State AIDS Council, UP June 29, 2009 Uttar Pradesh State AIDS Control Society First Meeting of

State AIDS Council, UP The History… 1981First case reported in USA 1986First reported case in a CSW 1987First reported case in U.P. 1987National AIDS control Program launched 1992AIDS Cell in UP 1999State AIDS Control Society formed

State AIDS Council, UP The Strategy… National AIDS Control Program – I, II, III State AIDS Control Societies Initially Prevention only Targeted Interventions Spread to general population Management of AIDS – ART NACP-III : prevention, treatment and care

State AIDS Council, UP The Present Scenario Estimated HIV+ in India 23.3 lac Estimated HIV+ in U.P lac 90% of HIV+ are in the age group of (most productive age group.) India being the youngest nation in the world average age being 28 years. On an average 6000 new infection per day 2/3 are in the age group of years 75% of this 2/3 are females 40% of total HIV + population are women. Some states highly affected, some are vulnerable

State AIDS Council, UP

Vulnerability of UP Population 180 million (growth rate 2.5%) Nearly 50% of UP Population in reproductive age group (i.e Years) Low literacy (rural 36.66%, state 57.2%) High incidence of poverty Low status of women & Gender disparity Large presence of high risk groups Migration : very high Highway network s : 8 national highways FSWs / IDUs / MSMs : high numbers Long porous Indo-Nepal border

State AIDS Council, UP Saharanpur Muzaffarnagar Bijnor Baghpat Meerut Ghaziabad Moradabad JP Nagar Rampur Gautam Buddha Nagar Bulandshahar Pilibhit Bareilly Budaun Shahjahanpur Lakhimpur Kheri Hardoi Farrukhabad Etah Aligarh Mathura Hathras Agra Firozabad Mainpuri Etawah Auraiya Jalaun Jhansi Lalitpur Sitapur Mahoba Hamirpur Banda Fatehpur Chitrakoot Kanpur Dehat Kaushambi Allahabad Mirzapur Sonbhadra Chandauli Varanasi Bhadohi Ghazipur Ballia Mau Deoria Kusinagar Maharajganj Siddharthnagar Balrampur Sharwasti Bahraich Bara Banki Gonda Basti Gorakhpur Azamgarh Ambedkar Nagar Faizabad Sultanpur Jaunpur Pratapgarh Rae Bareli Lucknow Unnao Kanpur Nagar Sant Kabir Nagar Legend - Up to – More than 3000 Cumulative number of persons tested HIV positive in ICTC Up to March 2009 Kannauj Total no. of persons tested HIV Positive

State AIDS Council, UP Number of Patients from different district Alive and on ART - Mar 2009

State AIDS Council, UP Role of AIDS Council Review of HIV/AIDS transmission and policy formulation for HIV/AIDS programming in the state Mainstream HIV/AIDS issue in all the departments and coordinate HIV related programs at all levels To include private / corporate / social sectors in the HIV programming under inter- departmental coordination Review status of inter-departmental coordination regularly

State AIDS Council, UP How HIV/AIDS affects? To Whom? Person Destroys immunity Opportunistic infections Society Stigma and discrimination Association with sex / sin / curse Costly and life long medicines Loss of skilled labour force Burden on health services

State AIDS Council, UP Sectoral Impact Decline in GDP – Economic Growth will decline by 0.86% and per capita GDP by 0.55% Increase in Health expenditure – 5% increase in Govt. Health spending on HIV will result in 0.67% Decline in Govt. saving and 1.16% in Investment. Unskilled labour sector Hit Hardest – Maximum decline in output will be for sectors with unskilled labour such as tourism (18.31%), Manufacturing (12.48%).

State AIDS Council, UP Contd.. GDP Loss in Industrial Sector – 4 Sectors will contribute to overall loss in industrial GDP: Construction, Mining, Quarrying and textile. Increase in Household Spending – 10% increase on health expenditure by HIV household will reduce their expenditure on education and consumption. Lower Labour Productivity – Lower labour productivity of HIV Infected and effected workers will affect the overall productivity of all sectors Source:- National Council of Applied Economic Research (NCAER)

State AIDS Council, UP Socio- Economic Impact Household Income Decreases – Illness with in household results in loss of income.66.25% income lost when PLHIV workers were not working and 9.24% lost due to leave/absence from work. Unemployment Increases – within the HIV households increased from 3.6% to 9.8%- own illness most important reason. – Borrowing Increase – 46% of HIV households borrowed compared to 27% of non-HIV households. Greater Expenditure – Per capita monthly expenditure Four Times Higher than non HIV households due to increase medical expenses.

