HIV/AIDS in India
A presentation by Dr. Kakrani to the workshop
held Jan. 1 & 2, 2010 at the Pune Union of
Working Journalists Hall in Navi Peth sponsored
by the University of Miami and Indiana University
titled, “Strengthening Media Professionalism and
the NGO-Media Interface in India, and Sri Lanka
for HIV/AIDS Coverage
Dr.A.L.Kakrani, MD
Dean, Faculty of Medicine
Dr DY Patil University &
Professor & Head, Department of Medicine
Dr D Y Patil Medical College, Hospital & Research Centre
Pimpri, Pune 411018
Phone: College & Hospital :
91-20-27423690/27420307 Ext 185
Residence: 91-20-25880873
Mobile: 09823972424
e-mail: kakrani@hotmail.com
Res Address: 201,Vishakha,DSK Akashganga,
New DP Road, Aundh,
Pune 411007
Probable Sources of Transmission in AIDS
Cases in India (July, ’05)
2.39
2
3.64
6.01
Sexual
IDUs
85.96
Blood and Blood
Products
Perinatal
Others
Transition Map of HIV prevalence
Evolution of HIV from 1986 to 2002
1986
First case of HIV
detected in
Chennai
1990
HIV Prevalence
reaches over 5%
amongst high risk
group in Maharashtra
and Manipur
1994
1.74 m infected
5.13
Indians Living
with
HIV/AIDS
4.58Million
m. Indians
living
with
HIV
1998
3.5 m. infected
> 1 % antenatal women
2001
4.01 m. infected
> 5 % high risk groups
2002
4.58 m. infected
< 5 % high risk groups
Decline in HIV incidence
According to NACO's newer estimates, the
prevalence of HIV/AIDS in India has to be scaled
down from about 0.9 per cent to one in 300 or
0.36 per cent, or to 2-3.1 million with an average
of 2.5 millions from the government's 2006
estimate of 5.2 million.
 Why are these numbers more accurate?
The credibility of the new HIV prevalence figures
is very high because they are derived from not
one but three authoritative sources.
Additional 'sentinel' surveys sites, NHFC-3 &
NBSS & IBBAS

Times of India
LEADER ARTICLE: Don't Be Misled On AIDS
10 Jul 2007, Pallava Bagla



It may be premature to start celebrating that
number of people infected with HIV has come
down by half to 2.47 million as per the latest
estimate released by the government.
The government went in for a different approach
in 2006. Earlier, it would restrict itself to 'sentinel'
surveys, This time, the government decided to
supplement these surveys with community data.
Prabhat Jha of the Center for Global Health
Research, Toronto, says, "It is hard to know how
much of this drop is due to a new computer
programme rather than the efforts of the AIDS
control programme".
Start of National AIDS
Control Programme
(NACP) was first step
towards the control of
HIV spread in India
NACP Phase I
Started in 1992 with Emphasis on
 Epidemic monitoring by surveillance
 Awareness generation through information
, education & communication
 Ensuring blood safety
This led to a firm footing for NACP Phase II
Objectives of NACP Phase II
(1999-2004-extendable )
 Reduce
the rate of growth of
HIV infection in India
 Strengthen India’s capacity
to respond to HIV/AIDS
NACP-III
2007 till date




Prevent infection through coverage of high-risk
groups with targeted interventions and scaled up
interventions in the general population.
Provide greater care, support and treatment to
larger number of PLHA.
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.
NACP III Expenditure
Antiretroviral Therapy
Till date the only hope
for long term survival of
HIV AIDS patients is use
of
Antiretroviral Therapy
Antiretroviral Therapy (ART)
ART for HIV disease has transformed
the common perception about HIV
from being a rapidly fatal disease to
some what more manageable chronic
disease
 Risk of Opportunistic Infections is
minimized & many non- infectious
complications are reduced
Global Response on HIV AIDS

Millennium Development Goal (MDG) By
2015: halt and begin to reverse the spread of
HIV/AIDS.

June 2001: UN General Assembly Special
Session “call to action” HIV/AIDS is a global
emergency, it undermines socio-economic
development& poses a challenge to full
enjoyment of human rights
Global Response on ART

April 2002:WHO released guidelines for ART in
resource limited settings, includes 10 ART drugs in
the list of “ Essential Medicines” for all countries,
put pressure on Pharma Industries for cost
reduction

Sept 03: WHO/UNAIDS: lack of ARV access is
“Global Health Emergency”

1st December 2003: WHO/UNAIDS revised “3 by 5”
Initiative launched

1st Dec 2003, GOI announced free ART from 1/4/04
In February
2004,NACO has
prepared the document
for ART Guidelines in
consultation with
clinicians in public &
private sector , technical
experts from GOI,
DGHS,
WHO,UNAIDS,
donors, CII, Pharma
industry, network of
HIV Positive,
paramedical groups &
NGOs. The document
ART Programme in India
Started after 3x5 initiative by WHO in 2003
 Govt of India decided to provide free
access to ART for 100,000 PLHA by 2005
but only 33000 could be enrolled
 GOI plans to expand the program up to
district level to cover 3 lac PLHA by 2012
through 250 centres across India
 Program is largely supported by GFATM
(Global Fund for AIDS,TB & Malaria )
 Public Private Partnership is encouraged

