DR. S.K CHATURVEDI UNICEF HIV/AIDS PREVENTION PROGRAMME PROGRAMME PLAN OF COOPERATION 2003-2007.

DR. S.K CHATURVEDIUNICEF

HIV/AIDS PREVENTION PROGRAMME

PROGRAMME PLAN OF COOPERATION

2003-2007

HIV Prevalence in India

Pondichery

Gujarat

Karnataka

Goa

Lakshwadeep

Dadra Nagar HaveliMaharashtra

Madhya Pradesh

Kerala

Tamil Nadu

Andhra Pradesh

Punjab

Rajasthan

Daman & Diu

J & K

Haryana

Uttar Pradesh

Himachal Pradesh

Delhi

Chandigarh

Bihar

West Bengal

Orissa

Andaman & Nicobar

Mizoram

Meghalaya

AssamSikkim

Manipur

Tripura

Arunachal Pradesh

Nagaland

Source: NACO, 2002

> 1% Antenatal Women

< 1% Antenatal Women

Child Mortality as an Indicator of Vulnerability

Pondichery

Gujarat

KarnatakaGoa

Lakshwadeep

Dadra Nagar HaveliMaharashtra

Madhya Pradesh

Kerala

Tamil Nadu

Andhra Pradesh

Punjab

Rajasthan

Daman & Diu

Jammu & Kashmir

Haryana

Uttar Pradesh

Himachal Pradesh

Delhi

Chandigarh

Bihar

West Bengal

Orissa

Andaman & Nicobar

Mizoram

Meghalaya

Assam

Sikkim

Manipur

Tripura

Arunachal Pradesh

Nagaland

HIV + U5MR

Percent women aged 15-49 who have heard of HIV/AIDS

21.6

26.2

65.8

76.1

59.7

84.7

8774.5

87.7

70.6

23.8

27.3

23.9

48.7

32

7441.3

54.3 74

12.7

35.4

43

56.3

88.3

43.4

31.1

59.2

92.8

54.7

41.1

54.8

63.9

Per cent

< 3030 - 4950 - 6970 & above

MICS-2000

Percent women aged 15-49 who know all threemodes of vertical transmission of HIV/AIDS

13.3

13

40.6

34.4

31.4

40.8

36.642.2

46.9

46.8

14

12.8

11.5

30.8

19

37.821.1

39.6 36.1

6.8

17.7

23.4

36.9

58.1

21

15

21.1

50.2

29.9

17.2

26.2

31.1

Per cent

< 2020 - 2930 - 3940 & above

MICS-2000

Proportion of 15-19 yr olds reporting casualsex in the last one year: select states

2

2

0

0

0

8

0

1

1

2

1 1

1 3

1 2

8

2

4

4

5

6

7

9

1 2

2 0

2 0

2 5

2 8

0 1 0 2 0 3 0

A ll I nd ia

K a r na ta ka

R a ja s tha n

T a m il N a d u

U P

M a h a ra s h tra

N ag a la n d

P u n j a b

M P

G u ja ra t

B ih a r

A P

C h a t is g a th

p e r c e n t

F e m a l e M a l e

Urban

HIV/AIDS Awareness among Adolescents< 20 years - FHAC 2000

0

10

20

30

40

50

60

RuralUrban Slums

Correct knowledge about benefitsof condom use to prevent STI/HIV

Used condomduring last intercourse

Source: FHAC Coverage EvaluationAIIMS/INCLEN/USAID 2000

32

53

3.46.3

Proportion of 15-19 yr olds willing to sharefood with a HIV positive person: Rural

0 20 40 60 80 1 00

A ll I nd ia

Ass am

W e st Be ng al

Jha rkha nd

Ch at is ga rth

K arn at aka

O ris sa

B i ha r

Si kk im

Gu ja rat

N E (exc l. s ikk i m & Ma ni pu r)

J& K

U P

M P

R aj as th an

M ah ara sh tra

U rrara nch al

Ha rya na

Hi m a ch al P ra de sh

A P

D el hi

Ta m i l Na du

Pu nj ab

Ke ral a

Ma ni pu r

Reported Data in 2001

• Over 50% of all new infections occurring among young people aged below 25.

• 25% of all HIV infection fall in women, with an accompany increase in vertical transmission and pediatric HIV.

• Reported median of HIV prevalence among pregnant women exceed 2% in most high prevalence states.

• Already about 660,000 young women and 345,000 young men aged between 15-24 years are living with HIV/AIDS

• 120,000 AIDS orphan children and 160,000 AIDS children living in the country.

