Lok Sabha Question No. 3431 (UNSTARRED), answered on 2015-12-18
Subject: HIV/AIDS
Ministry: HEALTH AND FAMILY WELFARE
Asked by: DODDAALAHALLI KEMPEGOWDA SURESH, FEROZE VARUN GANDHI, NALIN KUMAR KATEEL, (ADV.) JOICE GEORGE

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 3431 TO BE ANSWERED ON 18 TH DECEMBER, 2015

## HIV/AIDS

## 3431. SHRI D.K. SURESH:

SHRI FEROZE VARUN GANDHI:

SHRI NALIN KUMAR KATEEL:

ADV. JOICE GEORGE:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) the increase or decrease in the number of new cases of HIV/AIDS reported during each of the last three years and the current year, State/UT -wise;
- (b) whether  the  Government  has ascertained  various  factors/reasons  for  HIV/ AIDS transmission in the country and if so, the details thereof;
- (c) whether the Government provides financial assistance to the dependents of the people who die due to HIV/AIDS as a part of general social security network and if so, the details thereof;
- (d)  the  number  of  beneficiaries  granted financial  assistance  by  the  Government therefrom indicating the amount of assistance along with the procedure adopted for the purpose during th e above period, State/UT - wise; and
- (e)  the  present  status  of  implementation of  various  programmes  to  prevent  and control HIV/AIDS  along  with  the performance  and  the  steps  taken/proposed to  be  taken  by  the Government to fine tunethe programmes?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI SHRIPAD YESSO NAIK )

- (a): Under the National AIDS Control Programme (NACP) a declining trend of new HIV infection  has  been  reported.  The  State/UT  wise  number  of  people  detected  positi ve  for HIV/AIDS at Integrated Counseling and Testing Center (ICTC) of the last three years and current year is at Annexure I .
- (b): The following major factors/reasons have been identified with respect to HIV/AI transmission:
- Unprotected sexual intercourse including Men who have sex with Men (95%).
- HIV infected pregnant women to her foetus or infant before, during or after birth
- Use  of  improperly  sterilized  needles  and  syringes  that  have  been  in  contact infected blood can transmit HIV (0.9%).
- Transfusion  of  infected  blood,  blood  products  &  transplantation  of  HIV  infec organs or tissues (0.1%).
- Non specified factors (1%).
- (c): It may be noted that under NACP only linkages are provided, wherever possible, to social protection schemes of various Departments in the States. The financial assistance to dependent of people who died due to HIV/AIDS is provided as Widow Pension in most state However in the states of Bihar, Andhra Pradesh, Telengana, Kerala, Jharkhand, Tamilna Kerala and Rajasthan widow of PLHIV is given priority.

Apart from this, Jharkhand is providing one time financial assistance to the deceased

Delhi is also providing financial assistance to double orphan (whose parents die to HIV/AIDS)infected & affected with HIV/AIDS.

- (d): As of November, 2015, a total number of beneficiaries granted under Widow Pensio Scheme for PLHIV is 27,474 .

The State wise details of financial assistance under Widow Pension Scheme is as belo

|   Sl.No | State          |   Financial Assistance (in Rs) per |
|---------|----------------|------------------------------------|
|       1 | Andhra Pradesh |                               1000 |
|       2 | Bihar          |                                300 |
|       3 | Jharkhand      |                                600 |
|       4 | Kerala         |                               1000 |
|       5 | Rajasthan      |                                500 |
|       6 | Telangana      |                               1000 |
|       7 | Tamil Nadu     |                               1000 |

In Jharkhand, Family benefit (Parivarik Labh) is provided as one time financial b ofRs. 10,000 after death of PLHIV.  It takes 5 to 6 month to complete the process and cash transfer is made to beneficiaries/ family bank account (till date 5 families have such benefit under Parivarik Labh Scheme in Jharkhand).

In  Delhi,  as on  date  total  number  of  beneficiaries  granted  benefits  of  financ assistance to double orphan (whose parents died due to HIV /AIDS) infected & affected with HIV/AIDS are 17 HIV infected (Rs.2050/ - per month) and 22 HIV affected (Rs.1750/ - per month).For this purpose death certificate of both parents and their treatment book is t proof.

- ( e): The present status of implementation of various programmes to prevent and cont HIV/AIDS along with the performance is enclosed at Annexure II.

