INITIATIVES IN ANDHRA PRADESH TO TACKLE HIV/AIDS PROBLEM Asok Kumar IAS, Project Director, APSACS

HIV/AIDS Scenario in A.P A.P. is one of the six high prevalent States in the Country. Median HIV prevalence is 2% (in Urban ANC sites) Median HIV prevalence is 1 % (in Semi Urban ANC sites) HIV prevalence in STD clinic attendees is 22.8% 92.5% of the infections through sexual transmission 92% infections are in the age group of years.

HIV/AIDS Scenario in A.P. SENTINEL SURVEILLANCE ANC SITES (Urban) Adilabad NizamabadKarimnagar MedakWarangal Rangareddy Hyderabad Nalgonda Mahabubnagar Guntur Kurnool Prakasam Khammam Krishna AnanthapurCuddapahNellore Chittoor West Godavari Visakhapatnam East Godavari Vizianagaram Srikakulam 2.00% 2.50%1% 2.75% 1.50% 2.00 % 1.75% 0.25% 0.75% 2.25% 2.50% 1.75% 2.50% 2.75% 3.00 % 1.50% 3.50% 0.75% 2.00% 1.50% 3.25% 2.00% 1.25% 1% - < 2% < 1% 9 1 >= 2% 13

Mode of Transmission based on voluntary disclosure (January - December 2005) N= 45266

Factors fuelling HIV in AP  High Non regular sex partners  High (7%) prevalence of STIs  Low Condom use (25%) with non regular partners  Large migrant population  Vast network of national highways  Trafficking of the girls into sex trade  Existence of traditional/non traditional sex networks  High rate of tubectomy & hysterectomy  IT / BPO sector  Awareness not resulting in behavioral change.

Redefined Mission of APSACS MAIN STREAM HIV/ AIDS with –Medical department –All other departments concerned Prevent new HIV infections Save the next generation Stigma reduction Awareness to behavior change Palliative care and support ART support Involve people in the campaign

Targeted interventions NGO PROJECTS Sex workers 20 Truckers 20 MSM 03 Composite 23 Migrant11 Street children06 Total83 (plus prison 25) BLOOD BANKS Government64 Voluntary45 Attached to hospitals73 Private / 35 commercial Total 217

Mainstreaming of AIDS/HIV program A state level Committee formed with Hon CM as chairperson to plan and co-ordinate efforts of all departments concerned –CS, DGP, Secretaries of 16 departments, representatives of positive network, donor agencies, prominent NGOs involved FIRST TIME IN THE COUNTRY –1 st meeting held on Steering committee under Chief Secretary –1 st meeting held on

Mainstreaming with Health Dept HANDS ON training to PHC doctors from 3 rd July, 06 in 2 phases instead of the regular HAND OUTs training –Stigma among PHC doctors reduced –241 doctors trained HANDS ON training for NURSES started from 6 th November 2006 with the help of CHAI & Clinton Foundation –167 nurses trained Designation of Dist Leprosy Officer changed to Addl DMHO (AIDS&L) vide GO Ms.No.845 of HM &FW(F2) dept, dated

More ICTS, better monitoring New 302 ICTCs started on 1 December 2006 raising the total to 580 centers District Program Monitoring Units in 10 districts to ensure proper Monitoring & Control of the programs from Jan 15, 2007 All schemes under one umbrella for M&E Web monitoring introduced from Nov,06 HIV/TB co-infection co-ordination committees formed in all districts

Red Ribbon clubs First time in the country 15,000 Red Ribbon clubs formed –Letter from Union Health minister in April06 –Meeting by Governor on 11 June 2006 –To cover all children of age group Training for teachers completed Books- flip charts, FAQ prepared, translated, printed and sent to schools 19,00,000 FAQ booklets distributed by Nov 10,2006

New initiatives--IEC AASHA campaigns in July 2005, May 06 AASHAYAM serial started from Oct 4, 06 on DD Saptagiri channel –Based on real stories of AIDS victims AIDS awareness IEC materials printed in Braille, lambadi and urdu Ashanna and Ashakka to be spokespersons State office of TNP started in Hyderabad on Oct 2, 2006

