AIDS epidemic 1.1: HIV/AIDS Acquired Immuno Deficiency Syndrome (AIDS) is caused by Human Immuno-deficiency Virus (HIV). It is a serious disorder of the human immune system in which the body s normal defence system breaks down, leaving it vulnerable to a host of life threatening infections / conditions including unusual malignancies. HIV / AIDS is not a disease which spreads randomly but is transmitted as a consequence of a specific behavioural pattern and has strong socioeconomic implications. It not only costs huge sums of money in terms of controlling the opportunistic infections such as tuberculosis, pneumonia and cryptococcal meningitis, but also seriously affects individuals in their prime reproductive years causing serious economic loss to them, their families and the community; destroying people s lives and in many cases seriously damaging the fabric of societies. AIDS is unique in human history in its rapid spread, its extent and depth of its impact. Since the first AIDS case was diagnosed in 1981, the world has struggled to come to grips with its extraordinary dimensions. Few communities recognized the dangers ahead, and even fewer were able to mount an effective response. 1.2: Global Scenario HIV/ AIDS has brought about a global epidemic far more extensive than what was predicted a decade ago. UNAIDS estimates show that the number of people living with HIV/AIDS globally at the end of the year 2007 stood at 33 million. This is more than one and half times the estimate made by WHO s Global Programme on AIDS in 1991 on the basis of the data then available. The HIV/ AIDS epidemic continues its expansion across the globe with about 2.7 million newly infected cases including 3.70 lakh children under the age of 15 years in the year Approximately 7400 new infections occur every day in the world despite the fact that more is known than ever before about prevention and control of the epidemic. About 96% of all HIV/ AIDS infected people are living in developing countries least able to afford to care for the infected people but have to cope with the huge burden of suffering and deaths. Although HIV/ AIDS can affect all ages, about half of the new infections occur in young adults before they are 25 years old and who, if untreated, will die within 10 years of contracting the infection. Since the onset of the epidemic 25.0 million deaths have occurred all over the world. HIV deaths continue to increase, with an estimated 2.0 million during 2007 alone. HIV has more than doubled the adult death rate in some places, and is the single biggest cause of adult death in many countries. Indeed HIV/ AIDS is among the top ten killer worldwide and at given current rate of HIV infection it may soon move into the top five. Over 90% of the HIV infected babies are born to positive mothers in sub- Saharan Africa and worldwide there has also been a cumulative total of over 12 million AIDS orphans. AIDS is the most globalized epidemic in history and we are witnessing its growing feminization. Every year brings an increase in the number of women infected with HIV. Globally nearly half of all persons infected between ages of are women. In Africa the proportion is reaching 68%. Because of gender inequality, women living with HIV / AIDS often experience grater stigma and discrimination. 4

17 Table No. 1: Global summary of the HIV/AIDS epidemic, Dec Number of people living with HIV/AIDS TOTAL 33 million Adults 30.8 million Women 15.5 million Children <15 yrs 2.0 million People newly infected with HIV in 2007 TOTAL 2.7 million Adults 2.3 million Children <15 yrs 370,000 AIDS deaths in 2007 TOTAL 2.0 million Adults 1.8 million Children <15 yrs 270,000 Total number of AIDS deaths since the beginning of the epidemic TOTAL 25.0 million Source: UNAIDS HIV/ AIDS epidemic is characterized by marked regional variations between developing countries. In sub-saharan Africa an estimated 1.9 million people have been newly infected with HIV in 2007 alone, which was nearly two-thirds of the global annual total. Sub-Saharan Africa remains the hardest hit region, where the epidemic is having a devastating effect on social, economic and political development. This region alone in 2007 accounted for 67% of all the new HIV/ AIDS infections and 75% of all deaths due to this disease. It is estimated that 5.0 million people are living with HIV/AIDS in Asia and the Pacific at the end of The epidemic claimed the lives of 3.80 lakh people in the region in While HIV prevalence in adult population continues to be relatively low in many Asian countries, available behavioural data suggest increasing population vulnerability. Asian countries owing to their large populations have the potential to develop very large HIV epidemics in near future. 1.3: HIV/ AIDS in India The first case of HIV / AIDS in India was detected in 1986, at Chennai and was a Commercial Sex Worker. Within a period of about 19 years it has emerged as one of the most serious problems in the country. Though the initial cases of HIV/ AIDS were reported among commercial sex workers in Mumbai and Chennai and injecting drug users in north-eastern states of Manipur, the disease spread rapidly in the areas adjoining these epicenters and by 1997 Maharashtra, Tamil Nadu and Manipur together accounted for over three-fourths of AIDS cases and over two-thirds of HIV infections with Maharashtra reporting almost half the number of cases in the country. HIV infections are now being reported from all states and Union Territories. A shift in the epidemic has been observed from the high-risk population to bridge population (clients of sex workers, STD patients and partners of drug users) and then to the general population. There is a time lag of 2-3 years between the shifts from one group to another. The epidemic continues to shift towards women and towards young people with an accompanying increase in vertical 5

18 transmission and spurt of Paediatric HIV. Thus all the states go through a stage of low and then concentrated and finally generalized epidemic in the absence of effective interventions. Focusing on the future of the epidemic is complex. Low levels of infection in large population like India can translate into large number of new infections. Currently, the estimated HIV infection rate among adult population between years of age is 0.36%. The burden of AIDS cases is beginning to be felt in the states affected early in the epidemic. The present Indian scenario is equally serious with nearly 2.5 million HIV infections at the end of the year 2006 and the number of AIDS cases is likely to continue to increase in the country in the coming years. In view of the large population of the country, a mere 0.1 per cent increase in the prevalence rate would increase the numbers living with HIV by over half a million. Migration of labour, low literacy levels leading to low awareness, gender disparities, poverty, unemployment, patriarchy, cultural and behavioural attitudes, prevalence of sexually transmitted diseases (STD), and reproductive tract infections (RTI), are some of the factors attributed to the spread of HIV / AIDS. Alcoholism, drug abuse, sexual abuse, social and cultural beliefs, superstitions, slow degradation of social ethics and moral values, etc. also largely contributes to the spread. Based on the available sentinel surveillance data on HIV prevalence in adult population, the states/ union territories have been broadly classified in to three groups. Group I: High Prevalence States, which includes Maharashtra, Tamil Nadu, Karnataka, Andhra Pradesh, Manipur and Nagaland where the HIV infection has crossed 1% or more in antenatal women and there was more than 5% prevalence among STD patients. Group II: Moderate Prevalence States like Gujarat, Goa and Pondichery where the HIV infection has crossed 5% or more among High Risk Group but the infection is below 1% in antenatal women. Group III: Highly Vulnerable States which includes Bihar, Himachal Pradesh, Kerala, MP, Punjab, Rajasthan, UP, West Bengal, Chhattisgarh, Jharkhand, Orissa, Uttaranchal and Delhi were there are less than 1% antenatal women and less 5 % STD population. These States have large migratory population and weak health care infrastructure. Group IV: Vulnerable States, which includes, Jammu & Kashmir, Haryana, Mizoram, Meghalaya, Sikkim, Tripura, Andaman and Nicobar Islands, Chandigarh, Dadra and Nagar Haveli, Daman and Diu, Lakshadweep and Arunachal Pradesh where there are less than 1% antenatal women and less than 5% STD population. Since the detection of the first case of HIV infection in commercial sex workers in Chennai in 1986, there has been a steady increase in the number of AIDS cases seeking treatment in various hospitals across the country. Since 1986 till Dec 07 a cumulative total of 1, 60,112 cases of AIDS has been reported to National AIDS Control Organisation (NACO). These figures are considered as only a fraction of AIDS morbidity. AIDS cases reporting are highly inadequate due to under reporting by states and lack of diagnostic skills at different levels. It is observed that there is consistent rise in AIDS cases being reported every year. The above trend amply proves the worsening trends of HIV/ AIDS in India. Sex-wise and age group-wise distribution of the reported AIDS cases are given in Table 2. Proportion of reported AIDS cases by sex in different age groups is presented in Table 3 and distribution of HIV/AIDS cases by route of transmission are depicted in Table 4. While chart 1 depicts the trend in estimates of HIV in India during the period , Chart 2 presents the probable source of infection. 6

19 Chart No.1:Estimates of HIV infection in India, Estimated number of Persons Infected with HIV in India Source: National AIDS Control Organisation Table No. 2: Age/ sex wise distribution of AIDS cases reported in India,1986 to till May 06 Age group Male Female Total ,290 (3.8) 2,277 (6.2) 5,567 (4.5) ,804 (27.1) 15,807 (43.2) 39,611 (31.8) ,923 (61.4) 16,599 (45.4) 70,522 (56.7) > 50 6,789 (7.7) 1,877 (5.2) 8,666 (7.0) Total 87,806 (100.0) 36,560 (100.0) 1,24,466 (100.0) Note: Figures with in brackets indicate percentage to total Source: National AIDS Control Organisation Table No. 3: Proportion of reported AIDS cases by sex/age groups in India, 1986 to May 06 Proportion (%) of Age group Male Female Total 0-14 yrs yrs yrs >50 yrs Total Source: National AIDS Control Organisation 7

20 Chart No. 2: Proportion (%) of reported AIDS cases by sex/ age groups in India 1986 to till May 2006 Proportion of reported AIDS cases by sex in different age groups, 1986 to till May yrs yrs yrs. >45 yrs. Total Age group Male Female Source: National AIDS Control Organisation Table No. 4: Distribution of HIV/AIDS cases by route of transmission, Route Percentage Sexual 85.8 Perinatal transmission 3.8 Blood and Blood products 2.0 Injectable Drug Users 2.2 Others (not specified ) 6.2 Total Source: National AIDS Control Organisation Chart No.3: Probable source of infection among HIV/AIDS cases in India, 1986 to 2006 Mode of Transmission of HIV/AIDS (%) in India Sexual Blood and blood products Others/ not specified Infected syringes and neeles Parent to child Source: National AIDS Control Organisation 8

