ANNUAL REPORT

ORISSA STATE AIDS CONTROL SOCIETY (OSACS)

(Department of Health & Family Welfare), Government of Orissa

2nd Floor, Oil Orissa Building, Nayapalli, Bhubaneswar, Ph: 2395415/2393235 Fax: 2394560 (0674) E-mail: sacorissa@sify.com; orissasacs@gmail.com.

INTRODUCTION:

National AIDS Control Programme is being implemented through National AIDS Control Organization (NACO), New Delhi, under Ministry of Health & Family Welfare, Government of India with the support of DFID & World Bank fund. Accordingly autonomous organizations namely; State AIDS Control Societies have been formed in each of the States for smooth implementation of the programme. National AIDS Control Programme (NACP) I

From 1992 1999: National AIDS Control Programme, Phase - I (NACP-I) was implemented by Government of Orissa under Director, Health Services.

National AIDS Control Programme (NACP) - II

From 1999 13.07.04: - Programme under NACP II was implemented through Orissa State Health & Family Welfare Society in the name and style of State AIDS Cell (SAC).

From 14.07.2004 05.07.06: - As per the direction of National AIDS Control Organization (NACO), a new Society, i.e., Orissa State AIDS Control Society (OSACS) was formed and has been registered under Societies Registration Act XXI of 1860 vide Regd. No. 21886/64 of 2004-2005.

Goals of National AIDS Control programme (Phase - II):

1. To reduce the spread of HIV infection in the State and to detect, reduce and control the spread of HIV infection. 2. To strengthen the State's capacity to respond to the HIV/AIDS on long-term basis.

National AIDS Control Programme (NACP) Phase III (2007 2012)

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The year 2007 has started on an important note because, the 3rd phase of National AIDS Control Programme (NACP-III) have been launched from 6th of July, 2007. This programme builds on the attainments of NACP- II, which has led to a relative stabilization of the HIV/AIDS epidemic in the country. The overall goal of NACP- III is to halt and reverse the epidemic in India over the next five years by integrating programmes for prevention, care, Support and treatment. This will be achieved through a four pronged strategy:

1. Prevention of new infections in high risk groups and general population through: Saturation coverage of high risk groups with TIs. Scaled up interventions in the general populations 2. Providing greater care, support and treatment to a larger number of People Living with HIV AIDS 3. Strengthening of infrastructure systems and human resources in prevention care, support and treatment programs at the district, state & national level. 4. Strengthening the nationwide strategic information management system

Orissa is a low prevalent state but highly vulnerable to HIV/AIDS. The developmental activities and achievements of OSACS are given below:
General Information Orissa: 1 2 3 4 5 6 Total Area (Sq. Kms.) Total Population (2001) (a) Total Male (b) Total Female Total Urban Population (2001) Total Rural Population (2001) (a) Total Rural Male (b) Total Rural Female Population density/ sq.km Population growth rate 1991- 2001 Sex ratio females/1000 males Percentage of slum population Literacy Rate (2001) male Literacy rate female Percentage BPL Infant Mortality Rate Total hospital beds Population served per government hospital bed Per capita income of state at current prices 2003-4 155,707 36,804,660 18,660,570 18,144,090 5,517,238 (16%) 31,287,422 (84%) 15,748,972 15,538,452 236 15.94 972 11.4% 75.95 % 50.97 47.15 75 13146 2971 Rs. 12645 3

7 8 9 11 12 13 14 15 16 17 18

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19 20 21 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38

Total Scheduled Tribes Population (2001) %age to Total Rural Population Youth Population (15 to 49 years) Total Number of Villages Districts Tahsils Gram Panchayats Blocks Municipalities Notified Area Councils Medical Colleges District Headquarter Hospitals Sub Divisional Hospitals CHC I CHC II PHC Anganwadi Centers Health Workers (Male) Health Worker (Female)

8,145,081 22.13% 19,594,000 (53%) 51,349 30 171 6234 314 34 67 3 32 22 183 48 120 34,201 3,422 6,846

