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1 HIV/ AIDS in Goa Monitoring & Evaluation Unit Goa State AIDS Control Society st Floor, Dayanand Smruti Building, Swami Vivekanand Road, Panaji, Goa Tel: /24238/ FAX: Website:

2 Life in the 2 st century Should be better for all. We can pass no greater gift To the next generation Than a healthier future. That is our vision. Together the people of Goa Can make it a reality. Let us join and work together To face the challenge HIV/ AIDS imposes.

3 A: Global Scenario Figures at a Glance First case detected among MSM in USA in 98. Reported number of AIDS cases in 99was 0.37 million. Estimated number of people living with HIV/AIDS as on December, 2009 was 33.3 million. People newly infected with HIV in the year 2009 were 2.6 million. World wide 2.5 million children are living with HIV. Number of children (0-4 years) infected during the year 2009 was 3.70 lakh which accounts for 4.23 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 0 years of contracting the infection. Everyday 7000 new infections occur in the world in 2009 despite the fact more is known than ever before about prevention and control of the epidemic. About 000 are in children under 5 years of age and 6000 are in adults age 5 years and above. 97% of all HIV/ AIDS infected people are living in developing countries. HIV /AIDS was considered as a male disease two decades 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 5 % 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. 4% 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 the world. During 2009 alone, there were.8 million deaths due to AIDS of which 72% occurred in Sub-Saharan Africa. 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 (0%), Perinatal (0%) and blood and blood products (5%).

4 B: Indian Scenario First case of HIV detected among Female Sex Workers in Chennai in 986. It is estimated that India had approximately.2 lakh new HIV infections in 2009 as against 2.7 lakh in Of the.2 lakh estimated new infections in 2009, the six high prevalence States account for only 39% of the cases, while State of Orissa, Bihar, West Bengal, Uttar Pradesh, Rajasthan, Madhya Pradesh account for 4% of new infections. As per the latest estimates, 24 lakh people are living with HIV/ AIDS in India at the end of year Adult HIV prevalence at National level has declined from 0.4% in 2000 to 0.3% in 2009, the estimated number of new annual HIV infections has declined by more than 50% over the past decade. The adult HIV prevalence in India is 0.26% among women and 0.38% among men in 2008 and 0.25% among women and 0.36% among men in HIV prevalence infection is now prevalent in all parts of the country. All the high prevalence States show a clear declining trend in adult HIV prevalence. HIV has declined notably in Tamil Nadu to reach 0.33% in However, the low prevalence States of Chandigarh, Orissa, Kerala, Jharkand, Uttarakand, Jammu & Kashmir, Arunachal Pradesh and Meghalaya show rising trends in adult HIV prevalence in the last four years. The four high prevalence States of South India (Andhra Pradesh, Karnataka, Maharashtra, and Tamil Nadu) account for 55% of all HIV infections in the country. West Bengal, Gujarat, Bihar and Uttar Pradesh are estimated to have more than lakh PLHA each and together account for another 22% of HIV infections in India. The States of Punjab, Orissa, Rajasthan and Madhya Pradesh have 50,000 to lakh HIV infections each and together account for another 2% of HIV infections. It is estimated that.72 lakh people died of AIDS related causes in 2009 in India. Wider access to ART has resulted in a decline of the number of people dying due to AIDS related causes. The trend of annual AIDS deaths is showing a steady decline since the roll out of free ART programme in India in 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 83% of the reported cases belong to the age group 5-49 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 5-29 as against 27% for males. The predominant mode of transmission is through heterosexual contacts (88.6%), followed by perinatal (5.4 %), IDUs (.7%) and blood and blood products (.%) and not specified 3.2%.