Intensive campaign Started from DEC 1, WORLD AIDS DAY Intensively for a week but continued for a month Every body with risk behavior encouraged to get tested Questionnaire for initial screening (self referral) Testing helps to normalize the HIV tests, reduce stigma associated, prevents further transmission by HIV+ve persons, facilitates early treatment and gives better sample Services directory released Identification and testing of pregnant women for HIV Special drive to fight STI “UNDA MEEDAGERA” campaign for condom promotion Police initiatives—testings, peer educator badges

Intensive campaign Hon CM Dr YS Rajasekhara Reddy is BOLD to test his blood to know his HIV status. Testing was done on 18 Dec 2006

Intensive campaign Hon Speaker of APLA, Sri Suresh Reddy is BOLD to test his blood to know his HIV status. Testing was done on 18 Dec 2006

Intensive campaign gram/ward sabhas conducted in the state On 18 th December 75MLAs- led by the Chief minister & Speaker - including 8 ministers came forward to test their blood to know their HIV status Meeting of 3800 PLHAs on Dec 7 th, 2006 at Sampradika Vedika Hyderabad- said to one of the largest gathering of HIV +ve people in the world- and signed the Hyderabad Declaration The number of testings up from in December 2005 to 1,20,000 in December 2006 Calls to toll free information center up from 1100 in November 2006 month to 3313 in December 2006

Gathering of 3800 HIV+ve people on Dec 7,06 & THE HYDERABAD DELCLARATION

ART and Care & Support Services 13 ART/CART centers functioning- 4 more by March 30,07 Under CART initiative 2860 children tested, 501 put on ART Sharing of CD4 machines- ESI hospitals, Private Hospitals network (APAIDSCON). “Aasha poshakaharm” to ART patients from Dec 1, 2006 New Care and support centers, orphanages set up Tied up with swadhar homes of WD&CW dept First time state budget support for AIDS programs Rs 7.7 Crores assured from state budget for care and support of HIV/AIDS patients in

Effects of Efforts Cases tested April 05- Jan ,39,396 –Whole year 5,98,029 Patients in Care &Support ,071 ( ) Testing centers as on Oct 1, ART Centres - 3 (Aug,2006) –Patients -3075/16078(regd) Child ART - 0 Cases tested April 06 – Jan 07- 8,21,331 Dec 1-7 – 70,0000 Patients in Care & Support –24,303 (Apl-Jan 07) Testing centers from Nov 1, ART Centres –Patients – 8966/33601 Child ART - 501/

LEGISLATORS FORUM Formed in 2004 with 16 members Last meeting held on Major decisions taken –To involve MLAs in the monitoring of the HIV/AIDS activities in the constituency level –Sensitisation program for all MLAs and PRI members like Zilla Parishat, Mandal Parishat members and sarpanchs –Setting up of a secretariat for LF in Assembly

Future Plans Another 150 ICTCs to ensure geographical spread, minimum investments- mainstreaming More care and support centers/Swadhar homes / orphanages for affected / infected persons Start the 0/7campaign Nutrition for patients and kids Annapoorna / Anthyodaya cards for HIV patients Develop a dedicated cadre of 1,00,000 AIDS campaigners – AASHA MITRAS- in the state –SHG members and NYK volunteers Make it a “people’s movement”

THANKS

HIV/AIDS Scenario in A.P. SENTINEL SURVEILLANCE ANC SITES (Urban) Adilabad NizamabadKarimnagar MedakWarangal Rangareddy Hyderabad Nalgonda Mahabubnagar Guntur Kurnool Prakasam Khammam Krishna AnanthapurCuddapahNellore Chittoor West Godavari Visakhapatnam East Godavari Vizianagaram Srikakulam 2.00 % 2.50 % 1% 2.75% 1.50% 2.00 % 1.75% 0.25% 0.75% 2.25% 2.50 % 1.75% 2.50 % 2.75% 3.00 % 1.50% 3.50 % 0.75% 2.00 % 1.50% 3.25 % 2.00% 1.25% 1% - < 2% < 1% 9 1 >= 2% 13