40351

National AIDS Control
Program
Dr. KANUPRIYA CHATURVEDI
Lesson Objectives
To know about the extent of the problem of

HIV/AIDS in India
To learn about the evolution of Indias
response to HIV/AIDS: phases 1,2, 3 of
NACP(National AIDS Control Program)
To know about the goals, objectives,
strategies of NACP
To know about the achievements of NACP
Global estimates for

Adults and Children, 2008
CATEGORY
Estimated
People living with HIV
New HIV infections in 2008
Deaths due to AIDS in 2008
Range
33.4 million
31.1 35.8 million
2.7 million
2.4 3.0 million
2.0 million
1.7 2.4 million
HIV estimates for India (2007)

Category
Estimation
Total population
1.027 billion
HIV prevalence (15-49 years)
0.34%
HIV prevalence among men (15-49 years)
0.40%
HIV prevalence among women (15-49 years)
0.27%
Number of people living with HIV (adults and

children)
2.31 million
Number of Children living with HIV (>15 years)
3.8% of total
Current Scenario
HIV situation in the country is assessed and monitored

through regular annual sentinel surveillance
established since 1992.
There are 1.8 - 2.9 million (2.31 million) people living
with HIV/AIDS at the end of 2007. The estimated adult
prevalence in the country is 0.34% (0.25% - 0.43%)
and it is greater among males (0.44%) than among
females (0.23%).
The overall HIV prevalence among different population
groups in 2007 continues to portray the concentrated
epidemic in India, with a very high prevalence among
High Risk Groups - IDU (7.2%), MSM (7.4%), FSW
(5.1%) & STD (3.6%) and low prevalence among ANC
clinic attendees (Age adjusted - 0.48%).
Overview
In India, after the first case of HIV was detected in Chennai in

1986, the virus spread rapidly across the nation in both urban
and rural areas.
Since then, the HIV epidemic has traveled a long way,
establishing itself with the greatest speed in the six high
prevalence states of Andhra Pradesh, Maharashtra, Manipur,
Nagaland, Karnataka and Tamil Nadu.
The natural history of the HIV epidemic has played out in
various forms - from the injecting drug use-driven epidemic of
the North East seen in Manipur and Nagaland, to the sex
work-driven epidemic of the south of India.
Since, every country and every government needs to have a
solution to deal with such an issue; the government formulated
the National AIDS Control Program.
National AIDS Control Program

( NAPC)
1985 Govt. of India constituted a taskforce to study the

problem of HIV/AIDS as related to India
1991-1999 A comprehensive HIV/AIDS Control Project
Phase I was launched during VIII Plan with an outlay of
222.6 crores with the assistance of World Bank & WHO
1985 Govt. of India constituted a taskforce to study the
problem of HIV/AIDS as related to India
1991-1999 A comprehensive HIV/AIDS Control
Project Phase I was launched during VIII Plan with an
outlay of 222.6 crores with the assistance of World Bank
& WHO
NAPC Phase II (1999-200
NAPC Phase III ( 2006- 11)
National AIDS Control Programme

Phase I and II
Phase-I (1992 - 1999) was implemented across

the country with objective to slow the spread of
HIV to reduce future morbidity, mortality, and the
impact of AIDS by initiating a major effort in the
prevention of HIV transmission.
Phase-II (1999 - 2006) was aimed at reducing

spread of HIV infection in India and strengthen
India's capacity to respond to HIV epidemic on
long term basis
Significant Achievements of NACP-I

&II
Scaling up PMTCT and VCCTC services

especially in the high prevalence states.
Increasing access to free ARV is one of the
major achievements of NACP-II.
Recognizing the need of care and support for
people living with HIV and AIDS and scaling up
of Community Care Centers.
Contd.
The effectiveness of the condoms as one of the

safest methods to prevent and control the spread of
HIV and other STIs has been well established.
Initiating the process for developing draft legislation
on HIV and AIDS.
Focus has shifted from raising awareness to
behavior change, from a national response to a
decentralized response and an increasing
engagement of NGOs and networks of people living
with HIV/AIDS.
The National AIDS Prevention and Control Policy
and the National Council on AIDS (NCA), chaired by
the Prime Minister, provide policy guidelines and
political leadership to the response.
Phase-III (2007-2012)
Phase-III (2007-2012)is based on the

experiences and lessons drawn from NACP-I
and II, and is built upon their strengths. Its
priorities and thrust areas are drawn up
accordingly and include the following:
Considering that more than 99 percent of the