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General Information about HIV prevention in Orissa 2007 VCCTC total PPTCT Test 1495 2438 2579 Composite Composite 1 Migrant Posi 1 4 4 Prev 0.067 0.16 0.15 Tested 2304 2154 3853 Posi 1 8 0 Prev 0.04 0.37 0 Type of site Composite composite NGO sites TI proposed 1 FSW 2 Migrant 1 Migrant TI 2007 1 MSM,FSW 1 FSW MSM 1 FSW 1 FSW, MSM, IDU 1 FSW, MSM 1 IDU 1 IDU VCCTC DWI Posi 68 13 69 11 0 37 250 5 5 33 785 22 21 4 62 5 18 7 VCCTC DWI Posi Prev Test PPTCT Posi Prev 1.64 0.28 0.96 1.8 1957 1241 1652 1263 0 0 1 1 0 0 0.06 0.08 0.74 2333 2 0.09 712 3319 1126 250 3598 1.32 1.78 1429 1751 1 4 0.07 0.23 0 621 8.3 2817 22 0.78 7716 38 0 0 0 0 0 0 0 3.86 1753 10 0.57 883 4 0.45 0.49 0 0 0 0 0 0 0 Replacement donors in Blood Bank Tested Posi Prev TI 2007 1 FSW, MSM Composite 1 Migrant laborer 1Migr labo 1 FSW, 8 Migrant 1 FSW, MSM 1 FSW 1 FSW, MSM 0.54 0 1.78 5.78 0.58 0.31 1385 1525 1207 3492 414 2346 0 0 2 4 0 5 0 0 0.16 0.11 0 0.21 1297 246 710 7970 824 634 0 0 1 10 0 0 0 0 0.12 0.14 0 0 Prev 2.17 0.76 2.94 Replacement donors in Blood Bank

Districts Anugul Balangir Baleshwar Positive 71 29 69 24 0 40 266 7 20 82 1057 34 35 18 62 5 29 27 VCCTC total 1.64 0.28 1.02 0.98 0.57 1 1.55 7.21 3.93 0.78 0 1.76 3.23 0.46 0.63 Prev 2.09 0.73 2.94

Cat A A B

Popu 07 1253187 1469233 2225206

No ICTC 2008 5 6 4

Bargarh Baudh Bhadrak Cuttack Debagarh Dhenkanal

D C A C C D

1480057 410313 1465371 2574574 301483 1172499

3 1 3 7 1 3

Gajapati

570253

Ganjam

3450389

26

Jagatsinghapur Jajapur

C C

1162130 1785030

3 4

Jharsuguda

559922

Kalahandi Kandhamal Kendrapara Keonjhar

C D C C

1467706 712653 1431941 1717553

4 2 3 6

1 FSW, MSM

Composite NGO sites Type of site TI proposed

Districts Positive Prev

Cat

Popu 07

No of ICTC

Khordha Koraput Malkangiri 35 76 49 24 74 76 88 7 39 1.95 0.56 0.74 67 7 9 2.38 0.56 0.61 1622 926 2765 3 0 4 0.18 0 0.14 4041 744 4939 31 1 2 0.76 0.13 0.04 4.51 2.96 74 20 4.51 3.45 1065 658 0 4 0 0.6 199 131 1 0 0.5 0 0.85 11 0.62 87 0 0 195 0 0 1 FSW, MSM 1 IDU, FSW, MSM 1 FSW 1 FSW, MSM 1 FSW 2.44 83 7.16 1848 2 0.11 178 0 0 1 FSW, MSM 1.33 3.89 23 39 1.39 4.36 1710 1 0.06 2813 6 2 0 0.07 0 1 FSW, MSM 1 Migrant Composite

B B C

2061701 1295659 528218

6 4 1

147 114 19

3.85 1.74 1.04

99 32 5

3.32 2.09 0.79

4036 2021 895

6 5 2

0.15 0.25 0.22

5704 316 145

6 0 0

0.105 0 0

1 IDU, 1 FSW 1 FSW

1 MSM, 2 Migrant

Mayurbhanj Nabarangpur

C C

2443789 1119910

5 1

Nayagarh

950261

Composite Composite Composite

1 Migrant

Nuapada

583536

Puri Rayagada

C C

1648349 905257

3 4

1 FSW

Sambalpur Sonapur Sundargarh

C C C

1021706 594683 2012212

4 1 6

Composite

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HIV/AIDS SCENARIO:

In Orissa the first case of HIV was identified in 1993 in Nayagarh district. Till April, 2008 there are 9,306 nos. of people living with HIV/AIDS. Detailed year wise break up is given below: (Source: Reports received from ICT Centers) 2008 (Jan to TOTAL Apr) Counseled 4,287 6,762 22,820 54,752 131,671 368,278 119,943 708,513 Tested 2,932 4,397 5,363 17,058 56,689 172,760 67,165 326,364 HIV +ve 312 687 595 1,251 2,217 3,138 1,106 9,306 AIDS cases 209 156 186 184 149 28 46 958 Death due 74 135 160 184 114 28 46 741 to AIDS 2002 2003 2004 2005 2006 2007

Sl. Particulars No. 1 2 3 4 5

I:

ACTIVITIES UNDERTAKEN BY OSACS

Component: 1: 1.1.

Prevention of New Infection

Targeted Intervention:

Targeted Interventions are a specific set of intervention in AIDS control programme targeted towards high-risk behavior groups (HRG) i.e. Female Sex Workers (FSW), IDUs, MSM & Migrant laborers under NACP-III.

