Historical Background/Periodical Development
The Country and the State of Maharashtra have responded to the great challenge of the HIV/AIDS epidemic, which is tending to eclipse a generation of the State. The three societies under the Govt. viz. – Maharashtra State AIDS Control Society (MSACS), Mumbai District AIDS Control Society (MDACS) and AVERT are heading towards attainment of major goals of bringing about a behavior change in the population and also to care for the patients who are HIV positive and are facing the threat of getting into an immuno compromised state with full blown AIDS.
Maharashtra has the highest rate of urbanization i.e. 42%, major national highways pass through the state, it has a high rate of migrant and floating population, there exists a well established sex industry in the state and industrialization leading to availability of cash money in the hands of industrial workers. The bed occupancy in many hospitals due to HIV positive persons has been as high as 25% to 30%, the ANC (Antenatal cases) prevalence is around 1% the HIV prevalence in STD clinics is 10.4%. There are 216748 registered HIV positive persons in the state today and an estimated figure of 8,51,420 people living with HIV/AIDS. The total number of AIDS Cases is 47,386 and those who have died is 2958.
Nevertheless, the state has achieved many of its goals
- The ANC clinic HIV positivity has decreased from 1.25 to 0.88 %.
- The HIV positivity rate in people attending the STD clinics has come down from 18 in 1998 to 10.4 in 2005.
- Seropositivty among voluntary blood donors has come down from 1.35 to 0.66.
Most of these goals have been achieved through various programmes implemented like the STD control programme, targeted intervention, Condom promotion, Information Education Communication strategy, blood safety, Family health awareness Campaign, APEP, VCTC, PPTCT programme, Drop in Centres, Community Care Centres and others.
Two journals have been started by the societies.
“Nirdhar” (Determination) & “Yes – We dare to Care”, are two great ventures which have come up due to devotion, hard work and concentrated efforts of all the staff.
Maharashtra is 2nd largest state in India with population of 100 million and area of 3.08 lacs Sq. Km. The State has always remained on forefront in the world in health care delivery with a very well knit rural and urban infrastructure. The infrastructure fulfills the norms prescribed by Government of India under model health plan. A comprehensive package of promotive, curative and rehabilitative services are being provided through vast network of rural and urban infrastructure.
The first AIDS case was reported from Mumbai in 1986. An implementation of an effective HIV services programme in the state resulted in better understanding of epidemiological scenario in the state. The HIV infection is not restricted to the core groups in the state but has spread into bridge as well as low risk operation. Few cities in the state have already entered into 3 phases of the epidemic. It is now evident that spread of HIV in Maharashtra is not restricted to high risk behaviour individual, urban cities but it has established its roots in low risk population as well as distant rural area of the state.
The Sentinel Surveillance 2005 shows that sero positivity in high–risk group has gone up from 7.6% in 2002 to 10.4% in 2005. However, Sero positivity in low risk (ANC cases) has dropped from 1.25% in 2002 to 0.88% in 2005. There is no statistical significant increase or decrease in HIV prevalence. Therefore strengthening comprehensive, well co–ordinate HIV prevention activities involving NGOs, CBOs and the community in general and evolving care and support activities to HIV affected individuals and families are crucial issues.
2nd phase of AIDS Control Programme is built on experience gained in its implementation during the 1st phase. It has consolidated achievements made so far and has formulated effective, people friendly strategy for controlling the prevalence and reducing the HIV infection rates in Maharashtra. The project purpose to stabilize current HIV prevalence by 2003 and further reduce HIV incidence among high risk and low risk behavioral individuals. Adopting approach of formation of society resulted in speeding of the implementation of the programmes. The strategy adopted a mission mode approach for focusing on effective intervention in high–risk individuals.
Low risk behaviour groups to practice healthy and safe sex, strengthening and operationalising STI clinics, ensuring blood safety by strengthening and modernizing blood banks, trengthening database for better planning, emphasizing integration with RCH and Tuberculosis control programme. Reducing impact of HIV especially on children and promoting innovative scheme like PPTCT programme, generating the feeling of ownership among various sectors, mobilizing support of large number of NGOs and CBOs for broadened community initiatives and finally converting this programme into mass awareness and safe health movement.
To effectively manage and implement the 2nd phase State AIDS Control Society was responsible for project management which was started by Blood Transfusion Council and close liaison and co–ordination between MDACS and USAID assisted AVERT Society to avoid duplication of activities and funding it. The activities, which were implemented, have been evaluated concurrently and terminally through external agency.
The health care delivery system of India with all its emissaries starting from the policy makers, administrators, consultants, tertiary hospital staff, district hospital staff to the staff in the remotest primary health centre has undertaken enormous efforts during the past decade to tackle the problem of HIV/AIDS in the country.
It was in September 1992 that the Govt. of India started and launched the first phase of National AIDS Control Project. It was a five years project, named “National AIDS Control Project (NACP)” a hundred percent centrally sponsored scheme in all the States and Union Territories. With the first and the prime initiative taken by the Prime Minister and labeling. HIV/AIDS as the most important public health problem, the project got a considerable boost and began its function with the main aims as
- To slow the spread of HIV.
- To decrease morbidity and mortality associated with HIV infection.
- To minimize socio economic impact resulting from HIV infection.
The Phase I project was continued upto 31st March 99.
Soon after the Govt. of India, Ministry of Health and Family Welfare through National AIDS Control Organisation (NACO), accorded sanction to the launching of the phase II programme for Preventions and Control of AIDS in India with assistance from World Bank.
The main aims & objectives of the phase II programme are
- Shift the focus from raising awareness to changing behaviour through interventions, particularly for groups at high risk of contracting and spreading HIV.
- To support decentralization of service delivery to the States and Municipalities and a new facilitating role for NACO. Program delivery would be flexible, evidence based, participatory and rely on local programme implementation plans, to protect human rights by encouraging voluntary counseling and testing and discouraging mandatory testing.
- To support structured and evidence based annual reviews and ongoing operational research, and
- To encourage management reforms, such as better managed State level AIDS Control Societies and improved drugs and equipment procurement practices. These reforms are proposed with a view to bring about a sense of ‘ownership’ of the programme among the states, Municipal Corporations, NGOs and other implementing agencies.