population in the country is free from infection,
NACP-III places the highest priority on preventive
efforts while, at the same time, seeks to integrate
prevention with care, support and treatment.
Contd.
Sub-populations that have the highest risk of exposure

to HIV receive the highest priority in the intervention
programs. These would include sex workers, menwho-have-sex-with-men and injecting drug users.
Second high priority in the intervention programs is
accorded to long-distance truckers, prisoners,
migrants (including refugees) and street children.
In the general population those who have the greater
need for accessing prevention services, such as
treatment of STIs, voluntary counseling and testing
and condoms, will be next in the line of priority.
Contd.
NACP-III ensures that all persons who need

treatment would have access to prophylaxis and
management of opportunistic infections. People
who need access to ART will also be assured first
line ARV drugs.
Prevention needs of children are addressed
through universal provision of PPTCT services.
Children who are infected are assured access to
pediatric ART.
NACP-III is committed to address the needs of
persons infected and affected by HIV, especially
children.
Contd.
NACP-III also plans to invest in community

care centres to provide psycho-social
support, outreach services, referrals and
palliative care.
Socio-economic determinants that make a
person vulnerable also increase the risk of
exposure to HIV. NACP-III will work with
other agencies involved in vulnerability
reduction such as women's groups, youth
groups, trade unions etc. to integrate HIV
prevention into their activities
Lesson learnt from Phase I &II
The epidemic continues to progress with the

following characteristics
High risk groups to low risk groups

Urban to rural areas
High prevalence states to all states
High vulnerability of young persons and women
MSM and IUDs have not received appropriate

attention
Growing number of people living with HIV/AIDS has
increased the need for care , support and treatment
Goals and Objectives of NACP-III
The overall goals of NACP-III is to halt and

reverse the epidemic in India over the next five
years by integrating programmes for prevention,
care and support and treatment. This is achieved
through a four-pronged strategy
The specific objective is to reduce the rate of

incidence by 60 per cent 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 stabilise the epidemic.
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 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
Guiding principles
The unifying credo of Three Ones, i.e., one

Agreed Action Framework, one National
HIV/AIDS Coordinating Authority and one
Agreed National Monitoring and Evaluation
System.
Equity is to be monitored by relevant
indicators in both prevention and impact
mitigation strategies
Respect for the rights of people living with
HIV/AIDS (PLHA).
Contd.
Civil society representation and

participation in the planning and
implementation of NACP-III is essential
for promoting social ownership and
community involvement.
Creation of an enabling environment
wherein those infected and affected by
HIV can lead a life of dignity. This is the
cornerstone of all interventions.
Contd.
Provide universal access to HIV prevention,

care, support and treatment services.
For making the implementation mechanism
more responsive, proactive and dynamic, the
HRD strategy of NACO and SACS is based
on qualification, competence, commitment
and continuity.
1: Prevent new infections
Objective 1:To prevent new

infections
Saturation of coverage of high risk group

through targeted interventions.
Scaling up interventions among general

population
1.1 Saturation of coverage of high

risk group through targeted
interventions
Essential elements of targeted interventions are:
Access to behavior change communication

Prevention services ( condoms, STI services,
needles and syringes
Treatment services( STI services, drug
substitution for IDU
Creation of enabling environment at project sites.
1.2 Scaling up interventions

among general population
STD control program

Voluntary counseling and testing
PPTCT program
Universal precautions and Post exposure
prophylaxis
Blood safety
Improved access to quality condoms
Contd.
Focused efforts on women,children and

Young people
Expanding HIV/AIDS response at
workplace
Focused efforts on migrants, mobile
populations and in cross border areas
STD Control Program
An estimated five percent adult population affected by

STDs, also has HIV infection.. Limited diagnostic
facilities to manage complicated STDs and drug
resistance to major STDs are the other issues of concern
that NACP-III addresses
Under NACP-III, a demand for STD services is

generated through its awareness on one hand and on
the other STD services are expanded through its
integration with the Reproductive and Child Health
Programme..
Voluntary counseling and testing
HIV counselling and testing services were started in

India in 1997. There are now more than 4000
Counselling and Testing Centres, mainly located in
government hospitals.
Under NACP-III, Voluntary Counselling and Testing
Centres (VCTC) and facilities providing Prevention of
Parent to Child Transmission of HIV/AIDS (PPTCT)
services are remodelled as a hub or Integrated
Counselling and Testing Centre (ICTC) to provide
services to all clients under one roof.
An ICTC is a place where a person is counselled and
tested for HIV, of his own free will or as advised by a
medical provider. The main functions of an ICTC are:
PPTCT Program
The Prevention of Parent to Child Transmission of

