National AIDS control Programs of India: Illustration from a State

National AIDS control Programs of India: Illustration from a State Dr.D.K.Giri-Ph.D The national AIDS control programme was launched in India in 1987. In 1992, Government of India negotiated an IDA credit of US $84 million to support the implementation of a 5-year HIV/AIDS control project, from Sept. 1992 to Sept.1997. The project was later extended up to 31 st March 1999. The objectives of the project were: 1. To slowdown the spread of HIV/AIDS 2. To decrease, morbidity and mortality associated with HIV infection. 3. To minimize socio-economic impact, resulting from HIV infection. The 2 nd phase of the programme was launched in December, 1999 with a total outlay of Rs.1425 crore. The current phase of the national programme has seen the emergence of a strongly decentralized programme with responsibility for implementation clearly placed with the states. To facilitate the smooth implementation at the state level, new and more flexible state structures of state AIDS control societies have been formed with strong mechanism for programme management at the state level, including a strong NGO component of target intervention, supported by community awareness and treatment of STDS/ reproductive tract infections. Innovative approaches to provide technical support to state programmes have been launched through a network of 12 Technical resource groups each covering different thematic areas of the epidemic. Surveillance has been expanded and strengthened. The components of the 2 nd phase NACP (1999-2006) are: Priority targeted interventions for populations at high risk. Preventive interventions for general population. Low cost care for people living with HIV/AIDS. Institutional strengthening. Inter-sectoral collaboration. On 15 th August 2000 the P.M. of India spoke on various health issues and said Recently the rapidly spreading disease of HIV/AIDS has become a grave challenge to our nation. I appeal to all sections of society to fully participate in building awareness about the epidemic. They should also make necessary changes in their behavior so that this dreaded disease can be controlled. 4 Reflecting the extreme urgency with which HIV prevention and control need to be perused in India, the AIDS-II project of national AIDS control programme (NACP, Phase-II, 1999-2006) has the following firm targets to be achieved during project period. 1. To reduce blood borne transmission of HIV to less than one percent of the total transmission. 2. To introduce Hepatitis C as the fifth mandatory test for blood screening. 3. To set up new blood banks and upgrading of old blood banks and promotion of voluntary blood donation. 4. To attain awareness level of not less than 90% among the youth and those in the reproductive age group. 1

5. To train at least four NGOs in the country in conducting targeting intervention programmes among high risk grouped control STDs. 6. To conduct annual family health awareness campaigns among the general population. 7. Promotion of ordinary testing facilities across the country and every district in the country would have at least one voluntary testing facility. 8. Awareness campaign will be more interactive through traditional media such as folk arts and street theatre in the rural areas. 9. It is proposed to cover all the schools in the country targeting students studying in class IX to X through school education programme and all the universities through the Universities talk on AIDS programme during the project period. AIDS Prevention Programme in Orissa-An Illustration In response to the need of the prevention programme, the Orissa state government with financial assistance with NACO established the state AIDS cell (SAC Orissa) in 1992.Since then, through inter sectoral collaboration SAC is attempting to reach out to different categories of people in the 2 nd phase of the national AIDS control programme. Annual action plan of the state AIDS cell is formulated on the basis of the following objectives: a) To educate the high-risk population (sex workers, Truck Drivers, Migrant laborers, youth mass) about the prevention of NIV/AIDS infection. b) To educated the low risk population (School children, parents, Teachers and all people of different trades or vacations). c) Institutional strengthening of AIDS Education programme in different types of institutions. These institutions are divided in the following categories. Educational (School, College and University-mainly the students of secondary, Higher Secondary, professional courses and University). Social (Club, library, Mahila Mandal, Yuva Parishad, Adult Education center, school for orphans or destitute) Cultural (Club, youth camp, Dramatic Association, Migrant Drama Group/ Opera group, Orchestra group, Dance and music group etc.) Economic (Business Associations, Vyapaar Samiti, Mahila Udyoga Seva Samiti, Co-operative institution, Banks etc.) - Developing strategies for low cost community education project (School AIDS Education project, College and University AIDS Education project, project for NSS, NCC and Scouts etc.). The District/Block/Panchayat and Village AIDS Education Project are also coming under this. - Encouraging all scouts may be Govt., Private or Public to improve in this AIDS Education program(inter sectoral Collaboration) - Targeted Intervention, Programme Targeted interventions are a set of activities and approaches aimed at reducing the risk of HIV/AIDS infection, among people who practice high risk behaviour. Under this, SAC has entrusted the State Management Agency (CARE INDIA) the task of selecting NGOs to target high risk population and provide them awareness on AIDS through different modes, like peer counseling, condom promotion, treatment of STDs and generate on enabling environment. 2