The  steps taken  to  fine  tune  the  Programme  performance  include  regular  review meetings, field visits and feedback provided to State AIDS Control Societies etc.

| Annexure -I                                                                                                                                                   | Annexure -I                                                                                                                                                   | Annexure -I                                                                                                                                                   | Annexure -I                                                                                                                                                   | Annexure -I                                                                                                                                                   | Annexure -I                                                                                                                                                   |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------|
| State/UT wise number of people detected positive for HIV/AIDS at Integrated Counseling and Testing Center (ICTC) of the last three years and the current year | State/UT wise number of people detected positive for HIV/AIDS at Integrated Counseling and Testing Center (ICTC) of the last three years and the current year | State/UT wise number of people detected positive for HIV/AIDS at Integrated Counseling and Testing Center (ICTC) of the last three years and the current year | State/UT wise number of people detected positive for HIV/AIDS at Integrated Counseling and Testing Center (ICTC) of the last three years and the current year | State/UT wise number of people detected positive for HIV/AIDS at Integrated Counseling and Testing Center (ICTC) of the last three years and the current year | State/UT wise number of people detected positive for HIV/AIDS at Integrated Counseling and Testing Center (ICTC) of the last three years and the current year |
| Sl.No .                                                                                                                                                       | State/UT                                                                                                                                                      | 2012-13                                                                                                                                                       | 2013-14                                                                                                                                                       | 2014-15                                                                                                                                                       | 2015-16 (Till Sept.'15)                                                                                                                                       |
| 1                                                                                                                                                             | Andaman & Nicobar Islands                                                                                                                                     | 29                                                                                                                                                            | 29                                                                                                                                                            | 21                                                                                                                                                            | 11                                                                                                                                                            |
| 2                                                                                                                                                             | Andhra Pradesh & Telangana                                                                                                                                    | 58,686                                                                                                                                                        | 56,730                                                                                                                                                        | 47,618                                                                                                                                                        | 19191                                                                                                                                                         |
| 3                                                                                                                                                             | Arunachal Pradesh                                                                                                                                             | 21                                                                                                                                                            | 4                                                                                                                                                             | 28                                                                                                                                                            | 5                                                                                                                                                             |
| 4                                                                                                                                                             | Assam                                                                                                                                                         | 1,280                                                                                                                                                         | 1,161                                                                                                                                                         | 1,304                                                                                                                                                         | 730                                                                                                                                                           |
| 5                                                                                                                                                             | Bihar                                                                                                                                                         | 8,323                                                                                                                                                         | 9,323                                                                                                                                                         | 11,388                                                                                                                                                        | 4646                                                                                                                                                          |
| 6                                                                                                                                                             | Chandigarh                                                                                                                                                    | 836                                                                                                                                                           | 813                                                                                                                                                           | 863                                                                                                                                                           | 440                                                                                                                                                           |
| 7                                                                                                                                                             | Chhatisgarh                                                                                                                                                   | 2,430                                                                                                                                                         | 3,009                                                                                                                                                         | 3,047                                                                                                                                                         | 1341                                                                                                                                                          |
| 8                                                                                                                                                             | Dadra & Nagar Haveli                                                                                                                                          | 91                                                                                                                                                            | 88                                                                                                                                                            | 114                                                                                                                                                           | 52                                                                                                                                                            |
| 9                                                                                                                                                             | Daman & Diu                                                                                                                                                   | 67                                                                                                                                                            | 93                                                                                                                                                            | 95                                                                                                                                                            | 23                                                                                                                                                            |
| 10                                                                                                                                                            | Delhi                                                                                                                                                         | 7,274                                                                                                                                                         | 6,855                                                                                                                                                         | 7,035                                                                                                                                                         | 2350                                                                                                                                                          |
| 11                                                                                                                                                            | Goa                                                                                                                                                           | 515                                                                                                                                                           | 529                                                                                                                                                           | 445                                                                                                                                                           | 151                                                                                                                                                           |
| 12                                                                                                                                                            | Gujarat                                                                                                                                                       | 11,746                                                                                                                                                        | 13,771                                                                                                                                                        | 11,068                                                                                                                                                        | 5327                                                                                                                                                          |
| 13                                                                                                                                                            | Haryana                                                                                                                                                       | 4,299                                                                                                                                                         | 4,372                                                                                                                                                         | 3,359                                                                                                                                                         | 1067                                                                                                                                                          |
| 14                                                                                                                                                            | Himachal Pradesh                                                                                                                                              | 739                                                                                                                                                           | 526                                                                                                                                                           | 575                                                                                                                                                           | 231                                                                                                                                                           |
| 15                                                                                                                                                            | Jammu & Kashmir                                                                                                                                               | 403                                                                                                                                                           | 340                                                                                                                                                           | 311                                                                                                                                                           | 196                                                                                                                                                           |
| 16                                                                                                                                                            | Jharkhand                                                                                                                                                     | 2,228                                                                                                                                                         | 1,813                                                                                                                                                         | 2,502                                                                                                                                                         | 1082                                                                                                                                                          |