5 C: Goan Scenario First case of HIV detected in 987. Total number of HIV cases detected in Goa since 987 to 20 upto June is 3,806. Total AIDS cases reported to Goa SACS in 20 (upto June) is,445. Reported AIDS death upto May 20 is 787. HIV infection is now prevalent in all parts of Goa and majority of the cases are reported in the four coastal talukas viz. Salcete (7.%), Mormugao (6.5%) in South Goa District and Tiswadi (.5%) and Bardez (5.5%) in North Goa District during HIV infection is now prevalent in all parts of Goa and majority of the cases are reported in the four coastal talukas viz. Salcete (3.8%), Mormugao (9.9%) in South Goa District and Tiswadi (8.9%) and Bardez (5.2%) in North Goa District during % of the cases detected in Goa during 200 belong to the age group 5-49 years. The disease is more common in males than females. Out of every five cases detected three are males. Whereas in 997, out of four cases detected three were males. While nearly 44% of the females infected belong to the age group 5-34, more than 32% of the infected males belonged to this age group. Nearly 52.7% of males and 38.7% of females of the total detected cases were in the age group years during 200. During , Sexual route is the predominant mode of transmission in the range of 83 to 95% followed by Perinatal 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 6.40%, FSW 6.40 % and among antenatal mother was 0.67 %.

6 Total No. of tests conducted for HIV/AIDS testing, 986 to 20 No. of Blood Sample tested HIV +ve cases Positivity No. of AIDS Rate Year (%) Gen ANC Total Gen ANC Total M F T ,255 -, ,822-3, ,20-0, ,07-0, ,603-8, ,690-8, ,978-7, ,533-4, ,279-2, ,959-2, ,526-3, ,903-4, ,804-7, ,83-7, ,26-7, ,848-3, ,682 2,567 4,249,06 38, ,22 3,77 4, , ,84 3,068 4,882,029 4, ,023 7,357 8, , ,485 0,432 22,97,029 65, ,684,053 26, * 65, ,220 2,253 33, ,627,802 33, * (June) 0,46 6,65 7,03 335* Total 2,32, 9 68,864 3,0,775 3, , , ,445 Gen = General, ANC =Antenatal Clinic *Includes TS/TG case each reported for the year 2008, 200 & 20.

7 Year Sex-wise HIV/ AIDS cases detected/ reported in Goa, No. of Blood samples Tested* HIV +ve cases 986 to 20 Male Female Total No. of AIDS Positivity Rate (%) Male Female Total , , , , , , , , , , , , , , , , , , , , , , , , , * , , * (June) 0, * Total 2,32,9 8,859 4,486 3,348* 5.73,002 Reported to GSACS *Includes TS/TG case each reported for the year 2008, 200 & 20.

8 Sex-wise reported number of AIDS Deaths, Year Male Female Total Cumulative figures ( ) (May) 7 28 Total

9 Taluka-wise percentage distribution of HIV cases detected in Goa, 998 to 20 Taluka Proportion (%) of HIV positive cases detected (June) 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. Taluka-wise distribution of HIV cases detected in Goa, 998 to 20 No. of HIV positive cases detected Taluka (June) 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.

10 Age / Sex-wise distribution of HIV cases detected in Goa, 2008 to (June) Age group TS/ TS/ TS/ M F T M F T M F T M F TG TG TG <4 40 (6.9) 29 (7.8) 0 69 (7.3) 20 (3.7) 20 (5.4) 40 (4.4) 24 (4.8) 20 (7.4) 0 44 (5.7) 4 (7.0) (8.) T 0 25 (7.5) (4.5) 36 (9.7) 0 62 (6.5) 27 (5.) 3 (8.5) 58 (6.4) 28 (5.6) 9 (7.) 0 47 (6.) (5.6) 8 (5.9) 0 9 (5.6) (33.8) 262 (45.0) 56 (42.) 24 (33.4) (00. 0) (37.) 386 (40.5) 7 (32.0) 270 (50.6) 37 (37.3) 49 (40.6) 308 (34.2) 49 (46.5) 36 (27.3) 263 (52.7) 00 (37.2) 04 (38.7) (30.8) 333 (47.8) 54 (27.3) 98 (49.5) 44 (32.4) 54 (39.7) 0 99 (29.6) 52 (45.4) >50 57 (9.8) 26 (7.0) 0 83 (8.7) 46 (8.6) 30 (8.2) 76 (8.5) 48 (9.6) 26 (9.6) 0 74 (9.6) 2 (0.6) 8 (3.2) 0 39 (.6) Not specified (0.7) - (0.3) Total Proportion (%) of HIV cases by sex in different age groups, 2008 to 20 Age group M F (June) TS/ T M F T M F TS/TG T M F TS/TG T TG < > Not specified Total