The TI Programmes run by our NGO partners are monitored and Evaluated by State Management Agency- CARE, India. SMA also imparts training with the help of resource persons from SAC to strengthen these organizations for sustained interventions. Situational study Situational study focuses on the spread of AIDS Education and Prevention program on the high-risk behaviour groups in the State, the social as well as location of this group. As part of the Targeted Intervention programme a Situation mapping study has been initiated by SAC study and asses the high risk population for all the districts of Orissa. The study focused on, who are the high-risk groups of AIDS epidemic in Orissa and where are they located. Exposure visit SAC periodically arranges exposure visits of its staff along with the staffs of different NGOs, Govt. bodies to visit, learn and educate the AIDS Education/ Prevention program of different States IUTS. By this way interaction, communication and Education bonds between the AIDS workers of Orissa and different States development. Condom programming HIV infection in India is primarily transmitted through one of heterosexual transmission due to unprotected and multi partner sexual contacts. The most successful, easy and cheapest way to prevent transmission of HIV/AIDS is through the use of condoms. Under this activity SAC along with NGOs ensure the high-risk sexually active population about the easy access of good quality, affordable and acceptable condoms to promote safe sex encounters. These works are made available to help the high risk groups in protection and prevention from STD/HIV/AIDS through the following schemes. Free distribution Social marketing Commercial brand scheme Awareness to use condoms They also educate them about the benefit of condoms in AIDS prevention. Condom promotion and social marketing of condoms has emerged as a very successful approach for promoting condoms and enhancing their ability for use among people with multiple sex partners and youth. STD (sexually transmitted diseases) control measures Sexually transmitted diseases are the public health concern. The presence of STD increases the chances of HIV transmission by 3-10 times. The total numbers of STD clinics in the State of Orissa are 33. These clinics are in process of being upgraded by SAC through provision of essential equipment, lab supplies and drugs. IEC materials are also being supplied to create general awareness among the masses. IEC (Information Education and Communication) strategies. 3

Communication is a powerful tool. It influences people on whom to vote, what to buy and how to conduct their daily lives, even their sexual behavior. Poverty, illiteracy, ignorance, migration, low status of women, etc. are some of the factors which have contributed to the various myths prejudices and misconceptions associated with the HIV/AIDS in Orissa. Realizing the importance of effective communication a communication needs Assessment study was done and an IEC strategy was developed. The IEC strategy focuses on the individual need as well as the communities' needs. Some of the IEC and BCC activities implemented by SAC are:- People based Media Print Media Behaviour Change Audio-Visual Media - Puppet shows - Posters Communication - Television - Song and Drama - Pamphlets - Flip charts - Radio - Road shows - Vehicle stickers - Inter personal - Video - Quiz - Handbills communication - Audio - Rallies - Hoarding - Role play - Cinema slides Observance of National Days related to HIV/AIDS Prevention/Education programmes. Dec.1st. Observance of World AIDS Day on December 1st. every year. Oct. 1st Observance of Voluntary Blood donation Day on 1 st of October every year. Apr. 7th Observance of World Health Day on April 7th every year All these days are observed throughout Orissa to create awareness and rally people around the important of these issues and the need for community support to prevent HIV/AIDS. Interaction with District level functionaries through GRAMSAT SAC, through Orissa GRAMSAT Project (one way video and two way audio communication through satellite Insat-3B) has interacted with District level functionaries and people's representatives by conducting training programmes on Blood safety and the various dimensions of HIV/AIDS, issues and problems and how to confront it. Family Health Awareness Campaign. FHAC strives to reduce the burden of illness associated with STI/RTI and encourage people to seek help of these illnesses and ailments. Every year Family Health Awareness Campaign is held in all the 30 districts. In this campaign the main focus is on creating awareness on STD prevention and care as a means of HIV prevention. Efforts are made to detect RTI/STD early for treatment through community involvement in the village level camps. The parents are found very actively participated in it. Opening of voluntary Counseling and Testing Centre. 4

Voluntary counseling and testing services aims to address the multiple needs and rights of individuals at risk or already infected.all Hospitals located in the district of Cuttack, Sambalpur and Ganjam have Voluntary Counseling and testing Centers. These VCTCs have been upgraded and pre and post counseling is provided to the clients at these VCTCs. Seven more VCTCs have been opened in Balasore, Bolangir, Bhubaneswar, Koraput, Puri, Sundargarh and Jharsuguda. A National AIDS Help Line (Non-Metered 1097) has also been established in the State the AIDS Cell. Blood Safety Measures Communicated blood instead of saving life has the potential of skill. There is no substitute for human blood. The main objectives of the SAC blood safety programme are: - To ensure organized blood-banking services at the district/state level. - Educate people about voluntary blood donation. - Enforce quality control blood. Safe blood is now available in 46 blood banks under Red Cross Banner. These blood banks have been modernized by providing air conditioners, refrigerators and HIV testing equipment HIV kits (ELISA and Rapid). All blood banks are required to conduct mandatory tests for VDRL, HbsAg, HIV and Malaria. These are regularly and frequently monitored through monthly monitoring system as well as frequently visits by SAC every year observes Voluntary Blood Donation Day on 1st of October to create awareness among people regarding donation of blood. School AIDS Programme School AIDS programme is not only aimed at children going to school but also the teachers who need to develop adequate knowledge and skills to teach on how to acquire life skills in their reproductive and sexual lives.through School AIDS Education Programme, 9 high priority districts are going to be covered. - The total number of Secondary Schools to be covered 1948 - The total number of Higher Secondary Schools to be covered 359 - Number of English Medium Schools to be covered 67 - Total no. of schools to be covered are 2374 The curriculum shall address the students of class IX, X, XI and XII. NGOs will focus on extracurricular activities. Committed NGOs will help in putting Question Boxes. These Q boxes will answer all the doubts and queries raised by the students respecting their privacy, by putting the boxes in places so that their anonymity is ensured. These NGOs will also organize various competitions and events relating to HIV / AIDS. Training and sensitization workshops. 5 Sensitization workshops aim at forging partnership with individuals and institutions to help in the prevention of HIV / AIDS.All the Medical and the para-medical staffs in the Governments medical institutions are being trained in the