| 17                                                                                                                                                            | Karnataka                                                                                                                                                     | 35,838                                                                                                                                                        | 30,906                                                                                                                                                        | 27,804                                                                                                                                                        | 7885                                                                                                                                                          |
| 18                                                                                                                                                            | Kerala (Incl.Lakshadweep)                                                                                                                                     | 1,916                                                                                                                                                         | 1,660                                                                                                                                                         | 1,717                                                                                                                                                         | 610                                                                                                                                                           |
| 19                                                                                                                                                            | Madhya Pradesh                                                                                                                                                | 5,072                                                                                                                                                         | 4,978                                                                                                                                                         | 5,262                                                                                                                                                         | 2214                                                                                                                                                          |
| 20                                                                                                                                                            | Maharashtra                                                                                                                                                   | 44,389                                                                                                                                                        | 43,926                                                                                                                                                        | 39,111                                                                                                                                                        | 17135                                                                                                                                                         |
| 21                                                                                                                                                            | Manipur                                                                                                                                                       | 1,910                                                                                                                                                         | 1,660                                                                                                                                                         | 1,518                                                                                                                                                         | 519                                                                                                                                                           |
| 22                                                                                                                                                            | Meghalaya                                                                                                                                                     | 367                                                                                                                                                           | 459                                                                                                                                                           | 545                                                                                                                                                           | 221                                                                                                                                                           |
| 23                                                                                                                                                            | Mizoram                                                                                                                                                       | 1,180                                                                                                                                                         | 1,160                                                                                                                                                         | 1,269                                                                                                                                                         | 657                                                                                                                                                           |
| 24                                                                                                                                                            | Nagaland                                                                                                                                                      | 1,684                                                                                                                                                         | 1,672                                                                                                                                                         | 1,834                                                                                                                                                         | 906                                                                                                                                                           |
| 25                                                                                                                                                            | Orissa                                                                                                                                                        | 3,815                                                                                                                                                         | 3,467                                                                                                                                                         | 3,317                                                                                                                                                         | 1617                                                                                                                                                          |
| 26                                                                                                                                                            | Pondicherry                                                                                                                                                   | 699                                                                                                                                                           | 635                                                                                                                                                           | 593                                                                                                                                                           | 296                                                                                                                                                           |
| 27                                                                                                                                                            | Punjab                                                                                                                                                        | 4,863                                                                                                                                                         | 4,537                                                                                                                                                         | 5,333                                                                                                                                                         | 2677                                                                                                                                                          |
| 28                                                                                                                                                            | Rajasthan                                                                                                                                                     | 6,665                                                                                                                                                         | 7,871                                                                                                                                                         | 8,052                                                                                                                                                         | 3817                                                                                                                                                          |
| 29                                                                                                                                                            | Sikkim                                                                                                                                                        | 49                                                                                                                                                            | 31                                                                                                                                                            | 34                                                                                                                                                            | 14                                                                                                                                                            |
| 30                                                                                                                                                            | Tamil Nadu                                                                                                                                                    | 16,053                                                                                                                                                        | 16,653                                                                                                                                                        | 15,246                                                                                                                                                        | 7180                                                                                                                                                          |
| 31                                                                                                                                                            | Tripura                                                                                                                                                       | 197                                                                                                                                                           | 225                                                                                                                                                           | 264                                                                                                                                                           | 167                                                                                                                                                           |
| 32                                                                                                                                                            | Uttar Pradesh                                                                                                                                                 | 13,977                                                                                                                                                        | 12,954                                                                                                                                                        | 14,035                                                                                                                                                        | 7438                                                                                                                                                          |
| 33                                                                                                                                                            | Uttaranchal                                                                                                                                                   | 876                                                                                                                                                           | 786                                                                                                                                                           | 845                                                                                                                                                           | 198                                                                                                                                                           |
| 34                                                                                                                                                            | West Bengal                                                                                                                                                   | 7,342                                                                                                                                                         | 7,198                                                                                                                                                         | 7,171                                                                                                                                                         | 2942                                                                                                                                                          |
| Total                                                                                                                                                         | Total                                                                                                                                                         | 245,859                                                                                                                                                       | 240,234                                                                                                                                                       | 223,723                                                                                                                                                       | 93,336                                                                                                                                                        |