Pressures To Increase The Enrollments For
ART Are Inevitable & May Interfere With The
Rationale Use & Cause Gaps in Drug
Delivery
National ART Data
November 2009
Adults
269948
Pediatrics
18020
Total cases
287968
CD4 machines
174
ART Centres
230
Second line Anti-retroviral Therapy
Second line anti-retroviral therapy (ART) was
rolled out under the National ART Programme
on January 1, 2008 on a pilot basis at the JJ
Hospital, Mumbai and GHTM, Tambaram.
 Its access has expanded to 10 Centres of
Excellence which have necessary expertise and
laboratory facilities to initiate and monitor it.
 Out of 687 patients who were evaluated, 274
were put on second line ART & 49 counselled

Link ART Centres
Link ART Centres help decongest big ART
centres & reduce patient's time & costs
 It is planned to have 650 LACs under
NACP-III. & A total of 334 LACs were
sanctioned of which 68 are functional with
170 trained staff members

Thailand Vaccine trial


For the first time a vaccine against AIDS has
shown efficacy in humans. Although modest, it is
very encouraging for the scientific community.
With one third of protected persons only, “this
vaccine will not allow us to control the AIDS
epidemic, But it is a very strong signal to the
scientific community: it shows that we can
vaccinate against HIV no vaccine against AIDS
has so far shown efficacy in humans.
Types of HIV Counselling

Prevention



VCT: Pre-test/Post-test
ART





Risk reduction, behavior change
ART readiness
Adherence
Crisis intervention
Grief and bereavement
Peer counselling
Median Survival after AIDS
Diagnosis in Brazil (1989-2001)
Survival (in months)
70
58
60
50
40
30
18
20
10
5
Introduction of
universal
access to
HAART in Brazil
0
1982-1989
1990-1995
1996-2001
Year of AIDS Diagnosis
Chequer et al, 1992; Marins et al. 2002
Number of AIDS deaths (registered and estimated)
considering the actions of National AIDS Program
Brazil, 1989 to 2002
Thousand
35
30
1994-2002: 90,962 avoided deaths
25
20
Projected without NAP
actions
15
10
Registered with NAP
actions
5
0
89
90
91
92
94
93
95 96 97
Year of Death
98
99
'00 '01 '02
1
Registered*
Estimative without NAP actions
* Estimated deaths after 1999, using real trend
Coping with increased expenditure (Maharashtra)
20
19
18
16
14
11
12
10
10
8
6
5
6
6
5
4
1
2
0
Used past
savings
Borrowed
from others
Source, ILO New Delhi, 2003
Mortgaged
assets
NGO support Sale of assets
Loan from
Employer
Stopped
Medicines
Others
Stigma and discrimination
In Health Care System
 Confidentiality breach
 Mandatory testing – pre operative, ANC
 Refusal of invasive procedures or surgery, when
needed including elective caesarian section
 Refusal of treatment for PLHA
In Employment
 Due to misconceptions, risk of frequent absence
In Educational institutes
HIV TB Co-Infection





HIV infection is the most powerful risk factor for
progression from TB infection to disease.
An individual with dual infection of HIV-TB has more than
50% lifetime risk of developing TB as compared to 10%
in TB infected person without HIV infection.
The rate of progression of TB is also 30 times more rapid
in an HIV infected person.
TB accelerates the progression of HIV by causing a sixseven-fold increase in viral load.
It shortens the survival period of an HIV infected
individual and is a cause of death for one in three cases
of AIDS.
HIV AIDS Bill 2005


The HIV/AIDS bill, aimed at preventing
discrimination and protecting the rights of people
living with the disease, is 'under finalisation',
union Health and Family Welfare Minister
Ghulam Nabi Azad said on Tuesday 2009
'The draft of the bill on HIV/AIDS is at present
under finalisation. However, no firm date can be
indicated at this stage,' he said in a written reply
to a question on when the bill was going to be
introduced in parliament.
Indian Estimates
India had an estimated 1.8 – 2.9 million
HIV positive persons in 2007, with an
estimated adult HIV prevalence of
0.34%(Males 0.43% & females 0.29%
 HIV Prevalence among the high risk
groups (HRG) is very high compared to
that among the general population, India
continues to be in the category of
concentrated epidemic.

Indian Estimates


47 districts (48 sites) have shown >5% HIV
Prevalence among FSW, which also include
FSW sites in low prevalence states namely West
Bengal, Bihar and Gujarat FSW sites
in Pune, Mumbai and Thane have shown > 30%
HIV prevalence among FSW. Among FSW,
there is a decline in South Indian States
reflecting the impact of interventions
Indian Estimates


Except Andhra Pradesh with HIV Prevalence of
1%, all other states have shown < 1%
Prevalence among ANC Clinic attendees. 10
districts have shown a very high prevalence of
3% among ANC clinic attendees.
Expanded surveillance among MSM has
revealed more than 5% HIV prevalence in
Karnataka (17.6%), Andhra Pradesh (17%),
Manipur (16.4%), Maharashtra (11.8%), Delhi
(11.7%), Gujarat (8.4%), Goa (7.9%), Orissa
(7.4%), Tamil Nadu (6.6%) and West Bengal
(5.6%).
The Red Ribbon Express Project is the world’s
largest mass mobilization campaign on HIV/AIDS.
covering 27000 kms & 6.2 million people from Dec
07 to Dec 08
Maharashtra Data
November 2009
Total VCTCs 606
Reactivity Rate 0.54%
(old data 0.1.09%)
Total +ve reported cases 421578
 Total ART Centres 41
On ART 68460 (Pediatric cases 4967)
 Total CD4 machines 22
 Total Blood Banks 307

http://www.nacoonline.org
Quick links-publications-news letter, this is
available in English & Hindi
 http://www.mahasacs.org
Nirdhar in Marathi news letter on web site
 International information is available on
Unaids, WHO & UNICEF websites
