AIDS Control Programme in Assam:

The AIDS Control Programme in Assam was started as a State AIDS Cell which was established in the year 1992 in the office of the Director of Health Services, Assam under the National AIDS Control Organization (NACO) for implementing the National AIDS Control Programme (NACP) Phase I. One State AIDS Programme Officer in the rank of Jt. Director of Health Services was appointed to run the programme and other officers and staffs were also appointed as per guideline. The State AIDS Cell of Assam had followed the National AIDS Prevention Policy, Govt. of India for implementing the AIDS Control Programme in Assam. The first phase of the National AIDS Control Programme came to its end in the year 1997 and was extended up to 1998.

Meanwhile the Assam State AIDS Control Society (ASACS) was formed and registered in the month of October 1998 under the Society Registration Act 1860 of which Minister, Health & FW Deptt. Govt. of Assam is the Chairman of the Governing Body and the Senior most Secretary, Health & FW Deptt. is the Chairman of the Executive Council.

The Phase II of NACP had been started from January 1999 for a period of five years i.e. up to 2004 and the programme is extended up to 2007 March and ASACS implemented the AIDS Control Programme as per objectives and guidelines of NACP II. Then the phase III of the National AIDS Control Programme started from 2007 to 2012 and since 2012, the Phase IV of the National AIDS Control Programme is being implemented in the state till 2017.


Goals & Objectives as per NACP-IV:

Reduce new infections by 50% (2007 Baseline of NACP III)
Comprehensive care, support and treatment to all persons living with HIV/AIDS


Components of NACP-IV:

Component 1: Intensifying and Consolidating Prevention services with a focus on HRG and vulnerable populations
  This component will support the scaling up of TIs with the aim of reaching out to the hard to reach population groups who do not yet access and use the prevention services of the program, and saturate coverage among the HRGs. In addition, this component will support the bridge population, i.e. migrants and truckers. Component 1 includes the following two subcomponents:
1.1 Scaling up coverage of TIs among HRG
  The interventions under this sub-component will include: (i) the provision of behavior change interventions to increase safe practices, testing and counseling, and adherence to treatment, and demand for other services;(ii) the promotion and provision of condoms to HRG to promote their use in each sexual encounter; (iii) provision or referral for STI services including counseling at service provision centers to increase compliance of patients with treatment, risk reduction counseling with focus on partner referral and management; (iv) needle and syringe exchange for IDUs as well as scaling up of Opioid Substitution Therapy (OST) provision. This sub-component also includes the financing of operating costs for about 25 State Training Resource Centers as well as participant training costs over a period of 5 years.
1.2 Scaling up of interventions among other vulnerable populations
  The activities under this subcomponent will include: (i) risk assessment and size estimation of migrant population groups and truckers at transit points and at workplaces; (ii) behavior change communications (BCC) for creating awareness about risk and vulnerability, prevention methods, availability and location of services, increase safe behavior and demand for services as well as reduce stigma;(iii) promotion and provisioning of condoms through different channels including social marketing; (iv) development of linkages with local institutions, both public and NGO owned, for testing, counseling and STI treatment services;(v) creation of “peer support groups” and “safe spaces” for migrants at destination; (vi) establishment of need-based and gender-sensitive services for partners of IDUs; and(vii) strengthening networks of vulnerable populations with enhanced linkages to service centers and risk reduction interventions, specifically condom use.
Component 2: Expanding IEC services for (a) general population and (b) high risk groups with a focus on behavior change and demand generation
  IEC has been an important component of the NACP. With the expansion of services for counseling and testing, ART, STI treatment and condom promotion, the demand generation campaigns will continue to be the focus of the NACP-IV communication strategy. IEC will remain an important component of all prevention efforts and will include:
Behavior change communication strategies for HRGs, vulnerable groups and hard to reach populations
Increasing awareness among general population, particularly women and youth.
Component 3: Comprehensive Care, Support and Treatment
  NACP IV will implement comprehensive HIV care for all those who are in need of such services and facilitate additional support systems for women and children affected and infected with HIV / AIDS. It is envisaged that greater adherence and compliance would be possible with wide network of treatment facilities and collaborative support from PLHIV and civil society groups. Additional Centers of Excellence (CoEs) and upgraded ART Plus centers will be established to provide high-quality treatment and follow-up services, positive prevention and better linkages with health care providers in the periphery.

