US President’s Emergency Plan for AIDS Relief in India

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2007 Country Profile: India

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2007 Country Profile: India

National HIV prevalence rate among adults (ages 15 to 49): 0.9 percent1Adults and children (ages 0-49) living with HIV at the end of 2005: 5,700,0001 AIDS deaths (adults and children) in 2005: 270,000-680,0001 AIDS orphans at the end of 2005: not available1

Under PEPFAR, India received nearly $20.8 million in Fiscal Year (FY) 2004, more than $26.6 million in FY2005, and approximately $29.3 million in FY2006 to support an integrated HIV/AIDS prevention, treatment and care program.

Recognizing the global HIV/AIDS pandemic as one of the greatest health challenges of our time, President W. Bush announced the President's Emergency Plan for AIDS Relief (Emergency Plan/PEPFAR) in 2003 — the largest international health initiative in history by one nation to address a single disease. The United States is changing the paradigm for development, rejecting the flawed "donor-recipient" mentality and replacing it with an ethic of true partnership. These partnerships are having a global impact and transforming the face of our world today.

Partnership to Fight HIV/AIDS

Through the Emergency Plan, the U.S. Government (USG) and its partners are working in partnership with the Government of India to support the third National AIDS Control Plan (2006-2011).

The USG's strategic priorities are:

To support the efforts of the Indian National HIV/AIDS Control Program to achieve its key HIV prevention, treatment, care, capacity building, and monitoring and evaluation objectives; To work with other partners and leverage resources to bring programs to scale; To continue to implement prevention programs for most-at-risk populations; To promote a sustainable network model that integrates prevention, treatment, care and support services in the public and private sectors; To support the efforts of the Government of India to build capacity for policy and program development at the national and state level; To build indigenous capacity for program management and implementation; and To implement programs within the framework of the "Three Ones," which calls for one agreed upon AIDS action framework, one national AIDS coordinating authority, and one national monitoring and evaluation system.

Emergency Plan Results in India

# of individuals receiving antiretroviral treatment in fiscal year 2006

23,000

# of pregnant women receiving prevention of mother-to-child HIV transmission (PMTCT) services in fiscal year 20061

692,200

# of HIV-positive pregnant women receiving antiretroviral prophylaxis for PMTCT in fiscal year 2006

2,900

# of individuals receiving counseling and testing (in settings other than PMTCT) in fiscal year 20062

600,000

Note: Numbers may be adjusted as attribution criteria and reporting systems are refined. Numbers above 100 are rounded to nearest 100.1 The number of pregnant women receiving PMTCT services includes only women who have been counseled and tested, and received their test result.2 Counseling and testing includes only those individuals who received their test results.

HIV/AIDS in India

Approximately 5.7 million people were living with HIV/AIDS in India in 2005, the largest number of any country in the world. The overall adult prevalence rate is estimated at 0.9 percent.1 The epidemic in India is considered to be a concentrated epidemic, with an estimated 1.63 million infections among high-risk groups.2 There is substantial variation in HIV prevalence among and even within states. Sexual transmission accounts for the vast majority of HIV infections in India. Prostitution is a driving factor of the epidemic. In the North East and increasingly in cities, injecting drug use is also fueling the epidemic.

1 UNAIDS, Report on the Global AIDS Epidemic, 2006. 2Indian National AIDS Control Organization, Sentinel Surveillance Report, 2003.

Emergency Plan Achievements in India to Date

Challenges to Emergency Plan Implementation

Meeting the demand for high quality HIV/AIDS services for a population of over one billion is a major challenge. It is particularly difficult to reach the most-at-risk groups within this large population. HIV-related stigma remains strong in India, contributing to denial about the epidemic and deterring access to HIV/AIDS services. Stigma is compounded by the association of HIV/AIDS with socially unacceptable or illegal behaviors among marginalized populations. Additional efforts to educate Indians about HIV/AIDS are needed to combat the stigma that hinders efforts to fight the epidemic.

Providing Support and Care through Community Outreach

The Emergency Plan assists efforts to pioneer a new comprehensive care model, through which people living with HIV/AIDS and their families are provided with improved health care, prevention services, and psychosocial and economic support. Since the project began in 2001 , it has registered 6,028 people living with HIV/AIDS, of whom 51 3 are children, with the goal of improving the quality of life for these individuals and their families. Reaching into the community, the project has established and trained a cadre of community members, many of whom are HIV-positive themselves, to serve as "peer" community health workers. Community health workers provide critical information on counseling, treatment of opportunistic infections, and antiretroviral treatment. This program highlights the important role that trained community health workers play in HIV prevention and care for people living with HIV/AIDS.

A community health worker provides home- based care to a client.

Indian truck drivers learn about HIV prevention at social centers.

Social Hubs Help Teach About AIDS Every day, 6,000 long-distance truckers and their assistants travel along India's Chennai-Bangalore highway, often stopping for up to two weeks along the way to wait for their next assignments. Separated from their families for long periods of time, these drivers are considered a population at risk for HIV infection. With support from the Emergency Plan, the U.S. Government is working in partnership with the Government of India to design social hubs that attract truck drivers and educate them about HIV prevention. The Chennai-Bangalore highway has four social centers where peer educators - including mechanics, telephone operators, bicycle repairmen and tea-shop owners - share information about HIV prevention between socializing and games of carom. Each driver leaves the drop-in center with a handy kit to hold the paperwork required for highway inspections. The kit is lined with illustrations and information on HIV/AIDS prevention.

Innovative Workplace Program s HIV Prevention Messages Reaching Mumbai office workers with HIV/AIDS prevention messages in their lunchboxes is just one element of an innovative workplace program supported by the Emergency Plan. On World AIDS Day 2005, the project delivered lunches containing information about HIV/AIDS to approximately 200,000 offices. The lunches, known as "dabbas," were delivered by about 5,000 "Dabbawalas," who make daily deliveries throughout Mumbai through an efficient delivery system. The Emergency Plan supported efforts of the Dabbawala association to include in the lunches creatively designed materials and coasters bearing messages reflecting the World AIDS Day theme, "Stop AIDS, Keep the Promise." In addition to these World AIDS Day activities, the program works throughout the year to reach out to corporations to address HIV/AIDS in the workplace.

This sticker was distributed in lunches on World AIDS Day 2005.

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