## Status  of  Implementation  of programme Interventions under  National  AIDS  Control Programme

- I. Targeted  Intervention: Targeted  Intervention  programme  is  one  of  the  important prevention strategies under the National AIDS Control Programme. Targeted Interventions (TIs) comprise  preventive  interventions working  with  focused  client populations in a defined geographic area where there is a concentration of one or more High Risk Groups (HRGs). 80% of HRGs are expected to be covered via TIs with primary prevention  services  like  treatment  for  Sexually  Transmitted  Infection  (STI),  Condoms, needles/syringes, Opioid Substitution Therapy (OST), Behavioral Change Communication (BCC), enabling environment, with community involvement and linkages with Care and Support  services.  The  key  risk  groups  covered  through  Targeted  Intervention  (TI) programme include: Core High Risk Groups (HRGs)-Female Sex Workers (FSW), Men who have Sex with Men (MSM) including Transgenders (TGs), Injecting Drug Users (IDU) and Bridge  PopulationsMigrants  and  Truckers.  During  2014-15,  66  TIs  were  established against  the  annual  target  of  220  and  during  2015-16  (till October 2015),  15  TIs  are established against the annual target of 35 taking the cumulative no. of total TI to 1775 TIs that provide HIV prevention services to Female Sex Workers (492 TI), Men who have Sex with Men (149 TI), Injecting Drug Users (266 TI), Transgender (38 TI), Core Composite (Comprises of more than one typology Intervention under one TI) (441 TI) migrants (298 TI) & truckers (91 TI).
- II. Link Worker Scheme : This community-based intervention addresses HIV prevention and care needs of the high risk and vulnerable groups in rural areas by providing information on HIV, condom promotion and distribution and referrals to counseling, testing and STI services through Link workers. During 2014-15, in partnership with various development partners, the Link  worker  scheme was operational in 137 districts covering and during 2015-16, till October 2015, LWS is operational in 130 districts of India.
- III. Management  of  Sexually  Transmitted  infections  (STI)/Reproductive  Tract  Infection (RTI) prevention and control Programme: The STI/RTI Prevention and Control Programme  aims  for  providing  effective  control  of  sexually  transmitted  infections including  Reproductive  Tract  Infections  for  General  Population  through  continued support to the designated STI/RTI clinics (Surakasha Clinics) in public sector and for High Risk  population  through  Targeted  Interventions  (TI)  programme.  The  program  also reaches employees of organized sectors under public undertakings (Railways, Employees State  Insurance  Corporation,  Port  Trust,  Defense  and  Professional  Associations),  and Private sector by developing partnerships.

The  programme  supports  about  1,164  Suraksha  Clinics  located  at  district  hospitals, medical colleges and select sub-district hospitals. The Programme supports training and capacity building of the staff (doctors, staff nurses, laboratory technicians  and counselors), provision of a counselors, free colour coded standardized STI/RTI drug kits and by all these aims to standardize STI/RTI treatment to the patients. In coordination with the TI NGOs, STI/RTI treatment, care and prevention services are delivered for high risk groups such as sex workers, Men who have Sex with Men, migrant population such as truckers and People who inject drugs.

During 2014-15, against the physical target of treating 70 lakh episodes of STI/RTI, 75.46 lakh episodes of STI/RTI were treated. The coverage of Sexually Transmitted Infections services  has  been  scaled  up  through  designated  STI  clinics  and 48.81 Lakh  STI/RTI patients were treated as per the national protocol against the target of 56 lakh during FY 2015-16 (till October 2015).