OSACS undertakes 23 Targeted Intervention projects covering 22 districts. There are 29, 975 Target Population of Highly Vulnerable groups like FSWs, MSMs, IDUs, Migrant Labourers who are being covered through TI Projects. Besides above, OSACS is in process for selection of more NGOs / CBOs and also for empanelment for all districts to cover more HRGs thorough Targeted Intervention Projects.

The main components of the TI projects are; Behaviour Change Communications, STD Treatment, Condom Promotion, Enabling environment & Community mobilization

Objective of the Targeted Interventions: 1. Provision of services to target population in order to practice safe behaviors 2. Creation of enabling environment to overcome obstacles and to support practice of safe behavior 3. Empowerment for lobby and advocacy what they need (Community mobilization).

Capacity Building of Targeted Intervention: To ensure quality of interventions, TI staffs have been trained with various components of TI mentioned above in the light of NACP-III operational guidelines by Master trainers of NACO.

1.2

IEC & Awareness:

Communication continues to be one of the most important strategies in the fight against HIV/AIDS. In the absence of a vaccine or a cure, prevention is the most effective strategy for the control of HIV/AIDS. IEC is the tool of behavior change by combined use of mass media, traditional and interpersonal media having the effect of behavior change and de-stigmatizing HIV/AIDS. In India, the majority of the population is still uninfected. It, therefore, becomes imperative to continue intensive communication efforts that will not only raise awareness levels but also bring out behavior change.

1.2.1. Electronic Media Doordarshan: The impressive rise in the levels of awareness about HIV/AIDS in the general community can be partly attributed of the electronic media which has taken this message right up to the village level, which has been developed in local languages and ethos. Docu-drama (Katha Rakhiba), interactive programme like LIVE panel discussion, Phone-In and TV awareness spots are being telecast in regular intervals in various electronic media like Doordarshan, ETV and OTV from time to time. Regional specific TV documentaries are also being produced and telecast in Doordarshan considering local specific culture and needs.

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Radio Programmes: Radio plays an important role in any development communication as it has a high reach with minimum cost. Panel Discussions, LIVE Phone Ins, radio jingles are also being broadcast to have a direct link with listeners in the stat hook up as well as regional stations like Berhampur and Jeypore. Special Interactive Programmes Mita Janitha from AIR, Berhampur and Jeypore. Radio Jingles in respective dialects (lingua franca) are also being broadcast during important listening chunks. Private FM Radio channels also play a great role in influencing youth opinion and disseminating awareness on HIV/AIDS in urban areas. Special Interactive sessions with celebrities and experts on HIV/AIDS have been broadcast in Radio Chokolate, Big 92.7 FM in the state.

1.2.2. Print Media: News Paper, Magazines, and Souvenirs etc.:

To give detailed messages, print media is the appropriate media as electronic media is costly and only bears recollect effects. To create awareness on HIV/AIDS in general public, OSACS publishes messages on HIV/AIDS during special events/occasions in the Souvenirs / Magazines / Weekly / Oriya dailies from time to time.

1.2.3. Print Media: (Posters, Leaflets, Booklets, Stickers, Danglers)

OSACS has developed Posters, Leaflets, Booklets, Exhibition Kits, Stickers, Tin sheets and Flex Banner etc to disseminate messages on HIV/AIDS for General Population and BCC materials like Flip Chart, Penis model for the High-Risk Groups (HRG) have been developed and are being disseminated. These materials are being disseminated to all service centers like ICTCs, STD Clinics, ART Centre, Community Care Centre, Drop-in-Centre including all organizations/institutions and NGOs who are undertaking awareness activities in the state.

1.2.4. Mid-Media Activities: Messages on HIV/AIDS are also being disseminated through Wall Paintings, hoardings and tin sheets. Wall paintings are being done in all the medical premises up to CHC level in the state. Permanent hoardings are also being fixed in all districts and important public places.
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1.2.6 Village/ULB level HIV/AIDS Awareness Campaign In the previous years, OSACS covered 17 districts i.e. Koraput, Rayagada, Mayurbhanj, Keonjhar, Ganjam, Khurda, Balasore, Kendrapara, Puri, Bhadrak, Gajapati, Malkanagiri, Nuapada, Nawarangpur, Cuttack , Jagatsingpur & Deogarh districts under Village/ULB level HIV/AIDS awareness activities, conducting 14,857 programs covering 14,187 villages and 67 Urban Local Bodies of 188 Blocks, 3749 Gram Panchayats. Under the programme, traditional folk media i.e Street Play, Palla, Daskathia was adopted. Meetings, Rally, distribution of IEC Materials were also done. Under the programme, we could reach an approximately 66.28 Lakhs people (both rural & urban) who witnessed the programme.