11 Age / Sex-wise distribution of HIV cases detected in Goa, 2000 to 2007 Age group * 49+* 7 (3.0) M F T 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) 54 (27.6) 298 (53.3) 83 (4.8) 6 (6.5) 23 (49.6) 97 (39.) (4.4) 33 (4.) 277 (34.3) 395 (49.0) 94 (.6) 30 (5.6) 43 (26.6) 279 (5.9) 82 (5.2) 5 (5.7) 23 (46.8) 93 (35.4) 29 (.0) 45 (5.6) 266 (33.2) 372 (46.4) (3.9) 32 (4.9) 76 (27.0) 394 (60.4) 39 (6.0) 0 (2.9) 8 (52.2) 40 (40.3) 6 (4.6) 42 (4.2) 357 (35.7) 534 (53.5) 55 (5.5) 27 (4.2) 48 (22.9) 387 (59.9) 60 (9.3) 9 (5.) 87 (50.6) 47 (39.7) 4 (3.8) 46 (4.5) 335 (33.0) 534 (52.6) 74 (7.3) 38 (6.) 30 (20.9) 384 (6.6) 6 (9.8) 25 (7.5) 24 (37.2) 57 (47.) 24 (7.3) 63 (6.6) 254 (26.6) 54 (56.5) 85 (8.9) 37 (5.8) 20 (8.9) 425 (67..) 52 (8.2) 29 (7.3) 33 (33.7) 208 (52.7) 25 (6.3) 66 (6.4) 253 (24.6) 633 (6.5) 77 (7.5) 93 (5.6) 408 (68.6) 62 (0.4) 8 (34.2) 84 (53.3) 9 (5.5 2 (22.4) 592 (63.0) 8 (8.6) 9 (8.0) 424 (64.0) 80 (2.) 9 (32.4) 96 (53.4) 27 (7.4) 64 (6.2) 238 (23.) 620 (60.3) 07 (0.4) Not specified 7 (.3) (0.4) 8 (.0) 4 (0.7) 3 (.) 7 (0.9) (.7) 0 (0) (.) 24 (3.7) 3 (0.8) 27 (2.6) 0 (.6) 3 (0.9) 3 (.4) Total * The age group was and 45+ for the year 999 to 200 and as such not strictly comparable for the later years Note: Figures within brackets indicate percentage to total Proportion (%) of HIV cases by sex in different age groups, 2000 to 2007 Age group M F T M F T M F T M F T M F T M F T M F T M F T * * Not specified Total * The age group was and 45+ for the year 999 to 200 and as such not strictly comparable for the later years

12 Route of transmission of sero-positive cases detected in Goa, 2000 to 20 Route of transmission Sexual Infected syringes and needles Blood & blood Products Parent to child Others / not specified Total (June) 73 (90.6) - - (0.) 33 (4.) 42 (5.2) (83.2) - 45 (5.6) 90 (.2) (90.4) 6 (0.6) 3 (0.3) 4 (4.) 46 (4.6) (95.3) (4.6) (0.) (93.5) 4 (0.4) 3 (0.3) 55 (5.8) 952 (92.5) 7 (0.7) 5 (0.5) 65 (6.3) (92.3) 5 (0.5) (0.) 54 (5.8) 2 (.3) (93.9) 882 (92.4) 856 (95.) (0.3) 2 (0.2) 58 (5.6) 3 (0.3) (0.2) 72 (7.6) 37 (4.) - 3 (0.3) (92.5) 5 (0.7) 3 (0.3) 44 (5.7) 6 (0.8) (92.5) (0.3) 0 (0.0) 23 (6.9) (0.3) 335

