Ghulam Nabi Azad, Union Minister of Health & Family Welfare released HIV Estimations 2012 at New Delhi today.
The main features of the estimations are as follows:
(1) 57% REDUCTION IN NEW HIV INFECTIONS DURING LAST DECADE
(2) 1.5 LAKH LIVES SAVED DUE TO SCALE UP OF FREE ART SERVICES SINCE 2004
(3) SUSTAINING THE INTENSITY OF INTERVENTIONS TO CONSOLIDATE GAINS
(4) EMERGING EPIDEMICS GIVEN THE HIGHEST PRIORITY IN THE NEXT FIVE YEARS
(5) BALANCING PREVENTION AND TREATMENT IS A KEY CHALLENGE
National AIDS Control Programme in India has been recognised globally as a success story. This programme rests on two key pillars – prevention for those who are not infected and care, support & treatment for those who have been infected. Since large proportion of the population are not infected with HIV, prevention remains the cornerstone of the programme. The strategies for prevention include targeted interventions for high risk groups, condom promotion and strong IEC campaigns for general population. Care, support and treatment aim at increasing access to testing and treatment services.
In order to refine these strategies and to evaluate the impacts of the interventions, National AIDS Control Organisation conducts HIV Sentinel Surveillance and HIV Estimations at regular intervals. The latest round of HIV Sentinel Surveillance was completed in 2011. The data generated there has been used for estimation of HIV burden and projection of HIV epidemic trends in the country. The HIV estimations 2012 indicate an overall continuing reduction in adult HIV prevalence, new HIV infections and AIDS-related deaths in India.
Improved methodology & customised models to generate HIV estimates
The India HIV estimates 2012 utilised improved methodology and updated epidemiological data from the latest round of HIV Sentinel Surveillance, Census 2011 and other information on High Risk Groups for more accurate understanding of the Indian epidemic. Spectrum model has been customised with Indian data to allow robust projections for each state. The entire process is supported by national and international experts, epidemiologists and demographers from National Institute of Medical Statistics, UNAIDS, WHO, CDC and other public health institutes of India.
Adult HIV Prevalence
India is estimated to have an adult (15-49 years) HIV prevalence of 0.27% in 2011. Adult HIV prevalence among males and females is estimated at 0.32% and 0.22% respectively.
In 2011, among the states, Manipur has shown the highest estimated adult HIV prevalence of 1.22%, followed by Andhra Pradesh (0.75%), Mizoram (0.74%), Nagaland (0.73%), Karnataka (0.52%), Goa (0.43%) and Maharashtra (0.42%). Besides these, Odisha, Gujarat, Tamil Nadu, and Chandigarh have shown estimated adult HIV prevalence greater than national prevalence (0.27%).
Trends of Adult HIV Prevalence
The adult HIV prevalence at national level has continued its steady decline from estimated level of 0.41% in 2001 through 0.35% in 2006 to 0.27% in 2011. Similar consistent declines are noted among both males and females at national level. Declining trends in adult HIV prevalence are sustained in all the high prevalence states (Andhra Pradesh, Tamil Nadu, Karnataka, Maharashtra, Manipur & Nagaland).
Annual New HIV Infections
It is estimated that around 1.16 lakh new HIV infections among adults and around 14,500 new infections among children occurred during 2011. Of the 1.16 lakh estimated new infections in 2011 among adults, the six high prevalence states account for 31% of new infections.
Trends of HIV Incidence (New Infections)
India has demonstrated an overall reduction of 57% in estimated annual new HIV infections (among adult population) during the last decade from 2.74 lakhs in 2000 to 1.16 lakhs in 2011. This is one of the most important evidence on the impact of the various interventions under National AIDS Control Programme and scaled-up prevention strategies. Major contribution to this reduction comes from the high prevalence states where a reduction of 76% has been noted during the same period. However, rising trends of new infections are noted in the some of the low prevalence states. Programme has evolved focused prevention strategies to address these emerging vulnerabilities.
