Globally a total of 2.7 million people acquired HIV infection in 2010, including 390 000 among children less than 15 years. This current prevalence has come down from 3.1 million in 2001, contributing to the total number of 34 million people living with HIV in 2010.
Women constitute half (50%) the adults (15 years and older) living with HIV in 2010, according to UNAIDS estimates. That proportion has shifted very little in the past 15 years. The burden of HIV on women, however, varies considerably by region and is heaviest in sub-Saharan Africa.
Although the rate of HIV prevalence is substantially lower in Asia than in some other regions, the absolute size of the Asian population means it is the second largest grouping of people living with HIV. In South and South-East Asia, the estimated 270 000 new HIV infections in 2010 was 40% less than at the epidemic’s peak in 1996. In India, the country with the largest number of people living with HIV in the region, new HIV infections fell by 56%.
HIV/AIDS – Indian Scenario
• India witnessed the first case of HIV/ AIDS in the year of 1986 in Chennai (Tamil Nadu) among a female commercial sex worker – the core group of transmitters. This was almost a decade after its appearance in the globe.
• As of 2010, India is estimated to have 23.9 lakh people infected with HIV at an estimated adult HIV prevalence of 0.31%. Adult HIV prevalence among men is 0.36%, while among women; it is 0.25%. These figures highlight an alarming rise compared to 2009 estimate of 0.29%.
• HIV infection rates have seen a downfall since 2003, however the recent estimates of 2010 reveal a rise of almost 0.2 % which suggests increasing spread of the infection in low risk populations as well especially among women and youth.
• Nearly 87 percent of HIV infections are still occurring through heterosexual routes of transmission. While parent to child transmission accounts for 5.4 percent of HIV cases detected, injecting drug use (1.6%), Men who have Sex with Men (1.5%) and contaminated blood and blood products account for one percent.
National AIDS Control Organization - A Government of India Initiative
The 1990s saw the government set up NACO (the National AIDS Control Organization) and subsequently the National AIDS Control Programme (NACP-I) to oversee the formulation of policies, prevention work and control programmes relating to HIV and AIDS.
NACP-I (1992 – 1999)
The objective of NACP-I was to control the spread of HIV infection.
• During this period a major expansion of infrastructure of blood banks was undertaken with the establishment of 685 blood banks and 40 blood component separations.
• Infrastructure for treatment of sexually transmitted diseases in district hospitals and medical colleges was created with the establishment of 504 STD clinics.
• HIV sentinel surveillance system was also initiated.
• NGOs were involved in the prevention interventions with the focus on awareness generation.
The programme led to capacity development at the state level with the creation of State AIDS Cells in the Directorate of Health Services in states and union territories.
NACP-II (1999-2006)
During NACP-II a number of new initiatives were undertaken and the programme expanded in new areas.
• Targeted Interventions were started through NGOs, with a focus on High Risk Groups (HRGs) viz. commercial sex workers (CSWs), men who have sex with men (MSM), injecting drug users (IDUs), and bridge populations (truckers and migrants). The package of services in these interventions includes Behaviour Change Communication, management of STDs and condom promotion.
• The School AIDS Education Programme was conceptualised to build up life skills of adolescents and address issues relating to growing up. All channels of communication were engaged to spread awareness about HIV/AIDS, promote safe behaviours and increase condom usage.
• VCTC‘s (Voluntary Counseling & Testing Centres) and PPTCT‘s (Prevention of Parent to Child Transmission) Programme was introduced to cater to general population and pregnant mothers respectively. Towards the end of NACP II, PPTCT centres were combined with VCTCs to form Integrated Counselling and Testing Centres (ICTCs). Provision of free Anti-Retroviral drugs to people living with AIDS was a crucial step in battling against this epidemic.
• Surveillance was upgraded, with reported AIDS cases being tracked as a source of additional information.
During this second phase of NACP the number of people living with HIV/AIDS went down to half from 5.3 million in 2003 to 2.5 million in 2006 (HSS 2006). By the end of NACP-II, HIV transmission through blood was reduced to less than two per cent (from eight per cent when surveillance first started in the late 1980s).
NACP-III (2008 – 2012)
Currently in its third phase, the overall goals of NACP-III is to halt and reverse the epidemic in India by integrating programmes for prevention, care, support and treatment. This will be achieved through a four-pronged strategy:
• Prevent infections through saturation of coverage of high-risk groups with targeted interventions (TIs) and scaled up interventions in the general population.
• Provide greater care, support and treatment to larger numbers of PLHA (People Living with HIV/AIDS).
• Strengthen the infrastructure, systems and human resources in prevention, care, support and treatment programmes at district, state and national levels.
• Strengthen the nationwide Strategic Information Management System.
The specific objective is to reduce the rate of incidence by 60 percent in the first year of the programme in high prevalence states to obtain the reversal of the epidemic, and by 40 percent in the vulnerable states to stabilize the epidemic.
Mumbai District AIDS Control Society
National AIDS Control Organisation provides leadership to HIV/AIDS Control Programme in India, implementing one National Plan within one monitoring system. State AIDS Prevention and Control Societies (SACS) implement NACO programme at state level.
The Mumbai Districts AIDS Control Society (MDACS) is the Mumbai arm of NACO. Established on 27th July 1998 by the Municipal Corporation of Greater Mumbai (MCGM) for control & prevention of HIV/AIDS in Mumbai, MDACS collaborates with various concerned stakeholders viz. General Health Sector, NGOs, CBOs, people living with HIV/AIDS, Corporate Houses and Media etc.
Detection of the HIV virus - Integrated Counseling and Testing Centers
Integrated HIV counselling and testing is a very important tool both in prevention & control as well as in the early diagnosis of an individual and subsequent care & support. It is a fact that very few people who are living with HIV/AIDS are aware about their HIV status. The only means of knowing one’s HIV status is to undergo a blood test.
The HIV counseling and testing have been implemented by MDACS in Mumbai through the “Integrated counseling and testing centers” (ICTCs) for more than a decade. These ICTCs have been reformed from the earlier Voluntary Counseling and Testing Centers (VCTCs) and facilities providing Prevention of Parent-to-Child Transmission of HIV (PPTCT) services. The ICTCs serve as the entry point for a range of interventions in HIV prevention, care and support.
There has been a continuous scale-up in the establishment of new ICTCs to meet the need of increasing counseling & testing in Mumbai from 21 centers in 2001 to 96 in 2011. The ICTCs have been established in almost all the Govt. and Municipal Health institutions. There are 70 Stand-alone ICTCs and 30 Public-private partnership ICTCs in Mumbai.
As of 2012, there are 100 ICTCs in Mumbai.
MDACS also operates 3 mobile ICTC vans in addition to the 100, that have been providing counseling & testing to hard-to-reach population. These vans are stationed at the Hot-spot areas of the Targeted Intervention projects and the slum areas where the NGOs motivate their clients and bring them to the Mobile Van ICTCs. Counseling and testing is provided to such clients and the clients are provided with the HIV report on the same day along with further necessary referral services.
The ICTC services are also made available for Jail inmates (Arthur Road Jail for male & Byculla Jail for female inmates).
With the scale-up, the number of general clients (excluding pregnant women) tested for HIV at the ICTCs has almost doubled from 99392 in 2005 to 230628 in 2010. HIV positivity among these clients has decreased from 13% in 2005 to 6.75% in 2010.
ICTC Staff
Each ICTC has a team of skilled persons consisting of the manager (medical officer), counsellor and Lab Technician.
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