21 Epidemiological analysis of reported AIDS cases in India reveal that: The disease is affecting mainly the people in sexually active and economically productive age group 15 to 49 years of age. Almost 89% of the reported cases belong to this age group. The disease is more common in males than females. More than 70% of the reported cases were males. Relatively more females of younger age group are affected by the disease than males. About 43% of the females infected belonged to the age group years as against 27% among males. The predominant mode of transmission of infection in the AIDS patients is through heterosexual contacts (85%) followed by Perinatal transmission (3.8%), injecting drug users (2.2%), Blood transfusion and blood products (2.2%). The observations made in different parts of the country are clear pointer to the fact that the epidemic is spreading not only geographically, but also increasing in different risk groups numerically and further finds its route from these core groups to general population. It is spreading in two ways, from urban to rural areas and from individuals practicing high-risk behaviors to the general population. Taking into account the load of HIV/ AIDS infection as observed, India has all valid reasons to be alarmed and there is no denial of the enormity of the problem Situation in Goa HIV/ AIDS epidemic in Goa is nearly 22 years old. Since the first reported case of HIV in Goa in 1987, there has been a steady rise in the reported number of HIV/ AIDS cases. During the period from 1987 to 2009 (upto Sept 09) as many as 12,432 HIV cases have been detected at the Integrated Counseling and Testing Centres (ICTC). Prior to 1992, very few HIV cases ranging between 3 to 30 per year were detected but since 1992 the cases have been steadily rising and since the year 2000 more than 800 cases were detected each year. During the year 2009 ( upto Sept) out of 24,824 (including 9194 ANC) blood samples tested 758 (including 51 ANC) were sero positive. The number of blood samples screened, sero positive cases detected sex wise and reported number of AIDS cases sex-wise during the period from 1986 to 2009 (upto Sept) are presented in Table No. 5. The cases detected/ reported are not reflective of the actual position because of the lack of proper epidemiological data due to non-reporting and many of the infected persons are not aware of their HIV status. Further, there are many who are habouring HIV but are not aware of their HIV status. Again the blood samples screened may also cover some of the repeat tests i.e. people who may voluntarily walk-in to test their status more than once either at the same ICTC or at other centers or same patient referred during different episodes of illness/ treatment, etc. The estimated number of people living with HIV/ AIDS in Goa is around 16,

22 Table No. 5: Total No. of Tests conducted for HIV/AIDS testing from 1986 to 2009 (upto Sept) No. of Blood Sample tested HIV +ve cases Positivity No. of AIDS Rate Year (%) Gen ANC Total Gen ANC Total M F T ,255-1, ,822-3, ,210-10, ,071-10, ,603-8, ,690-8, ,978-7, ,533-4, ,279-2, ,959-2, ,526-3, ,903-4, ,804-7, ,813-7, ,216-7, ,848-13, , , , , , , , , , , ,684 11,053 26, * (upto Sept) 15, , Total 1,95,278 47,388 2,42,666 12, , Gen = General, ANC =Antenatal Clinic, *Include 1 TS/TG case each reported for the year

23 Chart No.4: Trend in number of HIV cases detected in Goa, 1986 to 2009 (upto Sept.) Chart. No. 5: HIV positivity rate in Goa, 1986 to 2009 (upto sept)

24 The taluka-wise distribution of the HIV cases (refer Table No. 6) in the general population, show that the majority of the cases detected are from the four coastal talukas namely Salcete followed by Mormugao, Bardez and Tiswadi. About two-thirds of the cases are reported from these four talukas. Incidentally these four talukas are relatively well developed both economically and socially compared to the other talukas. Till the year 2003, Mormugao taluka accounted for the highest number of HIV cases. Due to the demolition of the red light area at Baina located in Mormugao taluka, in June 2004, these HIV cases were scattered to various talukas. Since 2004, Salcete taluka is ahead of all the talukas except in Taluka wise distribution of HIV Cases is presented in Table No.6. Table No. 6: Taluka wise distribution of HIV cases detected in Goa, 2000 to 2009(Upto Sept) No. of HIV positive cases detected Taluka Tiswadi Bardez Pernem Bicholim Satari Ponda Salcete Mormugao Sanguem Quepem Canacona Others# Total *Others include those belonging to other states, foreigners as also those not specified. Chart No. 6: Taluka wise distribution of HIV cases detected in Goa, 2005 to 2009 T al uka wi sa Di str i buti on of HIV cases dur i ng 2005 to Taluka 12

25 From Table No.7, it is clearly visible that about 34% of the HIV cases detected in Goa are from the talukas of Mormugao and Salcete in South Goa District and about 27% was from Bardez and Tiswadi Taluka in North Goa District. Taluka-wise percentage distribution of HIV cases detected are presented in Table No. 7. Table No. 7: Taluka wise percentage distribution of HIV cases detected in Goa, 1998 to 2009 (Upto Sept) Taluka Proportion (%) of HIV positive cases detected Tiswadi Bardez Pernem Bicholim Satari Ponda Salcete Mormugao Sanguem Quepem Canacona Others# Total *Others include those belonging to other states, foreigners as also those not specified. 30 Chart No.7: Taluka-wise percentage of HIV cases detected in Goa, 1998 to 2009 (upto Sept) Tiswadi Bardez Pernem Bicholim Satari Ponda Salcete Mormugao Sanguem Quepem Canacona

26 Chart No.8: Taluka wise proportion (%) of HIV cases detected in Goa, 2009 (upto Sept) 14

27 Table No. 8: Age / Sex wise distribution of HIV cases* detected in Goa,2003 to 2009 (upto Sept) Age group * 49+* Not specifie d Total 27 (4.2) (5.1) 46 (4.5) 38 (6.1) (7.5) 63 (6.6) 37 (5.8) 29 (7.3) 66 (6.4) Age group (up to Sept) M F T M F T M F T M F T M F T M F T M F T (5.4) (7.0) (6.0) (5.9) (6.8) (6.2) (22.9 ) 387 (59.9 ) 60 (9.3) 24 (3.7) 646 (100.0) 187 (50.6 ) 147 (39.7 ) 14 (3.8) 3 (0.8) 370 (100.0) 335 (33.0) 534 (52.6) 74 (7.3) 27 (2.6) 1016 (100.0) 130 (20.9 ) 384 (61.6 ) 61 (9.8) 10 (1.6) 623 (100.0) 124 (37.2 ) 157 (47.1 ) 24 (7.3) 3 (0.9) 333 (100.0) 254 (26.6 ) 541 (56.5 ) 85 (8.9) 13 (1.4) 956 (100.0) 120 (18.9) 425 (67..1 ) 52 (8.2) 133 (33.7 ) 208 (52.7 ) 25 (6.3) 253 (24.6) 633 (61.5) 77 (7.5) (100.0) 395 (100.0) 1029 (100.0) 93 (15.6) 408 (68.6) 62 (10.4) 118 (34.2) 184 (53.3) 19 ( (22.4) 592 (63.0) 81 (8.6) 119 (18.0) 424 (64.0) 80 (12.1) 119 (32.4) 196 (53.4) 27 (7.4) (100.0) 345 (100.0) 940 (100.0) 662 (100.0) 367 (100.0) 238 (23.1) (60.3) (10.4) (100.0) Total * From 2002onwards the age group being and 50+the figures in the groups are not strictly comparable with those of earlier years. Note: Figures within brackets indicate percentage to total *Excluding ANC 40 ( (4.5) 197 (33.8) 262 (45.0) 57 (9.8) 29 (7.8) 36 (9.7) 156 (42.1) 124 (33.4) 26 (7.0) 69 (7.3) 62 (6.5) 353 (37.1) 386 (40.5) 83 (8.7) 18 (4.2) 24 (5.6) 136 (31.9) 209 (49.1) 39 (9.2) 15 (5.3) 23 (8.2) 110 (39.1) 114 (40.6) 19 (6.8) 33 (4.7) 47 (6.6) 246 (34.8 ) 323 (45.7 ) 58 (8.2) No specified (100.0) 371 (100.0) 953 (100.0) 426 (10.0) 281 (100.0) 707 (100.0) Chart No.9: Proportion of HIV cases detected in different age groups by sex, 2009 (upto Sept) Age/Sex wise distrubution of HIV female detected in Goa upto September 2009 Age group wise proportion of HIV-infected males in Goa, 2009(upto September) >50 < >50 15

28 Table No. 9: Proportion (%) of HIV cases by sex in different age groups 2003 to 2009 (upto Sept) Age (upto Sept) Age group group M F T M F M F T M F T M F T M F T M F T * * Not specified Not Specified Total Total * From 2002onwards the age group being and 50+the figures in the groups are not strictly comparable with those of earlier years. 16

29 Epidemiological analysis of the reported HIV cases reveals that: The disease is prevalent in all parts of Goa and the majority of the cases are reported in the four costal talukas of Goa viz. Mormugao, Salcete in South Goa District and Bardez and Tiswadi in North Goa District. One out of three cases detected belonged to age group year during 1999 to 2003, However, during 2004 to 2007, it is observed that one out of four cases belonged to this age group and in 2008&2009, more than two out of five detected cases belonged to the age group years. During 2009 (upto September) as much as 87% of detected cases are belong to age group. This disease is prevalent more among males than females. Of late out of every five cases detected three are males. Whereas. In 1997 out of four cases detected three were males. Males and Females are almost equally infected in the age group Females of younger age group are infected almost equally with their male counter parts. While 47.3% of the females infected belong to the age of years, about 37.8% of the infected male belonged to this group in In 2003, almost half of the infected females belonged to the age group years. Proportion of females infected in the younger age group i.e is relatively more than in higher age groups (refer Table 9). While in the higher age groups viz and 50+ the proportion of males is nearly 58 %, in the age group 15-24, female proportion is higher than the male proportion. While the proportion of females among the sero positive cases ranged between 10.1 to 12.3% during the years 1995 to 1998, 30.7 to 43.8% during 1999 to 2009, thus registering a steep rise in the prevalence of HIV among women. The corresponding figures for the years prior to 1995 are not strictly comparable because certain high-risk groups like sex workers were targeted during these years. The above data thus reveal HIV infection in women is on the rise and now out of every three cases detected one is a female compared one in eight or ten a few years back. Sexual route is the predominant mode of transmission and it ranged between 83 to 96% followed by mother-to- child transmission 4 to 8% (refer Table11). Infection through blood and blood products and infected syringes/ needles are negligible in Goa. 17

30 Table No. 10: Proportion of females infected to total HIV cases detected in Goa, 1987 to 2009 Proportion of females to total Year HIV cases detected (%) (upto Sept 09) 43.8 Chart No.10: Proportion of females to total HIV cases detected in Goa, 1987 to 2009(upto Sept) Proportion of females to total HIV cases detected (%) Percentage Years 18

31 Table No. 11: Route of transmission of sero positive cases in general population detected in Goa, 2000 to 2009 (upto Sept) Route of transmission Sexual Infected syringes and needles Blood & blood Products Parent to child Others / not specified Total (90.6) 666 (83.2) (0.1) 33 (4.1) 42 (5.2) 807 (100.0) - 45 (5.6) 90 (11.2) 801 (100.0) 903 (90.4) 6 (0.6) 3 (0.3) 41 (4.1) 46 (4.6) 999 (100.0) 968 (95.3) (4.6) 1 (0.1) 1016 (100.0) 894 (93.5) 4 (0.4) 3 (0.3) 55 (5.8) 952 (92.5) 7 (0.7) 5 (0.5) 65 (6.3) (100.0) 1029 (100.0) 868 (92.3) 5 (0.5) 1 (0.1) 54 (5.8) 12 (1.3) 940 (100.0) 966 (93.9) 881 (92.4) (0.2) 58 (5.6) 3 (0.3) 1029 (100.0) (7.6) 2009 (upto Sept. 08) 671 (95.0) 3 (0.4) 1 (0.1) 30 (4.2) - 2 (0.3) 953 (100.0) 707 (100.0) Chart 11: Route of transmission of sero-positive cases detected in Goa, 2009 (upto Sept) Sexual Blood &Blood Product Not Specified infected syringes and needles Parent to Child 19