- IV. Condom  Promotion: The National  AIDS  Control  Organisation  (NACO) has  successfully implemented seven phases of the Condom Social Marketing Programme in 28 States/UTs.  During  2014-15,  around  60.8  crore  pieces  of  condom  have  been distributed through social marketing by the NACO contracted social marketing organizations against the target of 44 crore pieces and in 2015-16 (till October 2015), 2.8 crore pieces distributed against the target of 35.2 crore pieces. During 2014-15, against the target of 37 crore, 28.7 crore pieces of condoms were distributed free and during 2015-16 (till October 2015), 8.79 crore pieces were distributed free against the annual target of 29.6 crore pieces.
- V. Blood Transfusion Services: Blood is an intrinsic requirement for health care and proper functioning  of the  health system.  The NACO  has  been  primarily responsible for facilitating provision of safe blood for the country.  The NACO endeavors to meet the blood  needs  of  the  country  through  voluntary  non-remunerated  donation through  a well-coordinated Blood Banking Programme. NACP continues to implement a scheme for modernization of blood banks by providing need based equipment grant for testing and storage, as well as annual recurrent grant for support of  manpower,  kits  and consumables.

The  blood  transfusion  services  supported  by the NACO comprise  a  network  of  1,161 blood banks, including 34 Model Blood Banks, 304 Blood Component Separation Units, 210 Major Blood banks and 613 District level Blood Banks were covered under the NACO support.

During 2015-16 (till October 2015) against the target of 48 lakh blood collection at the NACO supported blood bank, 33.53 lakh blood units were collected across the country, 78% of this was through voluntary blood donation. World Blood Donor Day was observed through a National event on 14 th June 2015 to felicitate blood donors for their valuable contribution. Mobile blood bank locator app and database of blood banks was launched on the National Health Portal.

- VI. Basic Services: The Basic services include free Counseling and Testing for HIV infection. It has three main components viz: (i). Integrated Counseling and Testing Centres (ICTCs), (ii).  Prevention  of  Parent  to  Child  Transmission  (PPTCT),  and  (iii).  HIV-TB  collaborative activities.
- i. Integrated Counseling and Testing Centres: An Integrated Counseling and Testing Centre (ICTC) is a place where free counseling and testing for HIV is offered to a person on his own free will or as advised by a medical provider. The population availing these services is  mainly  persons  engaged  in  the  high  risk  behavior,  STI  patients,  TB  patients  and  are more prone to acquire the HIV infection. In India, ICTCs are often the first interface of citizens  with  the  entire  gamut  of  preventive,  care,  support  and  treatment  services provided  under  the  umbrella  of  the  National  HIV/AIDS  Control  Programme.  HIV counseling and testing services were started in India in 1997.
3. With  the  increase  in  number  of  ICTCs,  the  uptake  of  clients  who  are  counseled  and tested in these centers has seen a commendable scale up in the past seven years with 27 lakh general clients (excluding Pregnant Women) accessing these services in 2007-08 to 150.9 lakhs (increase of about fivefold) clients  in  2014-15.  The  strategy  over  the  past seven years for scaling up of service delivery has been through establishing more and more Facility - Integrated Model ICTCs (through the existing general health system) and Public  Private  Partnership  (PPP)  Model  ICTCs  (through  greater  involvement  of  private sector  providing  health  services).  Free  counseling  and  testing  services  are  being provided through 5,353 Stand Alone ICTCs, 10,777 Facility- ICTCs and 2,395 PPP - ICTCs. During  the  FY  2014-15,  150.9  lakh  general  clients  have  been  provided  with  free counseling and testing services for HIV and 82.1 lakhs general clients during 2015-16 (till November 2015).
- ii. Prevention of Parent to Child Transmission (PPTCT): The prevention of parent to child transmission  (PPTCT)  of  HIV  transmission  under  NACP  involves  free counseling  and testing  of  pregnant  women,  detection  of  HIV  positive  pregnant  women,  and  the administration  of  prophylactic  ARV  drugs  to  HIV  positive  pregnant  women  and  their infants  to  prevent  the  mother  to  child  transmission  of  HIV.  The  NACO  has  decided to provide ARV  drugs  to  Pregnant  Women  infected  with  HIV,  irrespective  of  CD4  count nationwide, w.e.f January, 2014. During 2014-15, 117.6 lakh Pregnant Women have been provided  with  free  counseling  and  testing  for  HIV.  Also  97%  of  HIV  positive  Pregnant Women and their babies received ARV prophylaxis (Option B+) for Prevention of Mother to Child Transmission and during 2015-16 (till October), 64.9 lakh pregnant Women have been provided with free counseling and testing for HIV with 97.2% received HIV positive Pregnant Women and their babies received ARV prophylaxis for Prevention of Mother to Child Transmission of HIV.
- iii. HIV-TB collaborative activities: TB disease is the commonest opportunistic infection among HIV-infected individuals. Further it is also known that TB being a major public health problem in India accounts for 20-25% of deaths among PLHIV. It is known that nationally  about  5%  TB  patients  registered  under  the  Revised  National  Tuberculosis Control Programme (RNTCP) also have HIV infection.