State AIDS Council, UP Contd.. Drop out Rate Increase – 33.3% in 6-14 age group from HIV Households Dropped out to take a job and 22.3% to take care of siblings /household work. Greater Hospitalization – Five times more hospitalization in HIV Household than non-HIV household. More illnesses left untreated for women. Fear of Disclosure at workplace – 74% of PLHIV did not disclose their status at workplace for fear of losing jobs Source:- National Council of Applied Economic Research (NCAER)

State AIDS Council, UP Gender Impact Greater Burden of Care – 70% of Care givers for HIV households were women of which 20% were living with HIV Poor Health seeking Behavior – Expenditure per illness episode for HIV households were more for men (Rs 796) than women (Rs 487). More women (70.4%) used Govt. hospitals than men (59.7%) Lower Enrolment Levels – In age group current enrolment for girls from HIV households (64.81%) was lower than girls from non HIV households (79.54%) Source:- National Council of Applied Economic Research (NCAER)

State AIDS Council, UP Contd.. Girls Withdrawn from School – In 6-14 age group, 32.1% of girls from HIV households were withdrawn from school Higher Disclosure to spouse – 83% of the women informed their husbands immediately of their HIV status compared to only 69.3% of men. Lower Awareness among Women – 52% men knew where to go for voluntary testing in comparison to 36% of Women Source:- National Council of Applied Economic Research (NCAER)

State AIDS Council, UP Contd.. Greater Stigma Faced by Women More women living with HIV (5.5%) were asked to leave home after testing positive than men (1.9%) 95% of new infections in women were among married and monogamous Widows denied Right to Property – Widows represented a third of the sample and face stigma on 3 counts – As women – PLHIV – Widows – 90% were forced to leave marital home and 79% denied share in Husband’s property. 43% live alone and economically worse off than HIV households. Source:- National Council of Applied Economic Research (NCAER) Greater Stigma Faced by Women

State AIDS Council, UP Mainstreaming “ process of analyzing how HIV and AIDS impacts on all sectors now and in the future, both internally and externally to determine how each sector should respond based on its comparative advantage.” Becoming PART OF… … & NOT An ADD-ON Activity Reduces large expenditure on health care & social welfare. Minimizes negative impact on programmes related to education, livelihood, social welfare, Women and Child Health. Saves loss of skilled employees.

State AIDS Council, UP Expectations From Various Ministries, Industries & CBO/NGO Prevention – Display of Information Panels & Posters – Provide Free space for Hoardings at public places – Training of Departmental officials on HIV Issues – Free space for Installation of Condom Vending Machines (CVMs) – Each Department to identify nodal officers to address HIV issues at state and Dist level – Instructions to training institute to include HIV in curriculum Preventive and Treatment Services – Clinics for counseling & Testing, STD Treatment, referral linkages. – Treatment of Opportunistic Infection and ART.

State AIDS Council, UP Contd.. Enabling Environment – Disseminating knowledge about HIV through outreach programme – Implementing workplace policies in each and every establishment – Providing free transport facilities to PLHAs to treatment sites – Providing employment opportunities to PLHIVs in existing employment schemes – Providing soft/ cheap credit facilities to PLHIVs – Subsidized grains for nutritional support – Providing free legal aid to PLHAs to ensure implementation of their rights

State AIDS Council, UP To Start with … Proposed activities for approval by State AIDS Council  One Day orientation of District Magistrates and Chief Medical Officers of all district.  Sensitization Programme for Police Officers of all Districts  One Day Sensitization Programme from Special Secretaries to section officers of Secretariat  Installation of Posters on HIV/AIDS in Secretariat premises  Inclusion of HIV-AIDS related information in the websites of all the departments and to provide a link to UPSACS / NACO website on all the departmental websites.  Special Attention to be given to Varanasi and Allahabad Dist. May like to approve the above activity by State AIDS Council

State AIDS Council, UP

Thank You