32 Table No. 12: Sentinel surveillance for HIV infection in Goa Year No. of sentinel sites HIV prevalence (%) STD-2 ANC-3 MSM-1 FSW-1 STD-2 ANC-2 MSM-1 STD-2 ANC-2 MSM-1 STD-2 ANC-2 MSM-1 STD-2 ANC-2 MSM-1 SW-1 STD-2 ANC-4 MSM-1 SW-1 STD-2 ANC-2 SW 1 STD 2 ANC -2 SW 1 STD 2 ANC -2 STD 2 ANC -2 STD 2 ANC -2 STD 1 ANC 2 TB 1 STD 1 ANC STD STD ANC

33 In Goa Annual Sentinel Surveillance to monitor the trends of HIV infection among high-risk groups as well as low risk groups is being conducted regularly since Sentinel Surveillance methodology has been standardized by NACO and as such earlier data is not strictly comparable. In Round 2008, there were seven sentinel sites STD(2), ANC(3) and MSM(1) and FSW (1). During the period 2000 to 2003, there was a sentinel site for FSWs. With the demolition of the red light area at Baina in Mormugao taluka this has been discontinued since However, the FSW site has been started during 2008.The available data presents a varied picture. Sero positivity in STD patients was around 20% during 1995,1996 and 1998 and in other years it has varied between 12 to 16%. In 2007 and 2008 it has varied between 4.80 to 5.60%. In the red light area of Baina the prevalence among sex workers was more than 50% during 2000 and 2001, and in 2002 it was 24% and 30% in During June 2004, the red light area has been demolished and the site has been discontinued. During 2008, the site has reselected and the prevalence rate was 5.60 % Rate among antenatal mothers varied from 0.0 to 1.38% and the available trend presents a zig zag picture. Dring 2005 to 2008 the rate among antenatal mother are 0%, 0.5%, 0.18% 0.67% respectively Based on the available data Goa has been classified as a moderate prevalent state and the South Goa District as one of the 49 high prevalent districts in India. Table No. 13 presents the proportion of direct walk-in clients to total persons tested at ICTCs during the period 1999 to As could be seen from this table, the proportion of walk-in clients at the ICTCs ranged between 2.5 to 7.0 per cent during the years 1999 to The corresponding figure for the year 2002 was to the tune of 42.3%. This steep rise was mainly due to the initiatives taken up for an intensive voluntary test drive during the AIDS Fortnight 1 st to 14 th December During the year 2008, the proportion of walk-in clients was 20.8% and in 2009 it is 31.3%. The HIV prevalence rate amongst walk-in clients ranged between 3.9 to 16.4% during the years 1999 to During 2009, it was 6.6% 21

34 Table No.13: Proportion of direct walk-in to total persons tested at ICTC, (Upto Sept) Year No. of person tested for HIV No. of direct walk-in persons tested Proportion of direct walk-in to total persons tested (%) Total persons tested positive Direct walk-in persons tested +ve Number % Number % , , , ,848 5, ,682 2, ,221 3, ,814 4, ,023 2, ,485 2, ,684 3, (upto Sept ) 15, Table No.14: Proportion of females and those in the age group to total walk in clients Proportion (%) of Year females among walk-in clients Clients in the age-group Year females among walk-in clients Clients in the age-group Note: As per NACO guidelines, from 2008 onwards the age group has been changed to

35 Table No. 15: Number of persons counseled at ICTCs, 2003 to (upto Sept. 08) Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total 1. Number of persons counseled 1.1 Pre-test , * * 1.2 Post-test * * 1.3 Followup Proportion of persons Counseled (%) 2.1 Pretest Posttest Followup *includes 2 TS/TG in 2008 and 1 in

36 Chart No.12: Proportion of direct walk-in to total persons tested 1999 to 2009 (upto Sept) Proportion of direct walk-in Table No. 14 depicts age-group/ sex wise composition of direct walk-in persons undergoing HIV testing. It is observed that the proportion of direct walk-in females undergoing HIV testing was around 33 to 42% during the year 1999 to But these figures have registered a steep rise during 2003 and 2004 being around 81%. This is perhaps mainly due to the fact that with the launching of PPTCT programme all the antenatal cases referred by the Gynaecology Department were treated as walk-in clients. During the year 2007, it was around 39%. For reporting purpose, the existing age groups i.e15-29, and 45 & above has been changed to 15-24, 25-34, and 50 & above from 2008 onwards. Table No.15 presents the number of persons counseled at the ICTCs during 2003 to 2009 (Upto September). Though the proportion of reported number of clients receiving pre-test counseling was very high ranging between 95 to 100%, the actual situation is much different because in the case of most of the in-patients where the blood samples are sent with the consent form no counseling is done by the attending doctor/ nurse. But based on the consent form they are being treated as counseled. The proportion of received post test counseling was 95% in 2009 (upto Sept.) and in the year 2003 it was only 20%. This achievement is mainly due to active participation and awareness among the community. Table No 16 presents sex wise particulars of persons tested at ICTCs for the years 2003 to 2009 (upto Sept 09). It could be seen that the proportion tested positive in females both among walk-in clients as also total females, has registered a marginal fall since 2006.The same trend continued for year 2009 also. Among males, the proportions of test positive has gradually increased from 8.8% to 10.6 % during 2002 to But from 2006 onwards the trend has been reversed, i.e. the proportion of positivity among males has decreased from 10.15% to 3.9%. The same trend has been observed in voluntary walk-in clients among males. The proportion of positive among walk-in males clients has been decreased from 17.7% in 2006 to 4.8% in

37 Table No. 16: Sex wise particulars of tested at ICTCs 2002 to 2009 (upto Sept) S. No (upto Sept) 1. Total number of person tested 1.1 Male 7,434 6, ,215 11, Female 6,414 5, Total 13,848 11, ,485 15, * * 2. Number tested positive 2.1 Male Female Total 999 1, Proportion Tested positive 3.1 Male Female Total Total number of walk-in clients tested 4.1 Male 2, Female 3,632 2, Total 5,857 2, Number tested positive among walk-in clients 5.1 Male Female Total Proportion Tested positive among walk-in clients 6.1 Male Female Total *includes 2 TS/TG in 2008 and1 in The number of AIDS cases reported to Goa State AIDS Control Society in 2008 is 105 and AIDS deaths being115. The reported number of AIDS cases during the period from 1986 to 2009(upto Sept 09) was 1196 and the reported number of AIDS deaths was 637. The reported number of AIDS cases does not reflect the actual magnitude of the problem. This is mainly due to non-reporting and under reporting by the hospitals. The number of AIDS cases is expected to rise in the next 5 to 10 years as those who are already infected with HIV will by then end up with AIDS. 25

38 Chart No. 13: Trend in number of AIDS cases reported in Goa, 1989 to 2009 (upto Sept.) Table No. 17: Reported no. of AIDS Deaths in Goa, 2000 to 2009 (upto Sept) Year Male Female Total Cumulative figures ( ) (upto Sept 09) Total

39 Chart No. 14: Reported no. of AIDS Deaths in Goa, 2000 to 2009 (upto Sept)

40 2. Goa s Response to HIV/AIDS 2.1: Introduction When the first reported cases of HIV/AIDS were detected in 1987, Government of Goa initiated steps to target populations at risk of infection with HIV screening and prevention efforts. In Goa AIDS control programme was launched in May 1992with the setting up of the AIDS Cell under the Directorate of Health Services. As per the guidelines of Government of India, for smooth flow of funds to the programme and for greater functional autonomy, Goa State AIDS Control Society (GSACS) was established in April For effective control and prevention of the epidemic, GSACS primarily facilitates and directs various activities at the state and local levels. The first phase of the National AIDS Control Programme (NACP) was implemented during mainly to slow down the spread of HIV, to reduce future morbidity, mortality and the impact of AIDS by initiating a major effort in the prevention of HIV transmission. The second phase of NACP ( ) has two key objectives viz. (i) Reduce the spread of HIV infection in Goa and (ii) Strengthen Goa s response to HIV/AIDS on a long-term basis. Some of the strategies adopted in its efforts to prevent and control HIV/AIDS are: Prevent further spread of the disease by: Improving HIV/AIDS awareness and providing necessary skills/tools to protect themselves. Controlling STDs including condom promotion. Ensuring availability of safe blood and blood products. Creating a socio-economic environment that enables individuals to protect themselves from infection and allows families and communities to provide care and support to people living with HIV/AIDS. Improve services at all levels hospitals and community based home care that provide care for people living with HIV/AIDS. The Phase-III ( ) of AIDS Control Programme will no doubt build on the strengths developed, lessons learnt, gaps identified and experiences gained in the previous two phases of NACP, and consolidate the achievements. However, HIV can no more be the sole agenda of one organisation or department. Mainstreaming HIV/ AIDS into the exiting responses of various development processes and government/ nongovernment responses is a cost effective and efficient approach to address the direct and indirect causes and impact of the epidemic. Strengthened partnerships with traditional and non-traditional stakeholders from Government, Civil society and private sector are a critical strategy for facilitating sustained outreach and coverage. The long-term vision of NACP III is to make HIV/ AIDS everybody s responsibility and move towards the goal - to stabilise HIV prevention zero new HIV infection. 28

41 Some of the visions envisaged in the NACP III would be: By creating an enabling environment conducive for mobilization and empowerment and achieving saturated coverage (80%) of high-risk population towards reducing the risk of HIV infection by This includes addressing the core issue of capacity building among all constituencies involved in the planning and implementation of TI. To have a holistic approach to service delivery and provide all the required services at one stop centre in an integrated mode. Improve quality of care, enhance, and support initiatives for HIV infected ensuring sustained care and support with 90% coverage for OIs/ ART. To have a cohesive training strategy to translate the overall objectives of strategic planning for HIV/ AIDS prevention and control into reality with capacity building as the guiding principle. Decentralisation of the entire planning and implementation process down to district/ taluka/ grass root levels to match the ground realities. To protect all sexual acts having risk of HIV/ STI transmission and unintended pregnancies by enhancing knowledge and behaviour change, increasing access and minimizing wastage of condoms and directing specific condom promotion strategies. To prevent further spread of HIV to the general population based on the vulnerability. The vision is: Together we will win against HIV/ AIDS through social ownership and social action. Greater Involvement of People living with HIV/AIDS (GIPA) i.e. empowered involvement of people living or affected by HIV/ AIDS, which is critical for appropriate and effective responses. Everyone having access to rights without any discrimination, including the highest standard of health, living, services, information, support structures, facilities and networks. To mitigate the vulnerabilities of children, adolescents, young people, women and other gendered identities in relation to HIV/ AIDS by enhancing their access and participation to comprehensive and appropriate HIV/ AIDS programme in the prevention of HIV, care and support continuum through rights based gender sensitive approach. To have evidence based strategic planning and better programme management, Strategic Information Management Unit to be set up at the state level and M & 29