prevention and control of HIV / AIDS. They are also sensitized and oriented towards care and support towards people with HIV / AIDS. Sensitization Workshops are also being conducted for NGO organization, Panchayati Raj Institutions, hoteliers, religious leaders and school children to give them basic information regarding the spread of HIV / AIDS. These workshops have helped in cleaning the myths and misconceptions regarding the spread of the virus, exposure to the virus and the nature of the disease. Trained Resource persons from SAC have attended various colleges and institutions and focused on the routes of transmission and ways and means to protect you. SAC has carried out campaigns and printed posters on how ethically and morally bound individuals and communities are to honor the rights of People living with HIV / AIDS. Sentinel Surveillance Activities For collection of accurate and complete epidemiological information regarding spread of infection it is important to conduct Sentinel Surveillance regularly. Sentinel Surveillance at regular intervals has enabled SAC to keep track on the prevalence trends of HIV / AIDS infection in Orissa. The Sentinel Sites are located in all the high risk districts, these are- Orissa Ganjam, Kendrapara, Koraput, Balasore, Dhenkanal, Keonjhar, Balangir, Khurda and Sundargarh. Sentinel Sites in Orissa- STD sites -Cuttack -Sambalpur -Berhampur -Koraput -Bhubaneswar -Puri -Balasore ANC sites -Berhampur -Cuttack -Burla -Rourkela Low Cost Community Care and Support As Orissa is a low prevalent State and it has not reached a epidemic level SAC s focus is more in creating awareness and behaviour change. SAC with the aid of Medical Colleges and hospital is providing treatment of opportunistic infection of the people living with HIV / AIDS. It has also provided Post Exposure Prophylaxis medicines for Medical and paramedical staff to ensure safety for them in the three medical colleges and thirteen districts. 6

Inter-sectoral Collaboration with public and private sector. SAC has displayed a high level of commitment for prevention and control of HIV / AIDS. It has involved people who can make a difference and create awareness. Sensitization workshops have carried forth the message of AIDS free life. All sections of people are being mobilized in this fight against HIV / AIDS. Hoteliers, Dhaba owners, Religious leaders, Civil Servants, Students as well as School Children and Panchayati Raj institutions have been sensitized to create awareness as well as to stop the spread of disease. In conclusion OSACS owes for AIDS free life for all in Orissa and has come to realize that HIV / AIDS is not only a medical problem but also a social as well as an economic one and this problem can be tackled only if we forge effective partnership between the various sectors. References BBC (2003), Interview of UN Secretary General, Kofi Annan with BBC World Service on the occasion of World AIDS Day, 2003, Broadcast on 29 th and 30 th November, 2003, London, UK. UNAIDS (2003), Interview of UNAIDS Executive Director Peter Piot by Times of India on 23 rd October, 1998, New Delhi, India. Final Report of 14 th International Conference (2002), The excerpt of the Executive Director of UNAIDS Peter Piot s address on the opening day 7 th July, 2002, Barcelona, Spain. Vajpayee A.V. (2000), PM s message on Health issue on Independence Day, Ministry of Health, New Delhi, 15 th August, 2000. Annan Kofi (2003), Interview of UN Secretary General, Kofi Annan with BBC World Service on the occasion of World AIDS Day, 2003, Broadcast on 29 th and 30 th November, 2003, London, UK. AIDS Action (1991 to 2004) : The International news letter on HIV / AIDS, prevention and care, Asia Pacific edition, HAIN publication, Philippines. Dasgupta P.R., (1994) AIDS Education in New Delhi, 1994. Giri Dillip Kumar and et. al (2005) : 1000 Special collection of Articles from news papers (The Times of India, The Indian Express and The New Indian Express, The Hindustan Times, The Hindu). Giri Dillip K. (1996) AIDS : The Ticking Time Bomb, Article presented in super Brain Essay contest, competition success Review, New Delhi, June 1996. Global Estimates on AIDS (1998 to 2003) : World Switzerland, 2004. Health Organisation and UN AIDS Geneva, Gupta Anil (1994) : The indirect cost of AIDS, Article Published in December, 1994. Kalra, R.M. and Kalra, S (2000) : Adolescents and AIDS A new generation at risk, Vikas Publishing House 7

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