Another 4 districts i.e. Angul, Bolangir, Kalahandi & Nayagarh district have been undertaken to conduct the Village /ULB level HIV/AIDS Awareness programme. 4,304 programs in 4184 villages in 946 GPs & 12 ULBs, 4 District level Advocacy workshop & 43 Block level Advocacy workshops (Two-days) to be conducted in 43 Blocks of the above 4 districts. During last years, Special Interactive Programmes (SIP) are being conducted by Directorate of Field Publicity(DFP) and Song & drama Division the districts of Bhadrak, Bolangir, Boudh, Gajpati, Ganjam, Kalahandi, Kandhamal, Keonjhar, Malkanagiri, Mayurbhanj,

Nawarangpur, Nuapada, Puri, Sambalpur, Sundargarh, , Balasore, Khurda, Jajpur & Sonepur.

1.2.7 Observance of Events: Special Events like, World AIDS Day, Voluntary Blood Donation Day, International Womens Day and International Drug Abuse & Illicit Drug Trafficking Day Vigilance week, World Health Day, International Youth Day, National Youth Day etc. are being observed throughout the state in collaboration with line Govt. departments, agencies under the umbrella of OSACS.

1.2.8 Advocacy: Advocacy with various Govt. departments, NGO/INGO, corporate bodies, Community Based Organizations, Religious leaders, Journalists, Panchayati Raj members, Govt. Officials, Self Help Groups are being undertaken with the help of State Mainstreaming Unit.
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ICTC Campaign was launched on 16th August, 2007 in the Conference Hall of State Institute of Health and Family Welfare, Bhubaneswar for introduction of ICTC in the state.

1.3 Programs

1.3.1. Integrated Counseling Testing Centre (ICTC):

129 ICTCs have been established in the state. The ICTC provide HIV test with pre-test, post test counseling; drugs for Opportunistic Infections; free distribution of condoms; follow-up counseling for HIV+ve cases. ICTC also provides HIV test with pre-test, post test counseling to pregnant mother and HIV+ve pregnant women are advised for institutional delivery. During the delivery of HIV+ve pregnant women, counselors provide Nevirapin 200 mg capsules to the mother and Nevirapin Syrup to the new born baby within 2 hours of delivery to protect the new born from HIV infection. Delivery kits have been supplied for delivery of HIV+ve pregnant women and staffs have been advised to follow the Universal Safety Precaution.

PPTCT: In Orissa there were 32 PPTCT and in each PPTCT was manned by one female counselor and one laboratory technician. Table 3 shows the number of pregnant women tested and number of HIV positive pregnant women in all the PPTCT of Orissa has been increased but the prevalence of HIV among them has been decreased during 2005 to 2007 and it may be due to increase in number of PPTCT and increase of blood test (dilution effect) during the time period. Table 3: Comparison of number of tests performed in the PPTCT, number of pregnant women found positive and the prevalence of HIV among pregnant women in the PPTCT Orissa 2005 to 2007 Year Number of tests in Number of pregnant Prevalence of HIV among PPTCT women found HIV pregnant women in positive PPTCT 475 8 1.68 14724 41 0.27 41698 71 0.17

2005 2006 2007

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ICTC:

Earlier there were 52 Voluntary Confidential counseling & Testing Center (VCCTC) in Orissa state and manned by one male and one female counselor and one laboratory technician during 2006-07. Now during 2007 the Prevention of Parent to Child Transmission (PPTCT) and VCCTCs have been integrated and they become Integrated Counseling and Testing Center (ICTC). These are manned by one counselor and a laboratory ICTC. Because when a pregnant woman comes for antenatal check up and his husband wants to be tested then the male person is to be referred to the VCCTC. On the way there might be the chance of missing of the person. So in ICTC the counseling and testing is to be done under one roof. The ICTC 1 which is mostly situated in the outdoor they will get more client load of general population and few pregnant women and the vice versa in the ICTC 2, which is situated mostly in the Post partum Center of the hospital. Now in Orissa there are 129 ICTC since January 2007. The number of ICTC according to district has been listed on Table 9 in the Annexure 1. Table 4: Comparison of number of total clients tested in the VCCTC, total number of people found positive and the prevalence of HIV, VCCTC Orissa 2002 to 2007. Year 2002 2003 2004 2005 2006 2007 Number of clients tested total Number of test positive Prevalence in percentage for HIV 1233 112 9.08 2644 386 14.6 3835 399 10.4 17233 1270 7.37 40983 2161 5.27 101913 2623 2.57

Table 5: Comparison of number of Direct Walk in clients, number of HIV positives and prevalence of HIV, VCCTC Orissa 2002 to 2007. Year 2002 2003 2004 Number of Direct Number of Walk in clients tested positive for HIV 1782 939 2334 test Prevalence in percentage 297 101 290 16.67 10.76 12.43
6