42 E units to be set up at the district levels with requisite capacity building training for M & E and Project Managers on how to use data for management and in conducting self assessment of service quality & client satisfaction. With these brief visions, it is proposed to halt and reverse the epidemic in Goa by For the control and prevention of HIV/AIDS in Goa, GSACS over the last 13 years has initiated various measures and has also developed certain infrastructure facilities/ services, which are listed below: 2.2 Blood Safety All the blood banks under the state government i.e. the ones attached to the Goa Medical College and the two district hospitals viz. Hospicio and Asilo have been modernised and suitably strengthened with requisite blood bank equipments, trained manpower, consumables, chemicals and other infrastructure. Testing of every unit blood for detecting infections for diseases like Hepatitis B & C, Syphilis and Malaria apart from testing for HIV has been made mandatory to ensure that only safe blood is released for transfusion as per the National Blood Safety Policy. For this purpose necessary kits, equipment, reagents, glassware and blood bags are supplied to the above three blood banks by Goa State AIDS Control Society. Goa State Blood Transfusion Council has been set up to oversee blood transfusion services and ensure effective implementation of the programme and better management of blood banking services at state/ district levels. Professional donors have been totally banned in Goa and efforts are being made to gradually phase out replacement donors and achieve 100% voluntary donation programme. As could be seen from table19, voluntary donation has increased from 28.7% in 2000 to 62.6% in Regular blood donors and NGOs who organise blood donation camps on a regular basis were felicitated by the Goa State Blood Transfusion Council at the state level function on Voluntary Blood Donation Day i.e. 1 st Oct., in recognition of their contribution. 30

43 Replacement donors are being motivated to become regular voluntary donors. Young people are being encouraged to form voluntary blood donation clubs in colleges, etc. Sustained awareness campaigns to educate and motivate people to donate blood voluntarily using various media are being undertaken. A Blood Component Separation Unit has been set up at Goa Medical College in October 2002, which will help proper and optimal clinical use of blood for transfusion. This would also improve availability of adequate blood components and their use instead of whole blood. NACP-II envisages to reduce blood borne transmission of HIV to less than 1% by the end of the project. The percentage of HIV infection through blood and blood products ranges from 0 to 0.3% in Goa (refer Table.11) compared to about 3% in India. In Goa there are in all five t blood banks which three under the state government and two private. Table No. 18 presents the number of units of blood collected in the blood banks attached to Goa Medical College and the two district Hospitals. As could be seen from the table, about 8 to 14 thousand units of blood are collected annually in these three blood banks of which Goa Medical College alone accounts for 78 to 90%, followed by Hospicio Hospital with about 8 to 12 %. The number of units of blood collected by the private blood banks is relatively very less in Goa. 31

44 Table No. 18: No. of Units of Blood screened for HIV in State Government Blood Banks 2000 to 2009 (upto Sept) Year No. of units of blood collected HIV reactive %age reactive Voluntary Replacement Total Voluntary Replacement Total Voluntary Replacement Total (28.7) (71.3) (100.0) (30.9) (69.1) (100.0) (33.3) 6254 (66.7) 9374 (100.0) (45.3) (54.7) (100.0) (55.8) (44.2) (100.0) ,671 (53.4) (46.6) (100.0) ,558 (58.6) (41.4) (100.0) ,396 (62.6) (37.4) (100.0) ,862 (61.4) (38.2) (100.0) (upto Sept ) (65.8) (34.2) (100.0) *Cover three Blood banks under Goa Government only. Table No.19: No. of units of blood screened for other transfusion related diseases in state Government Blood Banks 2000 to 2009* Year No. Tested Reactive %age reactive Hep. B Hep. C VDRL Malaria Hep. B Hep. C VDRL Malaria N.A N.A N.A N.A (upto Sept) *Cover three Blood banks under Goa Government only. 32

45 Table No. 20: Blood Bank- wise no. of blood units collected during 2008 Voluntary Replacement Total Male Female Total Male Female Total Male Female Total GMC Hospicio Asilo INHS Jeevanti Sri Sai Fonseca s SMRC Apollo Victor Total Proportion of Blood units collected in the three blood banks under state Govt. was nearly 93% of which 78% was from GMC. Private blood banks contributed only 7% of the blood units collected. Voluntary donation accounted for 57% of the blood units collected. In the state government blood banks the proportion of voluntary donation was 62% in 2008 compared to 29% in the year % of the donors were females. Among voluntary donors the proportion of females was 18% compared to 11% among replacement donors. HIV Sero positive cases among donors blood bank wise in 2008: GMC 0.45% Hospicio 0.33% Asilo 0.0% INHS Jeevanti 0.0% Sri Sai 0.0% Fonseca s 0.0% Apollo 0.0% In all 160 bloods donation camps were organized during the year by GMC, 30 by Hospicio and 9 by Asilo units of blood was collected in the camps by the 3 Blood Banks which constituted 50% of the total blood units collected by these 3 Blood Banks. Average number of blood units collected per camp: GMC 46.6 Hospicio Asilo

46 2.3 STD Control Programme In view of the importance of treatment and control of STD in relation to HIV infection, STD control programme has been made an integral component of AIDS control policy. Government of India has accorded top priority to the prevention and control of STDs as a strategy for controlling the spread of HIV/ AIDS in the country. Suitable strategies have been devised for the control and prevention of STD as a priority in the overall planning to control the spread of the HIV infection. In Goa the STD control is being implemented as a part of the National STD Control Programme since mid sixties by the Directorate of Health Services. With the arrival/ spread of HIV infection and because of its strong relation with STD, the programme was brought under the purview of National AIDS Control Programme in the year 1992 as per the national pattern. With this, the programme has received the much needed boost in terms of: All the four Government STD clinics in Goa - in the Department of Skin and V.D., Goa Medical College; Hospicio Hospital, Margao; Asilo Hospital, Mapusa and STD Clinic, Baina have been strengthened by providing technical support, equipment, reagents and drugs. Funds have been provided by Goa SACS for renovating the STD Clinics at Hospicio, Asilo and Baina. Each STD Clinic is provided Rs.0.20 lakh per year for consumables by Goa SACS. Adequate and comprehensive case management including diagnosis, treatment, individual counseling, partner notification, provision of condoms, etc. Orientation trainings for all the medical and paramedical workers engaged in providing STD/ RTI services through syndromic approach have been organised. 27 doctors (including private practitioners) have been trained in STD case management through syndrome approach in 2009 i.e. management of STDs based on specific symptoms and not dependent on laboratory investigations. Management of STDs has been incorporated/ integrated in the general health service/ peripheral health system, so that unnecessary referrals can be avoided leaving the specialized service free for management of complicated cases. Development of appropriate laboratory services for the diagnosis of STD. Early diagnosis and treatment of mostly asymptomatic infections through case finding and screening. 34

47 Special emphasis on early detection and prompt treatment of STDs among Highrisk groups such as CSWs, MSM, migrant labour, Truckers, etc. STD referral system has been developed under targeted interventions undertaken by the NGOs in their respective project areas. Prevention and transmission of STD/ HIV infection through IEC including raising of awareness to educate the people for responsible sexual behavior, safer sex, condom usage and promotion of appropriate health care seeking behaviour. Surveillance to assess epidemiological situation and monitor and evaluate the ongoing STD control programme. Sensitisation of community about the problems related to RTIs/ STD through Family Health Awareness Campaign for early detection and referral to CHC/ PHC for treatment. In Goa six such rounds have already been carried out. Greater emphasis is placed on strategies to prevent STD through integration of STD prevention in IEC for HIV prevention. STD services are being made available through integrating STD case management at the first level of the health delivery system. 2.4 STD surveillance The HIV Positivity profile among STD patients in Goa during 1994 to 2008 is presented in Table No. 21. The details of STDs detected in the government STD Clinics during the period 2000 to 2009 are presented in Table 22. In Goa, the most common STD among males is Chancroid and Syphilis and among females Candidiasis. 35

48 Table No. 21: HIV positivity profile among STD patients in Goa, Year Prevalence rate (%) among STD attendees Sentinel Sites STD clinic Baina STD clinic Baina STD clinic Baina STD clinic Margao STD clinic Baina and Margao STD clinic Baina and Margao STD clinic Margao and GMC STD clinic Margao and GMC STD clinic Margao and GMC STD clinic Margao and GMC STD clinic Margao and GMC STD clinic Margao and GMC STD clinic Margao and GMC STD clinic Margao and GMC STD clinic Margao and GMC Chart No. 15: HIV positivity rate among STD patients in Goa, (%)

49 Table No. 22: Details of Sexually Transmitted Diseases detected in Govt. STD Clinics in Goa, 2008 to 2009 Type of Diseases 1.Vaginal/ Cervical Discharge(VCD) 2.Genital Ulcer (GUD)-non herpetic 3.Genital ulcer(gud) herpetic 4.Lower abdominal pain(lap) 5.Urethral discharge(ud) 6.Ano-rectal discharge (ARD) 7.Inguinal Bubo(IB) 8.Painful scrotal swelling (SS) 9.Genital warts 10.Other STIs 11. Asymptomatic STI treatment 12 No of people living with HIV/AIDS (PLHAs) attended with STI/RTI during the month (upto Sept) Total M F O T M F O T M F O T Total No of cases

50 2.5 Prevention of Parent to Child Transmission. HIV epidemic in Goa has entered the 3 rd phase (NACP-III ) where significant transmission is occurring through perinatal route. The annual proportion of HIV infection through this route is around 4 to 6% (including children < 14 years having HIV +) in Goa. The sentinel survey data in Goa indicated that the prevalence rate among antenatal mothers varied from 0.0 to 1.38%. The efficacy of mother-to-child transmission ranges from 20 to 40%. Antiretroviral prophylaxis can reduce the maternal viral load and bring down transmission by more than 50%. PPTCT being a cost-effective strategy for prevention and control of the epidemic, PPTCT programme was launched at Goa Medical College in April 03. In Goa, annually about 23,000 live births occur. Assuming the prevalence rate of HIV infection among pregnant women as one per cent and a vertical transmission rate of 30% about 70 infants acquire HIV infection every year. During the last eleven years i.e to 2009, the number of HIV-infected children (<15 years) detected in Goa at the ICTCs ranged between 33 to 69 in a year accounting for 4.1 to 7.3% of the total cases detected. With the progress of the epidemic in the general population and the increase in the proportion of women in the reproductive age group, HIV transmission from mothers to infants is likely to increase in the coming years. During the year 2009 in Goa 758 (including ANC) new HIV infections were detected of whom 332 or 43% were females. Among the infected females, 88% of the females infected were in the reproductive age group i.e years and nearly 39% of females were in the age group years and 8.2 % in the age group years. There by indicating that young women in the reproductive age are being infected more than women in older age/ group. Needless to point out Mother to Child transmission will become a greater problem unless aggressive and effective preventive measures are undertaken now. It is pertinent to point out here that rise in paediatric AIDS cases has the potential to undermine the infant/ child survival gains made in Goa in the last few decades through comprehensive maternal and child health programme. PPTCT programme was extended to the two District Hospitals during Coverage for surveillance of antenatal mothers has increased because of the availability of ICTCs at all the CHCs, thus the positive antenatal from all ICTCs are referred for the PPTCT facility at the District /GMC. Some of the critical components of PPTCT programme are: The programme envisages effective reduction of MTCT of HIV infection by providing quality antenatal care including preventive services. Provision of reproductive health related interventions in couple-setting Promotion of rational use of blood Voluntary Counseling and Testing for HIV infection Health education to pregnant mothers covering nutrition, infant feeding practices, exclusive breastfeeding, birth spacing methods, etc. Interventions to reduce MTCT including antiretroviral drugs Care and support to HIV infected mothers and children and reducing their vulnerability. 38