With increasing maturity of the epidemic, it is very likely that there will be greater demand for 2nd line ART, OI management. NACP IV will address these needs adequately. It is proposed that the comprehensive care, support and treatment of HIV/AIDS will inter alia include: (i) anti-retroviral treatment (ART) including second line (ii) management of opportunistic infections and (iii) facilitating social protection through linkages with concerned Departments/Ministries. The program will explore avenues of public-private partnerships. The program will enhance activities to reduce stigma and discrimination at all levels particularly at health care settings.
Component 4: Strengthening institutional capacities
  The objective of NACP IV will be to consolidate the trend of reversal of the epidemic seen at the national level to all the key districts in India. Programme planning and management responsibilities will be strengthened at state and district levels to ensure high quality, timely and effective implementation of field level activities and desired programmatic outcomes.

The planning processes and systems will be further strengthened to ensure that the annual action plans are based on evidence, local priorities and in alignment with NACP IV objectives. Sustaining the epidemic response through increased collaboration and convergence, where feasible, with other departments will be given a high priority during NACP IV. This will involve phased integration of the HIV services with the routine public sector health delivery systems, streamlining the supply chain mechanisms and quality control mechanisms and building capacities of governmental and non-governmental institutions and networks.
Component 5: Strategic Information Management Systems (SIMS)
  The roll-out of SIMS is ongoing and will be firmly established at all levels to support evidence based planning, program monitoring and measuring of programmatic impacts. The surveillance system will be further strengthened with focus on tracking the epidemic, incidence analysis, identifying pockets of infection and estimating the burden of infection. Research priorities will also be customized to the emerging needs of the program. NACP IV will also document, manage and disseminate evidence and effective utilization of programmatic and research data. The relevant, measurable and verifiable indicators will be identified and used appropriately.

Objectives of State AIDS Policy:

The Assam State HIV/AIDS Prevention and Control Policy aims to halt the AIDS epidemic in the State to zero transmission rate and to reduce the impact of the epidemic at all levels of general population. The specific objectives of the policy are:

i)
To reiterate strongly the Government’s firm commitment to prevent the spread of HIV infection and to reduce personal and social impact;
ii)
To ensure right to privacy and confidentiality of people living with HIV/AIDS (PLHIVs);
iii)
To ensure an environment free of discrimination for people living with HIV/AIDS and protection of human rights, including right to access healthcare system both at the government and private sectors;
iv)
To ensure prevention of hospital acquired infections for a safe environment;
v)
To ensure information, treatment and support to the people under care and custody of the State;
vi)
To strengthen safe blood transfusion system both at the Government and private institutions;
vii)
To mainstream AIDS Prevention and Control Programme with partnership development;
viii)
To ensure HIV/AIDS related information, education and communication (IEC) at all levels;
ix)
To promote strategies for risk reduction from drug addiction and unsafe sex;
x)
To prevent women, children and other socially weaker groups from becoming vulnerable to HIV infection by improving health education, legal status and economic empowerment;
xi
To promote mapping and surveillance for adequate intervention and estimation of the burden of infection in the State;
xii)
To promote proper Monitoring and Evaluation system and to ensure accountability;
xiii)
To develop appropriate legal framework.

HIV/AIDS Epidemic in Assam:

The first HIV positive case in Assam was reported in September, 1990. Till 1 st January, 2012 Assam has detected 6304 HIV positive cases with a positivity rate of 6.28 per thousand. However the recently published Technical Report on India HIV Estimates by NACO has reported an estimated 14,244 HIV positive cases in Assam.

Assam is categorized as a low HIV Prevalence state with an adult HIV Prevalence of 0.08% which is lower than the National Prevalence of 0.31%. However the adult HIV Prevalence in the state has increased from 0.05% in 2006 to 0.08% in 2009. Similar rising trends have been reported among the young population (15-24 years) in the state. Assam is also a highly vulnerable state for HIV transmission because of the following reasons:

  • It is the gate-way of Northeastern states.
  • It is surrounded by two high prevalence states of Manipur and Nagaland.
  • Large number of female migrants from other northeastern states, West Bengal, Nepal who has come to Assam for Employment and has taken to sex work.
  • High-prevalence of other Sexual Transmitted Infections, stigma and social discrimination, inequity, high prevalence of risky sexual behavior among young people, existence of mobile and hidden nature of female sex workers, drug abuse, injecting drug use, illegal drug trafficking,etc are also responsible for increased vulnerability of the state.

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