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2005 2006 2007

11588 25036 58351

915 1462 1884

7.9 5.84 3.23

Total number of clients and the number of direct walk in clients tested in the VCCTC have been increased (Table 4, 5). The number of HIV positive people out of the total and direct walk in clients has been increased from 2002 to 2007 (Table 4,5). Prevalence of HIV among the clients attending VCCTC and the direct walk in clients show a decreasing trend. It may be due to the dilution effect (Figure 6). Figure 8 shows that the pattern of positivity in different districts since 2002 to 2007 is similar and the positivity is decreasing in all the districts in a similar fashion due to dilution factor. Figure 8 shows that during 2007 more positivity is found in southern districts and coastal districts of Orissa. In the southern part of Orissa Ganjam has the highest positivity rate of 7.2% followed by Gajpati and Nawarangpur (3.9%) and Rayagada (2.9%). In the coastal districts Puri has the highest positivity (4.5 %), Khurda (3.9%) and Cuttack (3.2%). In western Orissa Samabalpur has more positivity rate. Since 2002 to 2007 highest number of clients have been diagnosed positive were from Ganjam (2736), which is around 39% of all the HIV positive clients diagnosed in ICTC of the state of Orissa. Figure 6: Prevalence of HIV among Direct Walk in clients and total clients in VCCTC Orissa 2002-2007

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Prevalence of HIV in VCCTC (%)

18 16 14 12 10 8 6 4 2 0 "2002" "2003" "2004" Years "2005" "2006" "2007" 10.76 7.9 5.84 3.23 12.4 Total DWI 16.67

Sentinel surveillance:

During 2007, in Orissa there was the tenth round of Sentinel Surveillance. Since 1998 the number of Sentinel sites has been increased gradually till 2005. During 2006 there has been a drastic increase in the number of sentinel sites. During 2007 the trucker site and fisherman folk site were dropped because the targeted intervention project for truckers and fisherman folk was closed in the month of April 2007. The migrant laborer sites were dropped because during the pre surveillance meeting in Regional Institute it was a question mark that during the surveillance period the migrant laborers may or may not come to their home, so there will be problem to asses whether the blood samples will be collected from the migrant laborers or not. For this reason the migrant laborer sites were closed for the sentinel surveillance 2007. During the year 2007 the number of Antenatal Clinic sites were increased to 30, which were situated in the district headquarter hospitals (urban sites) and one rural site in Ganjam district which was a composite site. The composite sites were in Hinjilikatu Community Health Center with sample size of 100 and Sub divisional Hospital with sample size of 300.

Table 1: Sentinel sites of Orissa since 1998 to 2007.

Year Antenatal Clinics Sexually Transmitted Disease 4 4 4
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Female sex worker

Injecting drug users

Migrant laborers

Men sex with men

Trucker

Fisherman folk

Total

1998 1999 2000

2 2 2

6 6 6 8

2001 2002 2003 2004 2005 2006 2007

5 5 5 5 5 23

7 7 7 7 7 7 2 2 2 1 5 0 6 0 1 0

12 12 12 14 14 45 48

31 7 5 3 0 2 (301 + 12) (1: District Head quarter Hospital urban site; 2: Rural site in Ganjam doistrict) The details of the sentinel sites are in Annexure 2.

Prevalence of HIV in different sites during 2005 to 2007

Sites

2005 Test ed

ANC STD IDU MSM FSW Migrant laborers Truckers

2006 Posit % Test Posit % ive ive 9200 51 0.5 1750 41 250 NIl 500 1250 1500 26 Nil 5 18 41 2.8 10.4 Nil 1 0.4 3.2

2007 Test

Posit % ive 12529 41 0.25 36 55 36 10 1.6 7.3 7.2 0.8 Nil Nil

494 751 494 1251 Nil Nil

Figure 1: Median prevalence of HIV among pregnant women in the ANC sites, Sentinel Surveillance 2001 2006
0.6 0.5 0.4 0.3 0.25 0.2 0.1 0 "2001" "2002" 0.13 0 "2003" 0.3 0.25 0.5 0.5 R = 0.3002
2

2004"

"2005"

"2006"

2007
9

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ANC Sites: The median prevalence of HIV among the pregnant women in the ANC sites of Orissa state since 2001 to 2006 shows an increased trend (Figure 1). There are five constant antenatal sites since 2001 to 2006 in Orissa. When the median prevalence of HIV among the pregnant women in the five constant ANC sites is considered since 2001 to 2006, it is found that these are same as that of the median prevalence of HIV among pregnant women of total ANC sites during this period. When we consider the prevalence of HIV among the pregnant women in ANC sites separately for each district we could find there is a clear increase in trend in Ganjam district since 2003 and there is also another increasing trend in the Cuttack district (Figure 2). When the HSS 2006 is considered, the prevalence of HIV among pregnant women in ANC sites of Ganjam, Anugul, Bolangir and Bhadrak districts is more than one percent. In Cuttack district the sentinel surveillance from 2002 to 2006 shows an increasing trend though the prevalence has not attended one. So these five districts are matter of concern. I stratified the pregnant women with the occupation of spouse and calculated the prevalence of HIV (Table 3). In Ganjam and Nuapada district, prevalence of HIV among pregnant women whose husband is unskilled laborer is high that is 5.5 and 1.9 respectively. In Kalahandi and Mayurbhanj district, prevalence of HIV among pregnant women whose husbands are taxi or truck driver is high, that are 8.8 and 5.1 respectively and in Bhadrak and Balasore district prevalence of HIV is 2.8 and 2.5 whose husbands are service holders. So that Ganjam, Cuttack, Anugul, Bolangir, Bhadrak, Kalahandi, Mayurbhanj, Nuapada are a matter of concern and the first priority is to be given to these districts. Table 2: Prevalence of HIV among pregnant women according to the occupation of their spouse HSS 2006.
Agriculture/ Unskilled worker District Tested Truck/Taxi driver or helper Service Business