51 Table No. 23: Data on PPTCT programme April 03 to Sept 09 Item 2003 (w.e.f. April) (upto Sept) 1.1 Total number of new ANC registered ,758 12, , Total number of women counseled ,489 11, , %age of women counseled among new ANC registered Total number of women who accepted HIV test ,432 11, , Proportion of women accepting HIV test among those counseled Total number of women found HIV positive HIV prevalence rate (%) Total number of women who received post test counseling , %age of women who received post test counselling among those tested Total number of HIV positive women who collected HIV results Percentage of HIV+ve women who collected the result Number of spouses/ partners of HIV positive women counseled %age of partners of +ve women counseled among those collected the report %age of partners of +ve women counseled to all +ve women Number of spouses/ partners of HIV positive women accepted HIV test %age of partners of +ve women counselled accepting the test Number of spouses/ partners detected HIV positive HIV prevalence rate (%) of partners Number of Women directly in labour without ANC registration 147 1,257 1, , Number of women counseled who arrived in labour without ANC , %age of women counselled who arrived in labour without ANC Total 39

52 3.4 Number of women accepted HIV test (out of 3.2) , %age pf women (without ANC) accepting the test among those counselled Number of women detected HIV positive (out of 3.4) HIV prevalence rate (%) Total number of deliveries , Total number of live births to positive women (out of 1.6and 3.6) Total number of mother-baby pair received NVP Number of mother-baby pairs received NVP who were registered for ANC (out of ) 4.5 Number of mother-baby pairs received NVP who come directly in labour without ANC (out of 3.6) 4.6 Proportion of mother-baby pairs receiving NVP among live births to +ve women Number of babies received NVP (out of 4.2) Some of the salient features of the PPTCT programme are: About 99 per cent of the antenatal mothers accepted HIV test after counseling. HIV prevalence rate among antenatal mothers who accepted HIV test ranged 0.62 to 1.48%. HIV prevalence rate among antenatal mothers who accepted HIV test has decreased from 1.48% in 2003 to 0.55 in About 86% of the spouses/ sexual partners of HIV positive women were counseled of whom 99 per cent opted for HIV testing. 80 per cent of the spouses who opted for HIV test were found to be HIV positive. Nearly 100% of partners of +ve women were accepted counselling Nearly 88% of women counselled who arrived in labour without ANC. HIV prevalence rate (%) directly in Labour has been decreased from2.36% in 2003 to 0.13% in % of mother-baby pairs receiving NVP among live births to +ve women 40

53 2.6 CD4/CD8 CD4/ CD8 blood count facility: For management of HIV/ AIDS patients, CD4/ CD8 count facility has been established at Goa Medical College in July With the setting up of ART centre at Goa Medical College on an average 6 to 8 patients are screened per day for CD4/ CD8 blood count to verify and assess the immune status of a HIV patient. It is proposed to have additional CD4/CD8 testing facilities in Goa keeping in view the expansion plan of the ART Centres and also increasing number of patients on ART. Table No. 24: Year wise cases of CD4/ CD8 count, 2001 to 2009 Activity 2001 (From March) 1. No. of New cases 2. No. of Old cases for repeat of counts 3. No. of cases performed within 6 months of previous estimation. 4. No. of tests performed free of charge 5. No. of tests performed on payment Total tosept 09) Antiretroviral Treatment Antiretroviral therapy has been launched in this state at Goa Medical College in March 05, which in it self is the elixir of hope for the HIV/ AIDS patients. To start with, Symptomatic AIDS patients with CD4 count less than 200 are being provided free antiretroviral treatment at Goa Medical College. During the period from April 05 to upto Sept 09, 3,460 patients were screened for ARV eligibility and 1253 patients were put on ART out of which 873 were alive and on ART as on Sept 09. Number of patients screened and put on ART is given in Table No. 25. It is proposed to extend ART facilities at two District Hospitals and the identification of the teams for training is under way. 41

54 Table No.25. No of patients screened/treated at ART centre April.05 to Sept 09 S. No: 1. Number of patients screened for ARV eligibility 1.1 Adult males Adult Females TG Children (<14 years) Total Number of patients enrolled for ARV treatment 2.1 Males Females Children (<14 years) Total Number of patients who discontinued 3.1 Died Transferred out Stopped treatment Lost to follow-up No. of patient not return to ART centre whose treatment 3 status is MIS in this month 3.5. Total Total Number of patients alive and on ART 873 Table No. 26: Taluka wise AIDS patient treated at ART Centre April 05 to Sept 09 Taluka < & above Total M F M F M F M F M F Total Pernem Bardez Tiswadi Bicholim Satari Ponda Mormugao Salcete Sanguem Qupem Cancona Others * Total *Includes from the state of Maharashtra, Karnataka, Andra Pradesh, and from U. P. 42

55 Parameters 2.8. Community Care Centre To take care of AIDS patients two Community Care Centers with 10 beds each, have been set up in Goa which are run by the NGOs and are being funded by Goa State AIDS Control Society. The one in North Goa is located at Guirim, Bardez, which is run, by Freedom Foundation and the other at South Goa is located at Cavellosim, Salcete which is run by Caritas, Goa. This Community Care Centre provides services required in between a home and a hospital. Table No. 27: Activities of Community Care Centres, 2008 to 2009 upto Sept. M Freedom Foundation Caritas Freedom Foundation Caritas F TS /RG C T M F TS/ RG C T M F TS/ RG C T M F New PLWA Registered On ART & Attended (Out patient) Not On ART On ART Old Registered PLHA 3 attended(out patient) 12 Not On ART New PLHA admitted On ART (In-patient) Not On ART Old Registered PLHA On ART admitted(in-patient) Not On ART No. of deaths among On ART PLHA (other than inpatient) Not On ART No. of deaths among On ART admitted PLHA (In Patient) Not On ART TS/ RG C T 43

56 2.9: Integrated Counseling and Testing Centres (ICTCs) In order to help people know their HIV status, to get early access to care and treatment, to prevent HIV related illness, to maintain safer sexual practices, to cope with HIV related anxiety and to plan for the future, voluntary testing facilities with pre-test/ post-test counseling have been made available at Goa Medical College, one centre each at the two Dist. Hospitals and one at Chicalim Hospital, Vasco. During the year , four more ICTCs were set up at the CHCs (Canacona, Pernem, Valpoi and Curchorem), which are in the process of being made fully functional. At present, on an average about 3,000 blood samples are screened per month. The proportion of walk-in clients at the ICTCs ranged between 2.5 to 7.0 per cent during the years 1999 to The corresponding figure for the year 2002 was to the tune of 43 per cent. This steep rise was mainly due to the initiative taken up for an intensive voluntary test drive during the AIDS Fortnight 1 st to 14 th December During the year 2009, the proportion of walk-in clients was 31.3%. From 2007 the VCTC has been changed to ICTC. Integrated because it caters to both pregnant and direct walk in clients. ICTC services has been made available at all the CHCs, coverage of spouses of pregnant mothers attending the ANC has been positively increased. Three new ICTC centres namely PHC Candolim, Central Hospital, Usgao and TB & Chest Diseases Hospital, St.Inez have been established. Three Private Public Partnership for ICTCs namely Campal Clinic, Campal-Panaji, Appollo Victor Hospital - Margao and Vrundavan Hospital.-Mapusa have also been established Information, Education, Communication (IEC) & Social mobilization Information, Education and Communication (IEC) is a process that informs, motivates and helps people to adopt and maintain healthy practices and life skills. It aims at empowering individuals and enabling them to make correct decisions about safe behaviour practices. IEC also attempts to create an environment that is conducive and supports access to treatment and services for those already infected. In the absence of a vaccine or a cure, prevention is the most effective strategy for the control of HIV/ AIDS and therefore communication is one of the most important strategies in the fight against HIV/ AIDS and STDs. The second phase of the National AIDS Control Programme gives highest priority to an effective and sustained strategy to bring about changes in behaviour to prevent further infection. A full range of activities and approaches from mass media campaigns for the general public to target specific interventions to help individuals to negotiate safer practices are being adopted. IEC programmes have also been integrated in various components of the programme such as STD services, condom promotion, Blood safety, TIs, etc. The basic objectives of the IEC strategy are: To raise awareness, improve knowledge and understanding among the general population about AIDS infection and STD, routes of transmission and methods of prevention. To promote desirable practices such as avoiding multi-partner sex, condom use, sterilization of needles/ syringes and voluntary donation of blood. 44

57 To mobilize all sectors of society to integrate messages and programmes on HIV/ AIDS into their existing activities. To train health workers in AIDS communication and coping strategies for strengthening technical and managerial capabilities. To create a supportive environment for the care and rehabilitation of persons with HIV/ AIDS. The various components of the IEC strategy for raising awareness, behavioural change and social mobilizations are: Use of mass media Advocacy at various levels Inter-sectoral collaboration Training Involvement of NGOs In order to develop Information, Education and Communication strategies to key target groups relevant to Goa, a Communication Needs Assessment Study was undertaken by the Tata Institute of Social Sciences, Mumbai in the year An IEC Committee consisting of qualified and experienced IEC specialists have been formed to strategize, review, provide feedback and extend support to Goa State AIDS Control Society. Some of the activities undertaken by Goa State AIDS Control Society to raise the awareness levels and to bring about behaviour changes are: A: General General education programmes on HIV/ AIDS are conducted for the youth organizations, voluntary bodies, government departments, women, high risk groups, opinion leaders, schools, colleges, etc. Hoardings with messages on HIV/ AIDS displayed at prominent places. Konkani dramas (tiatr) and magic shows on HIV/ AIDS were staged in villages. Video spots / audio cassettes/ Awareness promos on HIV/ AIDS. Folk media and floats were organized during the carnival and shigmo parades. 45