Vulnerabilities due to high risk groups and bridge population
Considerable declines in HIV prevalence have been recorded among Female Sex Workers at national level (5.06% in 2007 to 2.67%) and in most of the states, where long-standing targeted interventions have focussed on behaviour change and increasing condom use. Declines have been achieved among Men who have sex with Men (7.41% in 2007 to 4.43% in 2011) also, though several pockets in the country show higher HIV prevalence among them with mixed trends.
Stable trends have been recorded among Injecting Drug Users at national level (7.23% in 2007 to 7.14% in 2011). Besides North Eastern states where declines have been achieved, newer pockets of high HIV prevalence among IDU have emerged over the last few years, in the states of Punjab, Chandigarh, Delhi, Mumbai, Kerala, Odisha, MP, Uttar Pradesh & Bihar. Prevention strategies for IDU in the newer areas have been initiated recently and are prioritised for further scale up during the next five years.(contd next col)
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HIV Estimations 2012 Report
In certain North Indian states, evidence indicates the possible role of migration in fueling HIV epidemics. Besides high risk migrants, long distance truckers also show high levels of vulnerability and form an important part of bridge population.
People Living with HIV/AIDS (PLHIV)
The total number of people living with HIV/AIDS (PLHIV) in India is estimated at 21 lakh in 2011. Children (<15 yrs) account for 7% of all infections, while 86% are in the age –group of 15-49 years. Of all HIV infections, 39% (8.16 lakh) are among women.
Using globally accepted methodologies and updated evidence on survival to HIV with and without treatment, it is estimated that about 1.48 lakh people died of AIDS related causes in 2011 in India. Deaths among HIV infected children account for 7% of all AIDS-related deaths. Wider access to ART has led to 29% reduction in estimated annual AIDS-related deaths during NACP-III period (2007-2011). Greater declines in estimated annual deaths are noted in states where significant scale up of ART services has been achieved.
Lives Saved Due to ART
It is estimated that the scale up of free ART since 2004 has saved over 1.5 lakh lives in the country till 2011 by averting deaths due to AIDS-related causes. At the current pace of scale up of ART services, it is estimated to avert around 50,000 – 60,000 deaths annually in the next five years.
Sustained action needed for ‘Getting to Zero’
Above evidence shows that India is on track to achieve the global targets of ‘Zero New Infections, Zero AIDS-related deaths & Zero discrimination’. However, sustaining prevention focus and intensity in the areas where significant declines have been achieved, is highly critical to consolidate the gains, while effectively addressing the emerging epidemics. With increasing coverage of treatment & decreasing AIDS-related mortality, a significant number of people are likely to require first and second line ART treatment in the coming years. Major challenge for the programme will be to ensure that the treatment requirements are fully met without sacrificing the needs of prevention.
NACO has taken cognisance of these emerging challenges and have focussed on region specific prevention strategies and evidence-based scale up.
1. Scale up of Opioid Substitution Therapy and other harm reduction strategies are given focus in the North Western states where injecting drug use is identified as the major driver of the epidemic.
2. On the other hand, in the eight states of North India, where migration is increasingly being identified as playing role in HIV transmission, revised migrant strategy is being implemented with focus at source, transit as well as destination points.
3. In certain pockets of high prevalence states where HIV prevalence among FSW and MSM continues to be high, emphasis is given to sustain the higher coverage of targeted interventions and improve the quality of outreach.
4. Interventions to provide HIV prevention services to long distance truckers are being scaled up at the trans-shipment locations and truck halt points across the country.
5. More efficacious PPTCT regimen has been rolled out in high prevalence areas where number of HIV positive pregnancies is higher and where the impact on reducing new child infections will be maximum.
6. In the states that account for a larger share of HIV burden, treatment services are being scaled up through expansion of ART and Link ART centres. Second line ART and paediatric ART are being provided at greater number of centres across the country.
7. IEC campaigns have been strengthened through multi-media approach involving TV, Radio and innovative strategies such as Red Ribbon Express, National folk media campaign and North East campaign involving music and sports.
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