Percenta Percenta Percen HIV + ge Tested HIV + tage Tested HIV + Percentage Tested HIV + ge

Ganjam Kalahandi Boudh Kandhamal Nuapada

199 169 183 213 153

11 2 2 2 3

5.53 1.18 1.09 0.94 1.96

34

8.82

139 127

1 2

0.72 1.57

76

1 1.32 124

0.81
10

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Mayurbhanj Puri Bhadrak Balasore Keonjhar Khurda Anugul Jajpur Kendrapada Keonjhar

39

5.13 55 35 40 53 1 1 1 1 1.82 2.86 138 2.50 1.89 128 106 106 159 157 2 1.45

2 1 1 1 1

1.56 0.94 0.94 0.63 0.64

STD site: When the STD clinic attendees are considered the median prevalence of HIV in the Orissa state shows increasing trend and then a decreasing trend since 2001 to 2007 (Figure 4). When the districts are separated it is found that, Ganjam, Balasore, Koraput, Khurda, Puri and Cuttack shows an increasing trend (Figure 5). Figure 4: Median prevalence of HIV among the STD clinic attendees, Orissa HSS 2001 to 2006.
10 8 6 4 2
0.8 0.8 All districts 2001 2002 2003 2004 2005 2006 2007 Poly. (All districts) 2.4 2.8 4
2 y 2.8= -0.225x + 2.075x - 1.6429 2 R = 0.7586 1.5

Prevalence of HIV (%)

Years

Figure:5 Prevalence of HIV among STD clinic attendees MKCG Medical College Berhampur Ganjam and District Headquarter Hospital Koraput since 2001 to 2007

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11

8 7 Prevalence of HIV (%) 6 5 4 3 2 1 1.2 0.4 2002 2003 2004 Years 2005 2006 2007
3.2 4.8 4
2

6.8 y = -0.3095x2 + 2.7762x - 2.3429 R = 0.6248

5.2

5.2

4
3.6

3.2 2.4
y =- 0.2381x 2 + 1.5333x + 2.8 R2 =0.53

M KCG, M C Berhempur
1.6 1.6

DHH Koraput

0 2001

Poly. (M KCG, M C Berhempur) Poly. (DHH Koraput)

Inference from Sentinel Surveillance: Ganjam, Anugul, Bolangir, Bhadrak, Balasore, Khurda. Koraput, Kalahandi, Mayurbhanj, Nuapada districts are of primary importance. Categorization of districts according to Sentinel Surveillance 2006:
Criteria 1 More than 1 % ANC/PPTCT prevalence in district in any time in any of the sites in the last 3 years Less than 1 % ANC/PPTCT prevalence in all the sites during last 3 years associated with More than 5% prevalence in any HRG group (STD/CSW/MSM/IDU Less than 1% in ANC prevalence in all sites during last 3 yars with less than 5% in all STD clinic attendees or any HRG with known hot spots (Migrant, Truckers, large aggregation of factory workers, tourist etc.) Less than 1 % in ANC prevalence in all sites during last 3 years with less than 5% in all STD clinic attendees or any HRG OR no or poor HIV data with no known hot spots/unknown Category A Districts Ganjam, Anugul, Bhadrak, Bolangir

Khurda, Balasore, Koraput

Cuttack, Puri, Deogarh, Jajpur, Jagatsinghpur, Kendrapara, Keonjhar, Mayurbhanja, Nawarangapur, Nayagarh, Sambalpur, Sundergarh, Nuapada, Raygada, Baud, Malkangiri, Sonepur, Kalahandi Dhenkanal, Jharsuguda, Kandhamal, Gajapati, Baragarh

1.6

Blood Safety:

To provide safe blood and blood products OSACS supports financial grants to 53 Blood Banks (1 Govt., 50- Red Cross, 1- Charitable, 1- Public Sector -Paradeep Port Trust) and HIV & HCV Kits are provided to 54 Blood Banks (1 Govt., 50- Red Cross, 1- Charitable,
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12

2- Public Sector -Paradeep Port Trust, and Ispat Genral Hospital, Rourkela) out of 76 licensed Blood Banks in the state including 53 Red Cross, 1 Govt., 8 Public Sector Undertaking, 1 Charitable and 13 Private Blood Banks. OSACS provides annual grants to 56 Blood Banks in 27 districts out of 73 licensed Blood Banks. There is only one blood component separation unit in the State i.e. in Central Red Cross Blood Bank. Voluntary collection has increased from 26,291 in 2002 to 1, 11,772 in 2006. But there is a reduction in replacement blood donation, which has decreased to 76,858 during 2005 from 1, 19,341 during 2002.