Who Are Now Infected & Affected by HIV/AIDS?

ICO HIV/AIDS Programme Strategy

• Phased approach: Initial focus on four high prevalence states

- 2002-3: High Prevalence 2004-5: Concentrated

2006-7: Low

- AP, Mah, TN & Nagaland + Karnataka and Manipur (PPTCT)

• Modeling scaled-up actions in support of the National Programme

• Strong emphasis on building evidence-based approaches

Projects

PPTCT

Adolescents & YoungPeople

IntegratedCommunication

Thrusts

Scaling up to nationallevel of prevention of MTCT

Prevention of HIVamong young below theage of 25

Building an enablingenvironment for anexpanded responseagainst HIV

Results

Scaled up interventionson HIV prevention

Replicable models of Life Skills Education

Replicable district models

Young People

Coalition of civil societygroups & NGOs

VCCT services forpregnant women

Evidence based national

Operational network ofhealth facilities

policy

PPTCT

Programme Goal: To reduce the prevalence of HIV/AIDS among children and to alleviate the impact of AIDS on children, adolescents

and families affected by HIV/AIDS

PMTCT

1) Scaling up

Expected outputs

• An operational network of health facilities providing quality PPTCT services established

• PPTCT used as an opportunity to strengthen MCH services.

2) District Models

Expected outputs

• A comprehensive, integrated and sustainable distrit- based PPTCT programme

• Pre and in-service training modules for care providers to integrate youth friendly services

Key results:

• Operational network of health facilities for PPTCT established• A National Policy for PPTCT • Replicable district PPTCT models• Partnerships and resources mobilized for scaled up

3) Learning for Policy Development

Expected outputs

• A Feasibility Study of “PPTCT Plus”

• Studies on HIV and infant feeding

• Evidence-based National PPTCT Policy

Scaling up PPTCT to cover the whole countryTiming: Cumulative total of medical

centres participating:

11 Centers of ExcellencePilot project:2000-2002 11

81 Medical Colleges inHigh Prevalence States

December 2002 92

159 District Hospitals/Maternity Hospitals inHigh Prevalence States

June 2003 242

59 Medical Colleges inLow Prevalence States

Dec. 2003 301

450+ District Hospitals/Maternity Hospitals inLow Prevalence States

In 2004 780+

Monitoring and Evaluation

Quality assurance of

services

UNICEF’ s Role in PPTCT

Research

Training

Drugs

Counseling

Data

Disseminationof results

Studydesign

PPTCT“Plus”

DistrictModels

Infant Feeding

Adolescents & Young People

1) Preventive & Peer Education in School

Expected outputs

• Effective intervention models for scaling up in schools

• State-led sustainable response plan

• Linkages of life skills education to other key strategies

2) Young People as Agents of Change

Expected outputs

• Increased participation of young people in HIV/AIDS prevention

• Peer Education Package for out-of-school adolescents and young people

• A Youth forum for public debate and dialogue about HIV/AIDS and related issues

Key results:

• Scaled up interventions on HIV prevention in school• Replicable models of skills-based prevention education for young people

out of school• Coalition of civil society groups and NGOs on YP and HIV/AIDS

School AIDS Prevention Programme: Achievements so far….

Trends in Coverage of School AIDS programmes: Planned vs Actual 1999-2003

2025

40

60

80

100

0

20

40

60

80

100

120

1999 2000 2001 2002 2003

% s

ch

oo

ls c

ov

ere

d

Actual

Target

Impact of school HIV education

Delayed Sexual Debut Primary students (13-16yrs) following IEC

0

10

20

30

40

50

60

70

Boys Girls

% S

exu

al in

nitia

tion

1994

1996

2001

Source: AMREF 2001

Integrated Communication

1) Advocacy and Mobilization for Social Change

Expected outputs

• Documentation on the impact of HIV/AIDS and data analysis to sensitize key stakeholders for policy formulation and increased resource allocation

• Communication Strategies to reduce risks, increase demand for health services, and address stigma and discrimination among health care providers and the general population

• Expanded partnerships and alliances with civil society & private sector

2) Behavior Development and Change

Expected outputs

• Increased participation of communities, families, individuals, and service providers in responding to HIV/AIDS prevention.

• Effective communication packages for behavior change, focusing in safe behaviors and health care services

• Communication strategy to support PPTCT and Young People interventions

Key Results:

• Partnerships and resources mobilized for scaled up interventions• Packages of communication initiatives including innovative approaches