Broadly  the  national  HIV/TB  response  includes  Intensified  TB  case  finding  at  HIV Care Settings, Intensified TB-HIV Package, and Strategy for TB prevention among PLHIV. These activities are closely guided through duly constituted National HIV-TB Coordination Committee, Nation Technical Working Group and State and District level  Coordination Committees. During 2014-15, 16.83 lakh cross referrals have been made between ICTC & RNTCP and 11.4 lakh cross referrals have been made between ICTC & RNTCP during 201516 (till October 2015).

Innovative intensified TB case findings and appropriate treatment (3 I project)  at 30 high burden  Antiretroviral  therapy  (ART)  centres  in  5  States  (Andhra  Pradesh,  Telengana, Maharashtra, Tamil Nadu & Karnataka) in India has been initiated. Daily regimens service for  HIV/TB  co-infected  patients  has  also  been  started  under  the  NACO-CTD-WHO  3I project.  Fixed  Drug  Combinations  (FDC)  with  innovative mechanism of giving a missed call to hidden number to monitor the adherence has been initiated in 5 states.

Cartridge Based Nucleic Acid Anticipation Test (CBNAAT) service for early diagnosis of TB is used at 30 high burden ART centers in 5 States. It gives results for diagnosis of TB and Rifampicin resistant TB within 90 minutes which is benefited for making early diagnosis of TB among PLHIVs.

- VII. Care, Support & Treatment Programme: The Care, Support and Treatment programme under NACP includes comprehensive management of PLHIV with respect to treatment and prevention of Opportunistic infections, Anti-retroviral therapy (ART), Psycho-Social support, Home Based Care, positive prevention and impact mitigation.

The ART is offered free of cost to all PLHIV who are eligible clinically. Any person who has a confirmed HIV infection is subjected to further evaluation for determining whether he requires ART or not by undergoing CD4 count and other baseline investigations. All those PLHIV eligible as per technical guidelines are initiated on first line ART. This includes all PLHIV with clinical stage III & IV irrespective of CD4 count, clinical stage I & II with CD4 count <350 (Already announced to be increased to 500 cd4 count threshold limit).

ART  Centre  has  been  scaled  up  significantly  to  519 ART  centres  till October 2015.  In addition  1094  link  ART  centres  have  also  been  set  up  to  facilitate  the  delivery  of  ART nearer to residence of PLHIV. Against the establishment of 55 new ART Centers in 201516, 44 new ART centres has been established and 9.07 lakh People living with HIV/AIDS are receiving free ART in government health facilities up to October 2015. In addition to this 350 Care and Support Centres (CSC) are functional to provide a range of psychosocial services to PLHIV.

- VIII. Laboratory Services: Under  NACP,  routine  access  to quality assured HIV related laboratory services  is  made  universal  available.  All  testing  laboratories  are  assessed  for their  performance  under  the  External  Quality  Assurance  Scheme (EQAS).  11  National Reference Laboratories and 47 State Reference Laboratories (SRLs) under NACP have been accredited for HIV testing by the National Accreditation Board for Testing and Calibration of Laboratories. 5 SRLs have applied for accreditation. Laboratory services for CD4 Testing,

Viral Load (VL) testing, Early Infant Diagnosis (EID) of HIV in infants and children up to 18 months age and confirmatory diagnosis of HIV-2 are provided through under Lab services

- IX. Information  Education  &  Communication: The  NACO's  communication  strategy  has moved from creating general awareness to Behaviour Change Communication. It aims to motivate behavioural change among most at risk populations, raise awareness and risk perception among general population, particularly youth and women, generate demand for  HIV/AIDS  related  health  services  like  condoms,  ICTC/PPTCT  facilities;  and  create  an enabling environment that encourages HIV related prevention, care and support activities and to reduce stigma and discrimination at individual, community and institutional levels. The NACO implements integrated and comprehensive campaigns using 360° communication approach. Regular campaigns are conducted at national and state level using  mass  media,  mid-media,  outdoor,  interpersonal  communication,  and  innovative media vehicles  like  digital  cinema,  panels  in  metro  trains,  digital  screens,  internet,  and mobile phones among others.