Five more Blood Component Separation Units (BCSU) are proposed to be established along with 157 Blood Storage Units (BSU) in equal number of First Referral Units (FRU). Capacity building of programme staff for Medicine, Surgery, O&G & Paediatrics dealing with blood & blood components need to be strengthened. Percentage of voluntary blood donation and the percentage of blood units collected from camps in different districts
Districts Percentage of Voluntary Blood donation 79 66 58 75 69 76 80 39 71 64 60 100 27 84 33 67 60 41 65 77 83 53 98 93 Blood units from camp Blood units from camp and Blood bank 16528 8512 12521 6630 899 4388 54510 1659 2814 2579 24236 44 919 5319 6188 3940 887 7284 31546 3311 930 7548 1057 3373 Percentage of Blood units collected from camps

Anugul Balangir Baleshwar Bargarh Baudh Bhadrak Cuttack Debagarh Dhenkanal Gajapati Ganjam Jagatsinghapur Jajapur Jharsuguda Kalahandi Kandhamal Kendrapara Kendujhar Khordha Koraput Malkangiri Mayurbhanj Nawarangpur Nayagarh

4693 879 2780 572 113 1170 10738 25 504 47 3481 0 66 342 41 473 245 633 8504 407 63 1227 52 598

28 10 22 9 13 27 20 2 18 2 14 0 7 6 1 12 28 9 27 12 7 16 5 18 13

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Nuapada Puri Rayagada Sambalpur Sonapur Sundargarh Total

91 91 81 74 56 30

0 492 119 1511 199 230 40204

2195 3046 861 18339 2057 9509 243629

0 16 14 8 10 2 17

Table 6: Number of blood units collected by voluntary and replacement blood donation and number of blood units screened positive for HIV, Orissa 2002 to 2007 Year Voluntary Blood Donation Replacement Blood Donation Number of Screened Prevalen Number of Screened Prevalence Blood units as HIV ce HIV blood units as HIV HIV collected positive collected positive 2002 20782 19 0.09 90468 99 0.11 2003 25385 9 0.04 59493 95 0.16 2004 44423 25 0.06 86017 150 0.17 2005 83260 67 0.08 70047 114 0.16 2006 105018 80 0.08 73674 111 0.15 2007 116362 72 0.06 57628 105 0.18 Figure: 7 Prevalence of HIV among Voluntary and Replacement donors Blood banks Orissa 2002 to 2007
0.2 Prevalence of HIV (%) 0.18 0.16 0.14 0.12 0.1 0.08 0.06 0.04 0.02 0 "2002" "2003" "2004" "2005" "2006" "2007" Years 0.16 0.17 0.18 0.16 0.15

0.11 0.09 0.06 0.04 Prevalence HIV voluntary donors Prevalence HIV Replacement donors 0.08 0.08 0.06

Number of voluntary donation has been increased and the number of replacement blood donation has been decreased from the year 2002 to 2007 though the total number of blood unit collection has been increased (Table 6, Figure 7).

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Prevalence of HIV among voluntary donors has been remained static and among the replacement blood donors shows an increasing trend from the year 2002 to 2007 (Table 6, Figure 7). Figure 9 shows that the prevalence of HIV among replacement donors of Ganjam, Gajapati, Koraput, Rayagada district in the south and Puri, Khurda, Cuttack, Kenonjhar in coastal and north, Bolangir and Sambalpur is high and they have an increasing trend. Figure 8: Prevalence of the five diseases screened in the blood banks Orissa 2007

Malaria

VDRL

Diseases

Hep C

Hep B
Prevalence total

HIV
Prevalence replacement donor Prevalence voluntary donor

0.1

0.2

0.3

0.4

0.5

0.6

0.7

Prevalence

Figure 9: Prevalence of HIV among the replacement donors in the Blood Bank of different districts Orissa 2002-2007
1 0.9
Anugul

0.8 0.7 Prevalence (%) 0.6 0.5 0.4 0.3 0.2 0.1 0 "2002" "2003" "2004" Years "2005" "2006" "2007"

Balangir Baleshwar Bhadrak Cut tack Gajapati Ganjam Kalahandi KANDHAM AL Kendrapara Kendujhar Khordha Puri Rayagada Sambalpur

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Sonapur Sundargarh

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HIV, VDRL, Hepatitis B, C and Malaria are the five diseases are screened in the Blood bank. When we take the prevalence of all the diseases the prevalence of HIV, HBV, HCV and VDRL are more or less same but the prevalence of Hepatitis B is five times that of the prevalence of HIV. So that during any surgical intervention the surgeons should use universal safety precaution rather than doing the HIV test prior to surgery.