58 Fillers on HIV/AIDS in Konkani has been produced and screened on cable network throughout Goa. Screening of films on stigma discrimination and human rights related to HIV/AIDS. Televisions installed in and out-patient departments of GMC for screening of spots on HIV/AIDS during the OPD hours. Booklets on (i) Questions and answers on HIV/AIDS (ii) Containing HIV/AIDS in Goa (iii) AIDS in Women and Children and (iv) AIDS Fortnight, etc. were brought out. Handbills and pamphlets on STD and HIV/AIDS produced in different languages. Posters on STDs/ HIV/ AIDS/ Blood Safety/ Post Exposure Prophylaxis, etc. are produced and distributed to all the hospitals, Health Centres, NGOs, etc. Folders on STDs were produced and are being used extensively by field workers for interpersonal communication. Six rounds of FHAC were undertaken since 1999 to raise awareness in RTI/ STD/ HIV/ AIDS and encourage treatment seeking behaviour among the general population and marginalized groups. House to house awareness by field staff of Health Services and ICDS along with distribution of IEC pamphlets and folders on STD/ HIV/ AIDS. World AIDS Day fortnight is observed on 1 st December at State level and all the Primary Health Centres as also by the NGOs every year. Voluntary Blood Donation Day is observed on 1 st October every year. Regular voluntary blood donors and NGOs who organise regular voluntary Blood Donation Camps are felicitated. Posters and greeting cards have been made based on the prize-winning entries of the World AIDS Day commemoration Informative sessions/ open forum on HIV/ AIDS/ STDs are organised for industrial workers police departments, Postal staff. All queries, doubts, misgivings on sex, sexuality and other related topics are answered by a team of doctors at the work place. 46

59 B: Awareness in educational institutions Talks on HIV/AIDS given by the Health Officers/ M.O.s in schools and colleges in their jurisdiction. Programme on HIV/AIDS have been carried out at the PTA meetings in different schools in Goa. Question-answer sessions have been held in different educational institutions where a panel of resource persons from the GSACS and GMC answer the questions asked by the students anonymously. Disha 2000, a student-to-student educational programme was launched. Sessions on HIV/ AIDS have been conducted in different schools to the students of Std. IX and Std X. Under this programme, medical interns of Goa Medical College educate the students of high schools and higher secondary schools on family life values including sexuality and HIV/AIDS. A booklet on sexuality and other related issues based on the frequently asked questions by the students has been prepared, which will address the myths and misconceptions that youth have. To catalyze an expanded response towards HIV/ AIDS epidemic, Goa SACS has intersectoral collaboration with all the Govt. Depts., NGOs, industries, political leaders, etc. by networking and advocacy. Sports has proved to be an effective means of IEC to raise awareness in the state. The Goa Police Football tournament was hosted by Goa State Aids Society in collaboration with the Goa Football Association. At each match venue information stalls and counselors interacted with people Telling them about HIV/AIDS and demonstrating the use of condoms. Condom mascot was created to break the shyness of condom usage. Brand Ambassador was launched to initiate the Aids awareness among the youth. During , 22 Red Ribbon Clubs (RRCs) and in (upto Sept) ten RRC s have been established. Mobile IEC van launched for throughout Goa under Mid-Media campaign. 13 permanent/rented hording were displayed in prominent places conveying the HIV/AIDS messages. 47

60 Bus panel messages of HIV/DIS and Blood safety has been displayed in 20 KTC busses. Local Folk troops performed 270 programmes in various parts of Goa conveying the messages of HIV/AIDS. The National AIDS Control Programme seeks to attain awareness level of not less than 90% among the youth and others in the reproductive age group by the end of the project. It is rather encouraging to note that in some key important areas like generation of awareness about HIV/ AIDS which were almost insignificant at the beginning of the epidemic have increased among the general population both in urban and rural areas as also among the high risk groups. The Behavioural Surveillance Survey (BSS) carried out by Government of India in 2006 among the general population in various states has revealed that: The overall awareness about HIV/ AIDS among people in the age-group years in Goa was 93.6%, males 97.0% and females 90.2%. In urban areas awareness levels were much higher being 99.0% for males and 94.6% for females. The lowest awareness was among rural women (87.2%). About 91% of the respondents were aware that HIV/ AIDS is transmitted through sex. This level of awareness was next only to Kerala (96%). (Figures for all-india was 75% and the lowest was in Bihar 51%). The corresponding rates were higher among urban residents (95.5) and males (urban males 95 %) lowest was among rural females (84%). Awareness of transmission of HIV/ AIDS through blood (95%) and sharing of needles (94%) was consistently high. About 69% were aware that the infection could be transmitted through breast-feeding. About 87% of the respondents were aware of the potential benefits of consistent and correct condom use in prevention of transmission of HIV/ AIDS. More than 76% of the respondents were aware that having one faithful and uninfected sex partner could prevent the transmission. A significantly larger portion of the respondents (70%) were aware that sexual abstinence played an important role in prevention of transmission compared to other modes of transmission. Knowledge that the HIV infection cannot be transmitted by mosquito bites and sharing of meals with an infected person and that a healthy looking person may be suffering from HIV/ AIDS was relatively low in Goa. 48

61 Future strategies to address the gaps and response to the evolving epidemic inter alia include: Setting up of mobile exhibition units, innovative flex print displays, high swinging balloons, promoting folk media, magic shows, etc and also leveraging unconventional media like road shows, merchandise items such as mugs, wobblers, T-shirts, etc. in a bid to create community contact. Strengthening adolescent education and behavioural change communication amongst the educational institutions, by having more interactive two way programmes. Scaling up of School AIDS Education Programme to cover all the Secondary and Higher Secondary Schools in Goa in collaboration with the Directorate of Education. Extending Disha 2000 programme to all Educational Institutions. 2.11: Targeted Intervention Since particular groups of people such as sex workers, MSM, truckers, tourism related workers, migrants, street children, etc. are more vulnerable than others to the HIV/ AIDS epidemic, direct intervention programmes among those groups through a comprehensive and integrated approach beginning from behaviour change communications, counseling, providing health care support, referrals, condom promotion and creating an enabling environment that will facilitate behaviour change have been undertaken through NGOs since Oct who are being funded by Goa SACS. Refer Tables 28 to 30. During the year in all 19 Targeted Intervention (TI) projects have been funded by Goa SACS to the tune of Rs lakhs- Out of 19 TI, six projects for Female Sex Workers, three for Men having Sex with Men, two each of Truckers and IDUs, one group covering the core composite groups and five projects covering Migrants. Same projects have been continued for the year and an amount of Rs lakhs has been sanctioned and till 30 th of October,2009 Rs lakhs has been released. The Behavioural Surveillance Survey among Female Sex Workers undertaken by Government of India in the red-light area of Baina (which has been demolished in June 2004) has shown that there has been significant rise both in awareness levels and condom usage because of the interventions undertaken. The demand for condoms had also steadily increased over the years. However, with demolition of the red light area most of the sex workers either have gone to their native places or moved to other places in Goa. In view of this the NGO implementing the TI project for SWs is currently finding it rather difficult in mapping their current places of operation and providing requisite services for prevention/ control of HIV/ AIDS. 49

62 Dealing with HIV is much more than just creating awareness or use of condom. Since the awareness levels are already very high in Goa, we need to go beyond awareness and bring about attitudinal and behavioural change, empowerment, negotiating skill and creation of enabling environment that will facilitate behaviour change. For effective implementation of the targeted intervention efforts are being made for capacity building of NGOs through regular workshops, training programmes, exposure visits, etc. In order to identify the locations where the high-risk populations are concentrated and to estimate their number, the International Institute of Population Sciences, Mumbai had undertaken a mapping exercise of HRGs in Goa in Feb. 04. The above data formed the basis for allocation of TI projects. 50

63 Table No. 28. Grants sanctioned to NGOs by Goa State AIDS Control Society, Name & address of NGO Year Amount (Rs. in lakhs) Target Group & Population to be covered Area of intervention 1. Targeted Interventions 1.1. Rishta Hotel staff and Tourist related workers (2,000) Anjuna-Calangute belt Flat S-1, 2 nd Floor, Zeib Reina Hotel staff and tourist related workers (2,000) Anjuna-Calangute belt Complex, Near Hotel Maria Rosa, Naikavaddo, Hotel staff and tourist related workers (3,000) Anjuna-Calangute belt Calangute, Goa Hotel staff and tourist related workers (3,000) Anjuna-Calangute belt Tel : Hotel staff, Taxi drivers, motorbike pilots (4,150) Anjuna-Calangute belt rishta_vcare@hotmail.com and Jail inmates (600) Hotel staff, Taxi drivers, motorbike pilots (1,250) Colva belt Tourist related workers, Migrant labour, Fisher men, Sex workers, prison inmates (7,283) Tourism related workers (6345) Migrants (325), Fishermen (220) Street children (50), Sex workers (10) Anjuna-Calangute belt Anjuna-Calangute belt Prison inmates(383) Aguvada Central jail Tourism related workers (7000),Migrants Anjuna Calangute belt (325),Fisherman (220),Street children (50) Sex Workers (10) Prison inmates (285) Aguvada Central Jail Panaji jail Mapusa jail MSM (355) Calangute to Anjuna and Baga belt Sex workers (574) Calangute to Anjuna Belt composite (FSW + MSM1000) Calangute, Baga, Candolim, Sinquerim, Arpora, Vagator, Anjuna 7.42 MSM composite (FSW + MSM1000) Calangute, Baga, Candolim, Sinquerim, Arpora, Vagator, Anjuna MSM (500) Betim, Verem,Nerul & Mapusa, Pernem,Bicholim, Sattari 51

64 1.2. Saad Alashiro SF-4, Goa Housing Board Residential Commercial Complex, Block A, Journalist Colony, Porvorim, Bardez, Goa Tel : saad@goatelecom.com Life line Foundation Despamont Building,Shop 3, St. Inez, Panaji Goa Tel: llfgoa@sancharnet.in Rural women (450) Goa Rural women (450) Goa Migrant labour (2,500) Porvorim and St. Inez Migrant labour (2,500) Porvorim and St. Inez Migrant labour (2,500) Mapusa Migrant labour (2,500) and Porvorim and St. Inez Street Children (200) 5.88 Migrant labour (2,500)& Mapusa Street Children (200) Migrant labour (2,500) & Malim, Batim Fisherman (3000) Migrant labour (1,470) Malim and Mapusa Fishermen (3,000) Batim, Verem Truckers (5,840) Mapusa Migrants labour(1,470) Malim and Mapusa Fisherman (3,000) Batim, Verem Truckers (5810) Mapusa Migrants (7036) Malim, Batim, Verem, & Mapusa Truckers (2308) Mapusa, Colvale & Tivim Migrants (5000) Malim, Betim, Porvorim, Karaswada, Colvale, Guirim and Tivim Migrants (5000) Malim, Betim, Porvorim, Karaswada, Colvale, Guirim and Tivim Migrant labour (2,500) Indira Nagar, Chimbel Migrant labour (2,500) Indira Nagar, Chimbel Migrant labour (2,500) Indira Nagar, Chimbel Migrant labour (3,195) Panaji Migrant labour (1,.030) Chimbel, Merces, Baman Bhat, Caranzalem, St. Inez Fishermen (140) Caranzalem, Dona Paula 52