During  2014-15,  the  target  of  8  Campaigns released  on  Mass  Media-TV/Radio,  3  have been achieved and against the annual target of 6 media campaigns, 2 have been achieved during 2015-16 (till October 2015). Against the target of 550 new Red Ribbon Clubs (RRC) formed  in  colleges  in  during  2014-15,  550  has  been  achieved  and  during  2015-16 (till October 2015), against the target of 440, 32 new RRC has been formed. National Toll free AIDS helpline 1097 was launched on World AIDS day, 2014. Till October 2015, more than 6 lakh Calls have been received from different parts of the country.

## X. Mainstreaming and Social Protection

The NACO, with an objective to formalize its partnership with the various departments/ ministries, entered into Memoranda of Understanding with the following 14 Departments/Ministries till August 2015, presented in Table 1 below. These partnerships aimed at risk reduction, improved access to service and social protection for PLHIV and High risk Groups.

Table 1: Memorandum of Understanding with Ministries & Departments

|   S.No | Name of Department/ Ministry                                  | Date of Signing (Till October 2015)   |
|--------|---------------------------------------------------------------|---------------------------------------|
|      1 | Department of Rural Development                               | June 10, 2015                         |
|      2 | Department of Commerce                                        | June 8, 2015                          |
|      3 | Department of Empowerment of Persons living with Disabilities | January 27, 2015                      |
|      4 | Department of Electronics & Information Technology (DIETY)    | July 23,2014                          |
|      5 | Department of Telecommunications (DOT)                        | July 23,2014                          |
|      6 | Ministry of Road Transport & highways                         | June 09, 2014                         |
|      7 | Ministry of Defense                                           | February 18, 2014                     |
|      8 | Ministry of Shipping signed                                   | February 14,2013                      |
|      9 | Ministry of Housing & Urban Poverty Alleviation               | December 11, 2013                     |
|     10 | Ministry of Petroleum & Natural Gas                           | December 5,2013                       |
|     11 | Department of Sports, Ministry of Youth Affairs & Sports      | November 29,2013                      |
|     12 | Department of Youth Affairs, Ministry of Youth Affairs &      | Sports November 29,2013               |
|     13 | Ministry of Coal                                              | September 09, 2013                    |
|     14 | Department of Higher Education, Ministry of Human development | resource August 6,2013                |

The NACO recognizes the fact the reduction of vulnerability is a key to the success of its prevention,  care,  support  and  treatment  programme.  Hence,  it  has  placed  social protection  as  one  of  its  core  strategies  in  NACP-IV.  NACO  works  closely  with  other government departments to identify and advocate for amendment/adaptation of policies and  schemes  for  social  protection  of  marginalized  groups.  India  and  its  States/Union Territories have taken significant steps taking into consideration the special vulnerabilities faced by people affected by HIV and AIDS. Under mainstreaming training around 80,000 personnel till September 2015 from various departments at State, District level were trained. Apart from this training of the DAPCU led Single Window model for Social  Protection  of  PLHIV,  CLHIV  and  MARPS  were  organized  for  the  officials  of  180 DAPCU.

- XI. Procurement: Procurements are done using Pool Fund, Global Fund for AIDS, Tuberculosis and Malaria (GFATM) and Domestic Funds, through the Procurement Agent. All  the  main  items  required  for  the  programme,  including  test  kits  {HIV  (Rapid),  HIV (ELISA), HBs Ag (Rapid), HBs Ag (ELISA), HCV (Rapid), HCV (ELISA)} and other items such as  ARV  Drugs, STI  Drug  kits,  blood  bags  etc,  are  centrally  procured  and  supplied  to peripheral units and State AIDS Control Societies (SACS). To ensure transparency in the procurement  of  goods  Bid  Documents,  Minutes  of  pre-bid  meetings  and  Bid  Opening Minutes are uploaded on the websites of Procurement Agent  and the  NACO (www.naco.gov.in). Efforts made to streamline the Supply Chain Management of various supplies to consuming units include provision of training to the Procurement Officials of SACS.  Further  a  web  based  online  Inventory  Management  System  (IMS) has  been developed by the NACO with the support of Clinton Health Access Initiative  (CHAI)  to strengthen the Supply Chain Management for better tracking, monitoring and controlling of the Inventory. This has been rolled out across India.
- XII. Strategic  Information  Management: The  programme  generates  rich  data  on  service delivery  through  around  23,000  reporting  units  across  the  country.  The  Strategic Information Management System (SIMS), a web-based system for data management and analysis of all programme data has been rolled out across the country. Programme data is gathered through this online system.

