1. HIV/AIDS SCENARIO IN NAGALAND DR. S.K CHATURVEDI MD, MNAMS, FIAPSM, FIPHA

2. PEOPLE, ECONOMY & INDUSTRY  83% live in rural area  40% of rural & 7% urban below poverty line  Literacy rate of 67% (M:F=72%:62%)  Sex ratio less than national average  Border with Myanmar known entry points for heroin trafficking  Secessionist movements a major deterrent to development

3. STATUS OF HIV EPIDEMIC : reflection from sentinel surveillance  1990- HIV infection first seen in IDUs (50%)  1998- Sentinel Surveillance started : 2 sites  (IDU-14% & STD - 5%)  2002 – Crosses 1% in ANC  A shift from concentrated to generalized epidemic in four years  Needed ? : NSACS to strengthen its programme

4. Status (contd.)  Status of AIDS Programme in Nagaland Prevalence rate : 1.28% Prevalence among different populations (2004) STD clinic attendees : 1.7% Female Sex workers (Dimapur) : 4.4% Ante Natal clinic attendees : 1.28% HIV/TB : 7.2% Injecting drug users : 2.9%

5. WOMEN AND HIV :IN Nagaland  Diffused sex trade  High HIV prevalence of 9.7% in FSWs below 20 Yr  32% o FSWs are migrants  Needs? Interstate collaborative intervention -Thorough understanding of environmental factors and develop interventions based on it -Address needs of women not in the high risk groups

6. WOMEN AND HIV : contd.  Knowledge level poor- 37% of rural had heard of HIV  Only 53% could ask male to use condom  26% only knew all three ways of transmission

7. STIGMA & DISCRIMINATION  Struggle between individual morality and public health interventions  More discrimination against women  Address needs of Children orphaned by HIV/AIDS  Need for sensitization of hospital/health staff

8. Voluntary Confidential Counselling and Testing Centre (VCCTC) Presently, the State has 12 VCTCs established in all the 11 District Hospitals and Impur Mission Hospital. The State is beginning to see an increase in access to VCTC services.

9. Prevention of Parent to Child Transmission (PPTCT) - Total number of centers in the State -13. - pregnant women going to hospitals for delivery is low. - Access to PPTCT services is low. - Village Health Committees are being trained. - Importance given to hospital delivery. Blood Safety - The State has 8 district level blood banks. - Voluntary blood donation movement in the State in process of development.

10. Information, Education and Communication (IEC) - District AIDS Committee (DAC), in all Districts - Village Health Committees at village level. - IEC Action Plan by different Departments. - Develop effective communication strategies.

11. Some key infrastructures in place in the State are : - State Coordination Committee under the Chairmanship of the Chief Minister. - Nagaland Legislative Forum under the Chairmanship of Minister for Health & FW. - Committee of Concern under the Chairmanship of the Chief Secretary. - State alliance with different partners. - State IEC Committee including Members from NGOs and Nagaland Network of Positive People (NNP+). - District AIDS Committees. - Coordination committee with NBCC (Apex Church organization). - NSACS Web side opened. (www.nagalandaids.com)

12. School AIDS Education Programme (SAEP ) SAEP has been introduced into the school in the year 2004. A module on AIDS and Drug Prevention Education has been developed for classes 5 to 8. Initially, schools in five districts have been covered in the year 2004-05. SAEP is now a being owned by education deptt. with technical support from SACS Police Department HIV/AIDS training has been incorporated into Police Training Curriculum. Other Sectors – Government/NGOs/Church etc. Action Plans being prepared.

13. Care and Support Community Care Project - 8 community care projects -1 AIDS Hospice, 3 Drop- in- centers, 3 Church based care projects and 1 Network for Positive People. - Visible Network for PLHAs is important. - Many members of Network are current drug users.

14. Antiretroviral Therapy (ART) Programme Launched on 16 th April 2004 at Naga Hospital Authority, Kohima. Total registered till 31 st Dec. 2004114 Male - 66 Female- 48 Persons put on treatmentDeaths Total-59 8 Male-33 4 Female26 4

15. ART Programme - Not accessible to many people from other Districts. - All Doctors and Health workers trained on different aspects of HIV/AIDs. - Hesitation to access service from public sector. - Need to make services more client friendly.

16. Programme Management Staffing: - Need for increased manpower. Training: - Much importance given to training. - Ongoing training needed. - Hands on Training needed. - Focus for NGO capacities. - Develop Training Institutions. Sentinel Surveillance: - Urban and Rural included

17. Intersectoral Collaboration: - Epidemic driven by Sexual route and IDU - Need to address contributing factors. - Comprehensive multisectoral response needed. - Strong Political leadership. - Ownership by all Departments, Church etc. - Complement and avoid duplication of activities.

18. Some Outcomes of the intersectoral activities 1. The Nagaland Legislative Forum formed. 2. State Coordination Committee under the Chairmanship of the Chief Minister. 3. All Departments have been directed to identify Nodal Officer for HIV/AIDS and prepare Action Plans within each department’s existing infrastructure and programmes. 4. Committee of Concern under the Chairmanship of the Chief Secretary. 5. State Alliance of Agencies implementing HIV/AIDS formed.