HIV/AIDS (PPTCT) programme was started in the
country in the year 2002 following a feasibility study
in 11 major hospitals in the five high HIV prevalence
states.
Currently, there are more than 4000 Integrated
Counselling and Testing Centres (ICTCs) in the
country, most of these in government hospitals,
which offer PPTCT services to pregnant women.
Of these ICTCs, 502 are located in Obstetrics and
Gynaecology Departments and in Maternity Homes
where the client load is predominantly comprised of
pregnant women
Blood safety
NACO is committed to bridge the gap in the availability and

improve quality of blood under NACP-III. To achieve these
objectives NACO plans to:
Raise voluntary blood donation to 90 percent
Establish blood storage centres in Community Health Centres
Expand external quality assessment services for blood screening
Quality management in blood transfusion services
Sensitise clinicians on optimum use of blood, blood components
and products
Add 39 blood banks in districts that do not have blood transfusion
facility
Establish blood storage centres in 3222 community care centres
Provide refrigerated vans in 500 districts for networking with
blood storage centres
Blood safety contd.
Establish additional model blood banks in 22 states; 10 are

functional already
Set up additional Blood Component Separation Units (BCSU) in 80
tertiary care hospitals and separate at least 50 percent of the
collection at all BCSUs (162) into components
Promote autologous blood donation
Liaise with Indian Red Cross Society and Ministry of Youth Affairs
and Sports to promote voluntary blood donation among the youth
Set up 32 model blood banks in various states
Liaise with the Indian Medical Council (IMC) to mandate the
requirement of a department of transfusion medicine in all medical
colleges and appropriate transfusion practices in the syllabus of
MD/MS clinical subjects
Establish one additional plasma fractionation facility in the country
Establish four Centres of Excellence in blood transfusion services in
the four metros in order to cater to any region of the country in time
of a crisis
Introduce accreditation of blood banks
Post exposure prophylaxis
Post exposure prophylaxis (PEP) refers to

comprehensive medical management to minimise
the risk of infection among Health Care Personnel
(HCP) following potential exposure to blood-borne
pathogens (HIV, HBV, HCV).
This includes counselling, risk assessment, relevant
laboratory investigations based on informed consent
of the source and exposed person, first aid and
depending on the risk assessment, the provision of
short term (four weeks) of antiretroviral drugs, with
follow up and support
Improved access to quality

condoms
Under NACP-III condom promotion continues to be an important
prevention strategy. The programme seeks to:

Increase condom use during sex with non-regular partner, which
is the key to limiting HIV spread through sexual route.
Increase the number of condoms distributed by social marketing
programmes.
Increase the number of free condoms distributed through STI and
STD clinics, reaching those who are at the highest risk of
acquiring or transmitting HIV.
Increase access to condoms, especially to men who have sex
with non-regular partners.
Increase the number of commercial condoms sold.
Increase the number of non-traditional outlets for socially
marketed condoms, e.g., paan shops, lodges, etc. in strategically
located hotspots of solicitation
Care, support and treatment
Objective 2: Care support and

treatment
Improved treatment access for opportunistic infections

and continuation of care
Children affected and infected by HIV
Integration of prevention with care, support and
Community care and support programs
Collaboration with PLHA network
Impact mitigation and linking it with livelihood support.
Improving access to ART for PLHA, Children, quality
of services
ART
Adherence to ART is Critical

ART is Accessible to All
Criteria for ART:
CD4 (cell /mm3)Actions< 200 Treat irrespective of clinical

stage 200 350 Offer ART for symptomatic patients Initiate
Rx before CD4 drop below 200 cells/mm3For
Asymptomatic people *>350Defer treatment in
asymptomatic persons
There are 127 ART centres operating in the country as of
June 2007. By 2012, 250 ART centres will become
functional across the country in order to provide people
living with HIV/AIDS better access to treatment.
Strengthen the infrastructure,

systems and human resources
Objective 3:Strengthen the

infrastructure, systems and human
resources
State AIDS control societies
District aids prevention and control units