India  has  a  robust  system  of  annual  HIV  Sentinel  Surveillance  (HSS)  for  monitoring the HIV  epidemic  in  the  country  among  general  population  as  well  as  High  Risk  Groups. Besides  epidemic  trend  analysis,  data  from  surveillance  are  also  used  for  strategic planning  and  prioritization  under  the  programme  as  well  as  estimation  of  adult  HIV prevalence, HIV incidence and mortality. Globally accepted models are used to estimate and project the HIV burden in the country. HSS 2014-15 was conducted at 776 Antenatal Clinic (ANC) surveillance Sites, covering 574 districts across 35 States and UTs. NACO is currently implementing National Integrated Biological & Behavioural Surveillance (IBBS) among  high  risk  groups  and  bridge  population. IBBS  report  has  been  reviewed  by Technical Resource Group.

The National Data Analysis Plan is a first-of-its-kind activity in a public health programme, whereby retrospective  data  has  been  systematically  analysed  with  the  engagement  of analysts and mentors from ICMR institutions, Medical Colleges, development partners, NACO  and  SACS  to  address  programmatic  queries  of  the  National  AIDS  Control Programme.

In  order  to  address  the  programme  needs  with  respect  to  evidence  and  research  and make best use of the available data, a structured research plan has also been developed for identifying  research  priorities  and commissioning  research  studies.  A  detailed exercise  to  assess  existing  information  gaps  in  the  programme  has  been  conducted involving  programme  managers  at  NACO,  state  level  and  development  partners,  and research areas prioritised.

A summary of key achievements made under NACP during the last two financial years (2015-16) presented in Table 2 below.

Table 2: National AIDS Control Programme Performance on key indicators

| S. No   | Indicator                                                                                          | 2015-16           | 2015-16                         |
|---------|----------------------------------------------------------------------------------------------------|-------------------|---------------------------------|
| S. No   | Indicator                                                                                          | Target            | Achievement (Till October 2015) |
| 1       | New Targeted Interventions established                                                             | 35                | 15*                             |
| 2       | STI/RTI patients managed as per national protocol                                                  | 56 lakh           | 48.81 lakh                      |
| 3       | Blood collection in NACO supported blood bank                                                      | 48 lakh           | 33.53 lakh                      |
| 4       | Proportion of blood units collected by Voluntary blood donation in NACO Supported Blood Banks      | 75%               | 78%                             |
| 5       | Districts covered under Link Worker Scheme (Cumulative)                                            | 163               | 130*                            |
| 6       | Clients tested for HIV (General clients)                                                           | 94 lakh           | 82.1 lakhs                      |
| 7       | Pregnant Women tested for HIV                                                                      | 94 lakh           | 64.9 lakhs                      |
| 8       | Proportion of HIV+ pregnant Women and Babies who are initiated on Multidrug Antiretroviral regimen | 85%               | 97.2%#                          |
| 9       | HIV-TB Cross Referrals                                                                             | 10 lakh           | 11.4 lakh                       |
| 10      | New ART Centers established                                                                        | 55                | 44                              |
| 11      | PLHIV on ART (Cumulative)                                                                          | 9.41              | 9.07 lakh                       |
| 12      | Opportunistic Infections treated                                                                   | 3 lakh            | 2.85 lakh                       |
| 13      | Campaigns released on Mass Media - TV/Radio                                                        | 6                 | 2                               |
| 14      | New Red Ribbon Clubs formed in Colleges                                                            | 440               | 32                              |
| 15      | Persons trained under Mainstreaming training programmes                                            | 2.6 lakh          | 1.07 lakhs                      |
| 16      | Social Marketing of condoms by NACO contracted Social Marketing Organizations                      | 35.2 crore Pieces | 2.8 crore Pieces                |
| 17      | Free Distribution of Condoms                                                                       | 29.6 crore Pieces | 8.79 crore Pieces               |