13 Proportion of females infected to total HIV cases detected in Goa, 987 to 20 Proportion of females to total Year HIV cases detected (%) (June) 43.5

14 Sentinel Surveillance for HIV infection in Goa Year No. of sentinel sites HIV prevalence (%) STD ANC MSM FSW STD-2 ANC-2 MSM- STD-2 ANC-2 MSM- STD-2 ANC-2 MSM- STD-2 ANC-2 MSM- SW- STD-2 ANC-4 MSM- SW- STD-2 ANC-2 SW STD 2 ANC -2 SW STD 2 ANC -2 STD 2 ANC -2 STD 2 ANC -2 STD ANC 2 TB STD ANC STD STD ANC

15 Data on PPTCT programme in Goa, April 03 to June No. of PPTCT Centres: 3 Item 2003 (w.e.f. April) Total. Total number of new ANC registered 2,903 3,755 3,208 8,39 2,758 2,705 2,98 3,743 8,588 78,780.2 Total number of women counseled 2,707 3,74 3,073 7,387 0,489,7 2,355,847 6,627 69,36.3 %age of women counseled among new ANC registered Total number of women who accepted HIV test 2,567 3,77 3,068 7,357 0,432,053 2,250,80 6,62 68,857.5 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.9 %age of women who received post test counselling among those tested.0 Total number of HIV positive women who collected HIV results. Percentage of HIV+ve women who collected the result 2. Number of spouses/ partners of HIV positive women counseled 2.2 %age of partners of +ve women counseled among those collected the report 2.3 %age of partners of +ve women counseled to all +ve women 2.4 Number of spouses/ partners of HIV positive women accepted HIV test 2.5 %age of partners of +ve women counselled accepting the test 2.6 Number of spouses/ partners detected HIV positive 2.7 HIV prevalence rate (%) of partners 3. Number of Women directly in labour without ANC registration 3.2 Number of women counseled who arrived in labour without ANC 2,4 3,373 2,63 6,049 8,602 9,938,599,202 6,86 6, ,257,857 2,526 2,822 2,657 2, ,875 22,20,772 2,239 2,423 2,285 2, ,332

16 3.3 %age of women counselled who arrived in labour without ANC Number of women accepted HIV test (out of 3.2) 22,20,772 2,239 2,423 2,285 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 4,039 4,947 4,6 7,9 9,57 7,049 7,23 8,778 4,409 57, Total number of live births to positive women (out of.6and 3.6) 4.3 Total number of mother-baby pair received NVP 4.4 Number of mother-baby pairs received NVP who were registered for ANC (out of.6) 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 4.7 Number of babies received NVP (out of 4.2)

17 Year-wise cases of CD4/ CD8 Count, 200 to 20 Activity 200 (From March). 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 (Mar 0 to June )

18 No. of patients screened/treated at ART Centre April 05 to June S. No:. Number of patients screened for ARV eligibility. Adult males Adult Females TG 3.4 Children (<4 years) Total Number of patients enrolled for ARV treatment 2. Males Females Children (<4 years) Total Number of patients who discontinued 3. Died Transferred out Stopped treatment Lost to follow-up No. of patients not returned to ART centre whose 5 treatment status is MIS in this month 3.6 Total Total Number of patients alive and on ART 290

19 Details of Sexually Transmitted Diseases detected in Government STD Clinics in Goa, 200 to (upto Feb) S Type of Diseases No M F T M F T M F T M F T M F T M F T M F T M F T. Syphilis (early Primary).2 Chancroid Herpes genitalis Donovanosis Other unclassified genital ulcers Sub. Total Inguinal swelling (Bubo) LGV 3. Urethral discharge 3. Gonorrhoea Nongonococcal Urethritis Sub. Total Vaginal discharge 4. Vaginitis Bacterial vaginosis Trichomoniasis Candidiasis Cervictis Gonococcal Chlamydial Other unclassified vaginal discharge Sub. Total Balanoposthitis Genital warts Other types of syphilis. Secondary Late Cong Scrotal swelling (epididymoorchitis)/ Gonococcal and Chlamydial 9. Others Total