65 Truckers (1,460) Tourism related workers (260) Street children (18) Migrants labour (4,184) Fisherman (150) Truckers (1460),Tourism related workers(260) Street Children (18),MSM (46)CSW (50),IDU (9) Migrants (7700) Truckers (2500) Migrants (5000) Tiswadi Chimbel, Merces, Baman Bhat, Caranzalem, St. Inez, Karma Bhat, Opp.GMC, Bambolim. Caranzalem, Dona Paula Tiswadi Chimbel, Merces, Baman Bhat, Caranzalem Kamat classic, Caranzalem model millennium, St.Inez Tiswadi Dona Paula, Taleigao Plateau, Bambolim, Chimbel, Old Goa, Patto, St.Inez, Tonca, Caranzalem, Miramar 6.05 FSW () (1) Old Goa, Marcel, Bicholim (Sanquelim), Sattari (Valpoi) 6.05 FSW () (2) KTC bus stand, Below Mandovi Bridge, Cortim, Market Area, St. Inez, Taleigao, Bambolim, Dona Paula Migrants (5000) Dona Paula, Taleigao Plateau, Bambolim, Chimbel, Old Goa, Patto, St.Inez, Tonca, Caranzalem, Miramar 8.59 FSW (1) (400) Old Goa, Marcel, Bicholim (Sanquelim), Sattari (Valpoi) 8.59 FSW (2) (400) KTC bus stand, Below Mandovi Bridge, Cortim, Market Area, St. Inez, Taleigao, Bambolim, Dona Paula 53

66 1.4. Humsafar Trust (Humsaath) 1 st. Floor, Umashankar building, Near MPTground, Partrong, Baina, Vasco-da-Gama, Goa. Tel : humsafargoa@rediffmail.com 1.5. Positive people 1 ST Floor, Maithili Apartments, Opposite Govt, Quarters, St.Inez, Panaji, Goa Tel: / people@sancharnet.in MSM (500) Baga, Panaji, Margao, Vasco MSM (1,000) Goa MSM (936) Goa MSM (1,000) Goa MSM (1000) Goa MSM (1000) Goa MSM (1000) Vasco, Cortalim, Zuarinagar, Margao, Quepem, Sarvordem MSM(1000) Vasco, Cortalim, Zuarinagar, Margao, Quepem, Sarvordem, Sada, Mangor Hill Truckers (10,000) Vasco and Ponda Truckers (10,000) Ponda 3.44 SWs (1,000) Baina, Vasco SWs (500) Vasco, Margao Truckers (52,050) Ponda 8.66 SWs (1,000) Vasco, Margao Truckers (52,050),SWs,Street Children, Migrants Ponda SWs (1,150) Vasco, Margao Truckers (7,500),SWs (50),Migrants (3000) Ponda 8.71 Industrial workers (500)Police &Transport workers (200) SWs(800) Vasco, Margao, Palolem IDUs (619) 300 Shadow user & 300 Partners North Goa FSW (400) Margao, Palolem 54

67 11.76 IDU (North) Calangute, Baga, Candolim,Vagator, Anjuna, Sinquerim, Morjim, Arambol, Panaji City, Miramar, Bambolim and Dona Paula 8.89 IDU (South) Margao, Vasco, South Coastal Belt FSW (600) Margao, Palolem IDU (North ) (400) Calangute, Baga, Candolim,Vagator, Anjuna, Sinquerim, Morjim, Arambol, Panaji City, Miramar, Bambolim and Dona Paula 9.95 IDU (South) (150) Margao, Vasco, South Coastal Belt 1.6. Sai Sports and Cultural Association (Sai Life Care) Kothambi, Pale mines, Tisk,Usgao Goa Tel: sudeshgaude@yahoo.co.in Mine Workers (2,500) Mining area in North Goa Migrants,Mine Workers, Truckers & SWs Pale Migrants (10984)Truckers /Mine Workers(6000) Pale MSM (25) SWs (162) Migrants/Truckers /Mine Workers (14,876) Pale, Mine Tisk 7.79 FSW (600) Tisk, Ponda, Pale, Usgaon, Velguem, Sanquelim, Mollem, Honda 4.80 Truckers (5000) Tisk, Ponda, Pale, Usgaon, Velguem, Sanquelim, Mollem, Honda FSW (500) Tisk, Ponda, Pale, Usgaon, Velguem, Sanquelim, Mollem, Honda 8.24 Truckers (5000) Tisk, Ponda, Pale, Usgaon, Velguem, Sanquelim, Mollem, Honda 16. FXB Fisherman (2,700) Betul to Palolem 55

68 Plot No. 8, Solitaire Villas, Quirbhat, Nuvem, Salcete, Goa. Tel : / fxbgoa@goatelecom.com FSW (78),Migrants (1,382),Fisherman (4,100),Truckers (1,205),Tourism related workers (948),Street Children (262) Colva to Palolem 1.7. Community Resource Foundation Flat no. B-1, 2 nd floor, R.A. Apartments, Opp. KTC Bus stand, Margao, Salcete Goa Tel: sanjaygurudas@yahoo.com Street Children (1,000) Goa Migrants (1,070) Margao Tourism related workers (313) Street Children (192) Margao & Savordem Migrants (2,936) Margao Tourism related workers (462) Street Children (192) Margao & Savordem Migrants (5000) & Truckers (1000) Margao Sex workers(50) Margao & Savordem Migrants (5000) Margao & Savordem 4.80 Truckers (5000) Migrants (5000) Margao, Fatorda, Colva, Navelim 8.29 Truckers (5000) Margao, Cuncolim, Ind. Estate, Birla Vasco 1.8. Hope Foundation, Flat No.1, 1 st Floor, Aquiar Apartments, Opp. Hotel welcome, Birla Rd., Zuari Nagar, Goa. Tel: ashok_mmegeri@rediffmail.com Migrants (4,250) Sex workers (10) Truckers (3,000) Prison inmates (94) Migrants (4,000) Sex Workers (10) Street Children (500) Truckers (2,000) Prison inmates (120) Zuari Nagar Zuari Nagar Sada Sada Zuari Nagar Sada 56

69 1.9. Desterro Eves Mahila Mandal Sapna Terrace, Swatantra Path, Vasco da Gama, Goa Tel : adhar_goa@sancharnet.in. Mineral Foundation of Goa P.B. 113, Vaglo Building, Panaji , North Goa Sex workers (1,000) Baina Sex workers (1,000) Baina Sex workers (1,000) and Migrant labour (2,000) Baina / Mangor Sex workers (1,000) Baina Migrants (300) Katem Baina, Fishermen (2,700) Kharewada, Tourism related workers (339) Vasco, Street children (206) Vasco Truckers (1,460) Mangor Hill 3.13* SWs (1000) North Goa Migrants (1,000) Vasco Fisherman (2,700) Tourism related workers (339) Street Children (1,000) Truckers (1,460) Migrants (12000) Truckers (1000),SWs(500) Kharewada Katem Baina Vasco Mangor Hill Vasco, Mangor Hill, Zuari Nagar, Verna Mangor Hill, Zuari Nagar Verna FSW (1000) Mapusa Bardez, North Goa 9.34 FSW (600) Vasco City Area, Birla, Baina, Mangor Hill, New Vaddem, Bogda Jetty, Chicalim, 8.87 FSW (845) (North ) Mapusa Tivim, Pernem, Bicholim FSW (600) Vasco City Area, Birla, Baina, Mangor Hill, New Vaddem, Bogda Jetty, Chicalim, FSW (864) (North) Mapusa Tivim, Pernem, Bicholim Migrants (5000) Sanguem (Collem, Kalay, Uguem Rivona, Costi,Sanvordem, Mollem, Usgao, Darboandora, 57

70 / / Migrants (5000) Sanguem (Collem, Kalay, Uguem Rivona, Costi,Sanvordem, Mollem, Usgao, Darboandora, Presentation Society St.Theresa s High School, Mangor Hill, Vasco-Da-Gama Goa jeevanjyothi@sancharnet.in Migrants (5000) Vasco City, Bogda, Baina, Mangor, Shantinagar Migrants (5000) Vasco City, Bogda, Baina, Mangor, Shantinagar Zindagi (Darpan)-Goa First Floor, Reev Apts. Near Little Angels School, Malwara, Agacaim, Goa Tel. No goa-zindagi@yahoo.com goazindagi@gmail.com MSM (500) Tiswadai, Ponda, Canacona MSM (500) Tiswadai, Ponda, Canacona Jan Ugahi Vikrant, 5 th Floor V-14, Malbhat, Margao, Goa Tel: Migrant labour (2,500) Margao Migrant labour (2,500) Margao Migrant labour (2,500) and SWs (200) Margao Migrant labour (3,500) Margao Migrant labour (3,000) and Street Children (100) Margao Tourist related workers, Migrant labour, Fisher Margao, Colva men (3,218) Sex workers (1,000) Baina Sex workers (1,000) Baina Vasco Anti-AIDS Association Behind D souza Bar, Baina Beach, Vasco Da Gama, Goa Sex workers (1,000) Baina Visionaries Slum dwellers and industrial workers (1,000) Colva and Verna Behind Vincy Resort, Colva Beach, Slum dwellers and industrial workers (1,000) Colva and Verna Salcete, Goa Hotel Staff, Taxi/Auto Drivers etc. (1,500) Colva 58

71 1.13. Arz 40 (1), Jannat Gali, Behind Manila Bar, Baina Beach,Baina, Vasco da Gama, Goa Tel: Partners/Potential partners of Sex workers (300) Baina 2. Community Care Centres 2.1. Caritas-Goa, ASRO, Near Holy Cross Church, Cavelossim, Salcete, Goa. Tel: Freedom Foundation, 105/A-2, Sorvem, Guirem, Bardez, Goa Tel: Drop-in centres 3.1. Zindagi, Flat No. C-3, Penguin Apartments, Pixem, Dongri, Vasco da Gama, Goa Tel: Positive Lives Foundation, AP/41, G,2 C.P. Villa, Opp. Petrol pump, Betim Road, Near Sriram People Living with HIV/ AIDS People Living with HIV/ AIDS South Goa North Goa Drop-in centre for People Living with HIV/ AIDS Goa Drop-in centre for People Living with HIV/ AIDS South Goa Drop-in centre for People Living with HIV/ AIDS South Goa Drop-in centre for People Living with HIV/ AIDS South Goa Drop-in centre for People Living with HIV/ AIDS South Goa Drop-in centre for People Living with HIV/ AIDS North Goa Drop-in centre for People Living with HIV/ AIDS North Goa Drop-in centre for People Living with HIV/ AIDS North Goa 59