Strengthening of the National AIDS control
organization
Capacity building
Sustained technical training support to public and
private agencies
Mainstreaming HIV and partnership development
Convergence with RCH, TB and MoHFW
Coordination and partnership with donors
Strengthening strategic
information systems (SIMS
Objective 4: Strengthening
strategic information systems
(SIMS
)
One nationwide
strategic information system
Strengthening the comuterised management

system (CMIS) and making it more appropriate
and userfriendly
Developing community friendly information
systems
Developing indicators for the state plans and
instiutitonal arrangement for collecting, analyzing
and monitoring progress
Hardware and software procurements
Key Achievements under NACP
Promotion of voluntary blood donation has enabled

reducing transmission of HIV infection through
contaminated blood from about 6.07% (1999), 4.61%
(2003), 2.07% (2005), 1.96% (2006) to 1.87% (2007).
The number of integrated counseling and testing

centres increased from 982 in 2004, 1476 in 2005,
4027 in 2006, 4567 in 2007 and 4817 in 2008 (till
September, 2008). The number of persons tested in
these centres has increased from 17.5 lakh in 2004 to
37.9 lakhs in 2008-09 (August, 2008).
.
Contd.
The number of STI clinics being supported by NACO

has increased from 815 in 2005 to 895 in 2008. The
reported number of patients treated for STI in 2005
was 16.7 lakh, in 2006, 20.2 lakh and in 2007, it has
increased to 25.9 lakh.
. In the year 2007, a total of 3.2 million pregnant
women accessed PPTCT services at ICTCs across
the country of which 18449 pregnant women were
diagnosed to be HIV +ve. Of these 11460 (62%)
pregnant women and the infants born to them received
prophylactic single dose Nevirapine to prevent parent
to child transmission of HIV.
Contd.
As of September 2008, 5,61,981 patients have been

registered at ART centers and 1,77,808 clinically eligible
patients are receiving free ART in Govt. & inter-sectoral
health sector.
This is achieved through 179 ART centers across 31
states. Total 159 Community Care Centers are
established across country of providing Care & Support
Services to PLHA's.
The Targeted Intervention (TI) projects aim to interrupt
HIV transmission among highly vulnerable populations.
Such population groups include - commercial sex
workers, injecting drug users, men who have sex with
men, truckers and migrant workers.
As on date, 1132 Targeted Interventions are operational
in various states and UTs in the country

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National AIDS Control

To know about the extent of the problem of

Dr. KANUPRIYA CHATURVEDI

Global estimates for

People living with HIV

New HIV infections in 2008

Deaths due to AIDS in 2008

31.1 35.8 million

2.4 3.0 million

1.7 2.4 million

Dr. KANUPRIYA CHATURVEDI

HIV estimates for India (2007)

HIV prevalence (15-49 years)

HIV prevalence among men (15-49 years)

HIV prevalence among women (15-49 years)

Number of people living with HIV (adults and

Number of Children living with HIV (>15 years)

Dr. KANUPRIYA CHATURVEDI

HIV situation in the country is assessed and monitored

In India, after the first case of HIV was detected in Chennai in

National AIDS Control Program

1985 Govt. of India constituted a taskforce to study the

National AIDS Control Programme

Phase-I (1992 - 1999) was implemented across

Phase-II (1999 - 2006) was aimed at reducing

Significant Achievements of NACP-I

Scaling up PMTCT and VCCTC services

Dr. KANUPRIYA CHATURVEDI

The effectiveness of the condoms as one of the

Phase-III (2007-2012)is based on the

Considering that more than 99 percent of the

Dr. KANUPRIYA CHATURVEDI

Sub-populations that have the highest risk of exposure

NACP-III ensures that all persons who need

NACP-III also plans to invest in community

Lesson learnt from Phase I &II

The epidemic continues to progress with the

High risk groups to low risk groups

MSM and IUDs have not received appropriate

Dr. KANUPRIYA CHATURVEDI

Goals and Objectives of NACP-III

The overall goals of NACP-III is to halt and

The specific objective is to reduce the rate of

Dr. KANUPRIYA CHATURVEDI

Prevent infections through saturation of

The unifying credo of Three Ones, i.e., one

Dr. KANUPRIYA CHATURVEDI

Civil society representation and

Dr. KANUPRIYA CHATURVEDI

Provide universal access to HIV prevention,

Dr. KANUPRIYA CHATURVEDI

1: Prevent new infections

Dr. KANUPRIYA CHATURVEDI

Objective 1:To prevent new

Saturation of coverage of high risk group

Scaling up interventions among general

Dr. KANUPRIYA CHATURVEDI

1.1 Saturation of coverage of high

Access to behavior change communication

Dr. KANUPRIYA CHATURVEDI

1.2 Scaling up interventions

STD control program

Dr. KANUPRIYA CHATURVEDI

Focused efforts on women,children and