20 Details of Sexually Transmitted Diseases detected in Government STD Clinics in Goa, 2008 to 20 Type of Diseases (June) M F O T M F O T M F O T M F O T.Vaginal/ Cervical Discharge (VCD) Genital Ulcer (GUD)-non herpetic Genital Ulcer (GUD) herpetic Lower Abdominal Pain (LAP) Urethral Discharge (UD) Ano-rectal Discharge (ARD) Inguinal Bubo (IB) Painful Scrotal Swelling (SS) Genital Warts Other STIs Asymptomatic STI treatment No of people living with HIV/AIDS (PLHAs) attended with STI/RTI during the month Total No. of cases

21 No. of blood units screened for HIV in State Government Blood Banks 2000 to 20 Year No. of units of blood collected HIV reactive %age reactive Voluntary Replacement Total Voluntary Replacement Total Voluntary Replacement Total (28.7) (7.3) (30.9) (69.) (33.3) (66.7) (45.3) (54.7) ,942 (55.8) (44.2) ,67 (53.4) (46.6) ,558 (58.6) (4.4) ,396 (62.6) (37.4) ,862 (6.4) (38.2) ,76 (65.8) (34.2) (76.5) (23.5) (June) (72.6) (27.4) *Covers three Blood banks under Goa Government only.

22 No. of blood units screened for other transfusion related diseases in State Government Blood Banks 2000 to 20 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 , , , , , , , , (June) 5, ,

23 Age group/ sex-wise direct walk-in persons undergoing testing, Age group M F T M F T M F T M F T M F T M F T M F T M F T M F T * * Not specified Total

24 Proportion of direct walk-in to total persons tested at ICTCs, 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 % 999 7, , , ,848 5, ,682 2, , ,22 3, ,84 4, , ,023 2, ,485 2, , ,684 3, ,220 6, ,627 6, (June) 0,46 3, Proportion of females and those in the age group 5-34 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 5-34 Note: As per NACO guidelines, from 2008 onwards the age group 5-29 has been changed to 5-34.

25 Number of persons counseled at ICTCs, 2002 to Male Male Female Female Total Male Total Female Male Total Female Male Total Female Male Total Female Male Total Female Male Total Female Male Female Total Total Male Male Female Female Total Total Male Male Female Female Total Total. Number. Number of persons of persons counseled counseled.. Pre-test. Pre-test , , *.2.2 Post-test.2 Post-test *.3 Followup 2. Proportion of persons Counseled (%) 2. Proportion of of persons Counseled (%) (%).3 Follow-up Pre-test Pretest Pre Post-test Follow-up Post test 2.3 Follow up (June) Male Female Total Male Female Total Male Female TS/TG Total. Number of persons counseled. Pre-test * * Post-test * * Follow-up Proportion of persons Counseled (%) 2. Pre-test Post-test Follow-up *includes TS/TG

26 Sex-wise particulars of number of persons tested at ICTCs, 2002 to 20 S. No (June). Total number of persons tested. Male 7,434 6,538 5,974 5,980 5,860 7,806,25 4,988 5,03 6,683.2 Female 6,44 5,44 5,245 5,834 5,63 4,679 4,467 6,228 6,586 3,728.3 TS/TG Total 3,848,682,22,84,023 2,485 5,684 * 2,220* 2,627 0,46 2. Number tested positive 2. Male Female TS/TG Total 999,06 956, , Proportion tested positive 3. Male Female TS/TG Total Total number of walk-in clients tested 4. Male 2, ,078,536 2,23 4,66 4,32 2, Female 3,632 2,378 2,92 3,378,28 964,032,746 2,25, TS/TG Total 5,857 2,948 3,590 4,32 2,296 2,500 3,263 6,362 6,455 3, Number tested positive among walk-in clients 5. Male Female TS/TG Total Proportion tested positive among walk-in clients 6. Male Female TS/TG Total