72 Super Market, Alto Porvorim, Drop-in centre for People Living with HIV/ AIDS Bardez Goa, Tel: plf@rediffmail.com 3.2 Goan Community for Positive People (GCP+) H.No.155, Mount Mary s Ward, People Living with HIV/ AIDS Opposite Goan Maharaja Hotel, Verna Electronic City, Verna, Goa School AIDS education programme 4.1. Inner Wheel Club of Vasco da Gama 203, Gabmar Apts. Opp. St. Andrews Church Vasco da Gama, Goa Indian Red Cross Goa Branch, Panaji, Goa Super School Complexes, College of Commerce and Management Studies, Mapusa, Goa. 5. Others projects 5.1. Rishta AIDS Helpline 1097 Flat S-1, 2 nd Floor, Zeib Reina Complex, Near Hotel Maria Rosa, Naikavaddo, Calangute, Goa Positive people 1 ST Floor, Maithili Apartments, Opposite Govt, Quarters, St.Inez, Panaji, Goa Tel: School AIDS Programme (23 Higher Secondary Schools) School AIDS Programme (High/ Higher Secondary Schools) (This project could not be undertaken by the NGO and the amount was refunded.) School AIDS Programme (26 Higher Secondary Schools) HIV/ AIDS patients and General population Goa HIV/ AIDS patients and General population Goa HIV/ AIDS patients and General population North Goa Goa Funding of this project was discontinued w.e.f. Oct. 02 South Goa District North Goa District Pretest/Post test Counseling VCTC/ hospitals Pretest/Post test Counseling VCTC/ hospitals Pretest/Post test Counseling Goa Goa VCTC/ hospitals 60

73 Table No. 29: Number of Projects funded by Goa SACS, Targeted Intervention among: 1.1. SWs 2* MSM Composite ## Migrant labour & other HRGs Industrial workers/ Slum dwellers Tourism related workers & other HRGs Rural women Partners/ potential partners of SWs Truckers Mine workers Fishermen Street children IDU Sub. Total Others 2.1 Counseling School AIDS Programme Drop in Centre for PLWH/A - 1** AIDS helpline Community Care Centres Sub. Total Total One of the projects covered migrant labour ** Funding of this project has been discontinued w.e.f. Oct. 02 # Composite projects cover all the HRGs in the project area. ##Composite project for Migrants and Truckers in

74 Table No. 30: Grants released to NGOs by Goa State AIDS Control Society, (Rs. in lakhs) Targeted Intervention among 1.1. SWs 8.31* MSM Composite # Migrant labour & other HRGs Industrial workers/ Slum dwellers Tourism related workers & other HRGs 1.5. Rural women Partners/ potential partners of SWs Truckers Mine workers Fishermen Street children IDU Sub. Total Others 2.1 Counseling School AIDS Programme Drop in Centre for PLWH/A ** AIDS helpline Community Care Centres Sub. Total Total * One of the projects covered migrant labour also. ** Funding of this project has been discontinued w.e.f. Oct. 02 # Composite projects cover all the HRGs in the project area. ##Composite project for Migrants and Truckers in

75 Table No.31: Family Health Awareness Campaign in Goa, April/May Total target Population: 1.1 Males 70, Females 75, Total 1,45,518 Dec ,962 44,384 90, No. of persons actually attending camps: 2.1 Males 2.2 Females 2.3 Total 3,253 5,340 8,593 2,494 2,556 5,050 June ,65,008 1,64,674 3,29,682 6,546 8,995 15, Percentage of persons actually attended camps: 3.1 Males 3.2 Females 3.3 Total Total no. of patients referred from the camps: 4.1 Males 4.2 Females 4.3 Total N.A. N.A. 5. No. of cases treated RTI/ STI 5.1 With ulcers: Males Females Total With discharge: Males Females Total 5.3 Others (STD): Males Females Total 6. Percentage RTI/ STI cases treated: 6.1 Male 6.2 Female 6.3 Total N.A N.A April ,91,689 2,71,571 5,63,260 7,280 14,744 22, Feb ,86,000 2,72,000 5,58,000 4,240 9,123 13, ,147 1, ,012 1, * 96.4 June ,53,260 1,52,542 3,05,802 3,215 6,838 10, * 238.0* 210.0* Sept ,71,557 1,76,165 3,47,092 3,127 7,495 10, * 414.8* 3686* * Includes persons treated at camp site and as such % of RTI/ STI cases treated to total cases referred exceeds 100% during 2002, 2003 &

76 2.12: Work place intervention For strengthening the world of work response to HIV/ AIDS both in the formal and informal sectors a comprehensive work plan has been drawn in close collaboration with the International Labour Organisation, New Delhi and is being implemented w.e.f. December 2004 in Goa. GSACS is working in collaboration with Goa Chamber of Commerce and Industries in this regard. In all eleven industrial organizations have taken the initiatives for the intervention. The KABP study conducted recently projected a low awareness on HIV-STD among the unorganized labour sector. Efforts are being made to bridge these gaps. 2.13: Training Under NACP-II, training programme on HIV/ AIDS/ STD prevention and control for specialists, Medical officers and other paramedical staff have been organised. Since April 1999, 921 doctors, 1023 Nurses, 114 Lab. Technicians have been trained. 160 Doctors were trained in syndromic management of STDs. Training manuals for specialists, Medical Officers, Nurses, Health Workers, Standard operative procedures, HIV Testing Manual, Counseling, etc. developed by NACO have made available to them during the trainings. Some of the doctors and paramedical staff were also sent to other Centres of Excellence for training in their field of specialization. GSACS has also trained 315 teachers, 30 CDPOs/ Mukhya Sevikas, 69 NGOs, 971 Anganwadi workers since April : Toll free AIDS helpline 1097 To provide information pertaining to HIV/ AIDS/ STDs, particulars of services available and other related issues including providing psychological support to those already infected, help families and partners of infected persons to receive prevention services, etc., a toll free AIDS Helpline 1097 has been set up. An Interactive Voice Response System has been set up for providing round the clock access to information on HIV/ AIDS, available services and other related issues including providing psychological support to those already infected. 2.15: Free drugs for OIs and PEP GSACS provides drugs for treatment of all opportunistic infections such as Tuberculosis, Herpes, Candidisis, etc. in HIV/ AIDS patients. Similarly drugs for STIs/ RTIs for STD patients are being provided in all Government STD clinics. Drugs for post exposure prophylaxis for Health Care Workers are also being provided by GSACS Condom Promotion GSACS provides free Condoms to all NGO s and other groups working in the field of HIV/AIDS. GSACS proposes to set up 50 Condom Vending Machines (CVMs), at some of the important public and commercial places. For this purpose, GSACS has tied up with Hindustan Latex Ltd, who will at their cost provide, install and maintain the CVMs. From this year we are venturing in Social Marketing of Condoms Website: Goa State AIDs Control Society has launched its own website on the eve of the world AIDs Day i.e. on 1 st December The address of the website is It provides detailed updated information of all the activitied carried out by the Goa SACS. 64

77 2.18: Conclusion HIV/AIDS is immensely preventable provided each one of us recognize it as an important public health and developmental threat and each of us respond to our maximum capacity. The main obstacles that undermine effective response to AIDS allowing the disease to spread are: Widespread denial and complacency the attitude that AIDS only happens to some one else, somewhere else and not to us leading to low level of risk perception. Myths and misconceptions about its cause, spread and methods of prevention. Absence of either a preventive vaccine or cure. HIV/ AIDS is still in early stages in Goa and effective responses are possible now. Unless more is done today and tomorrow and the epidemic is left to run its natural course, it is sure to cause devastation on an unprecedented scale and would reverse the achievements of the last few decades. One of the biggest lessons learnt globally as well as in the country is that responses should not wait for HIV/ AIDS cases to soar. Policies should not wait till crucial prevention and care information and services are needed. Another important lesson learnt is that a multi-sectoral response must be designed in the context of the overall development strategy to ensure its sustainability and effectiveness. There is no room for complacency. Government of Goa is fully committed to prevent the spread of HIV/ AIDS at the initial stage itself. But Government alone cannot do it. It is everyone s responsibility. Making a token towards one s own safety is not enough. People should effectively respond to the threat that the community is facing. NGOs and private sector have an equally critical role to play in an effective response. The challenge is to identify appropriate, locally relevant interventions and reach out to the people. By following a concerted policy and an action plan that emerges out of it, Government hopes to control the epidemic and slow down its spread in the general population within the shortest possible time. 65

78 SERVICES/ FACILITIES FOR PREVENTION /CONTROL OF HIV/AIDS IN GOA. Toll free AIDS helpline 1097: 24 hours Interactive voice Record information on HIV/AIDS related issues. Integrated Counseling and Testing Centres at: Goa Medical College, Bambolim Tuberculosis and Chest Diseases Hospital, St. Inez, Panaji Hospicio Hospital, Margao Asilo Hospital, Mapusa Cottage Hospital, Chicalim CHCs at Canacona, Curchorem, Pernem and Valpoi Central Hospital, Tisk Usgao, Ponda-Goa and PHC Candolim. CD4/ CD8 cell count facility at Dept. of Microbiology, Goa Medical College Bambolim. Sexually Transmitted Diseases/ Infections related services at : Dept of Venereology & Dermatology, GMC, Bambolim STD clinic, Hospicio Hospital, Margao STD clinic, Asilo Hospital, Mapusa STD clinic, Cottage Hospital, Chicalim, Vasco All Health Centers under Directorate of Health Services Free drugs for treatment of Opportunistic Infections: For HIV/ AIDS patients in Goa Medical College, Bambolim. Hospicio Hospital, Margao, Asilo Hospital, Mapusa. Prevention of Parent-to-Child Transmission of HIV infection during pregnancy. Programme includes counseling, testing and drug administration at Ob & Gy. Dept., Goa Medical College, Bambolim at Hospicio Hospital, Margao and at Asilo Hospital, Mapusa. Drop in Centres for people living with HIV/AIDS at: Zindagi, F-11, 2 nd floor, Pai Building, Behind Uma Petrol Pump, Mundvel, Vasco da Gama, Goa , Ph Positive Live Foundation, PLF-Goa, Victor Apartments, Ground floor, Behind Senior Translines, Cujira, St. Cruz, Panaji Goa. Cell No: Community Care Centres Free short stay, check-up, treatment, counseling for People Living with HIV/AIDS at: Freedom Foundation, 105/A-2, Sorvem, Guirim, Bardez. Ph ASRO, Near Holy Cross Church, Cavelossim, Salcete. Ph Antiretroviral Treatment (ART) Centre at Goa Medical College (Opp. Paediatric OPD), Bambolim: Free supply of antiretroviral drugs Provision of free Post Exposure Prophylaxis (PEP) in case of exposure to potentially infectious fluids in Health care workers in all Government institutions Public Private Partnership (PPP): (1) Campal Clinic, St. Inez, Panaji, (2)Vrudavan Hospital, Mapusa, (3)Apollo Victor Hospital, Margao, 66

79 Shri. Sanjay Srivastava, Chief Secretary, Govt of Goa addressing the workshop for Greater Involvement in People Living with HIV/AIDS (GIPA). Shri. Vishwajeet Rane, Hon. Minister for Health and Shri. Sanjay Srivastava, Chief Secretary, Govt of Goa flagging off Mobile hoarding van for promoting Voluntary Blood Donation drive. 67

80 The battle against HIV/AIDs in India has entered a crucial phase. And the stakes are high. From Political leadership to civil society Activists, from grassroot level CBOs to industrial conglomerates, From the Central & State Government organizations and International agencies to local self Government institutions it is clear That the entire society is entering An intense phase of HIV/AIDS Related activity. And the resolve is Clear. We shall defeat HIV/AIDS! 68