1.3.2. Tele-Counseling Centre / Helpline:

A National AIDS Help Line (Non-Metered 1800 3456 778) is operational in Orissa State AIDS Control Society, Bhubaneswar and in 3 Medical Colleges for tele-counseling on HIV/AIDS and STD. Total of 24,479 calls (Till April, 2008) have been received and the queries are about HIV/AIDS, Testing, Sexuality, Support, Myths and Misconceptions, Condoms and other Personal Queries.

Year 2003 2004 2005

Nos. of Telecounseling 1437 5138 6539

Total (2003 to April -2008)

Year 2006 2007 2008 (Till April 2008)

Nos. of Telecounseling 6114 4362 889

24,479

1.4.

Sexually Transmitted Diseases (STD) Clinics:

Sexually Transmitted Infections (STI) / Reproductive Tract Diseases (RTI), especially those characterized by open sores and discharge, increase the risk of HIV transmission by ten times. Quality management of STI/ RTI serves as a valuable entry point for organizing prevention programme for HIV/AIDS. Facilities for free treatment of STI & RTI are available in the STD Clinics. STD Drugs like: Gama Benzene Hexa Chloride, 100ml. Bottle; Veginal Gel 30gm. Tube; Tab. Metronidazole 400 mg; Cotrimazole Passaries 500mg; Cap. Doxycycline 100mg; Tab. Norfloxacine 400mg ; Tab. Fluconazole 150mg ; Tab. Acyclovir 200mg ; Tab. Erythromycin 500mg are provided free of cost to STD patients. Free distribution of Condoms and partner treatment is also done in STD Clinics.
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At present there are 34 STD clinics in the state. They are located in S.C.B. Medical College, Cuttack; VSS Medical College, Burla and MKCG Medical College, Berhampur; ESI Hospital, Khurda and in 30 DHHs. The number of RTI/STI patients attending STD Clinics has gone up to 39,097 in 2006 from 16,847 in 2002. All Medical Officers and Para-medical staffs have been trained on Syndromic Management as part of institutional strengthening of STI Clinics; drugs and other consumables have been provided to the Clinics. STD Clinics are operating at district level and services are inaccessible to the rural and tribal population of Orissa. The people with symptoms of STI/RTI in rural areas dont have access to STD treatment which are currently available only at DHH level. So it is proposed to extend the STD services up to Block CHC/Block PHC level. More satellite clinics needs to be established and the static clinic operating at TI level is to be placed in more accessible locations so as to increase the number of attendees. In 34 STD Clinic there was attendance of 2, 32,961 patients and out of them 1, 36,490 persons were treated till April, 2008. 2008 (Jan Apr) 8,322 3,104

Sl. No. 1 2

Particulars No. of Patients attended No. of Patients treated

2002 16,847 16,847

2003 28,767 28,767

2004

2005

2006 39,097 15,427

2007 30,397 15,498

Total 232,961 136,490

50,965 58,566 22,273 34,574

Condom Promotion:

Among the probable sources of HIV transmission in our country, heterosexual promiscuity constitutes the major route. The most successful and practical way to prevent the transmission is the use of condoms according to experience from all over the world and in India. Condoms are not only affordable but also user friendly and an effective possible way to protect further transmission of HIV. The continuous intervention and efforts of OSACS through different agencies in condom promotional activities during the year has increased the utility of condom in the State.
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The social marketing of condoms is done through Partner NGOs & other three agencies i.e. Population Services International (PSI), Orissa (an international NGO) & Hindustan Latex Family Planning Promotion Trust (HLFPPT), Orissa & Parivar Seva Sanstha, Orissa, Bhubaneswar. Along with these the free distribution of condoms also done by OSACS through ICTCs, ART Centers, STD Clinics, TI and Non TI partner NGOs as well as through other agencies.

The promotional programmes undertaken by the Partner NGOs (implementing Targeted Intervention Programmes) in all districts of Orissa for creating awareness among the target population for increasing the usage of condom in high risk groups and general population.

Three Condom Vending Machines (CVMs) have been installed in Capital Hospital, Bhubaneswar, Badambadi area of Cuttack and in City Hospital, Berhampur for easy access of condoms for high risk groups on pilot basis.

In Association with HLFPPT and OXFAM:

For the first time Female Condoms for Social Marketing have been launched on 16.03.07 at Malisahi, Bhubaneswar The CSW site for HIV/AIDS prevention programme, which is a measure step forward for empowering women to play effective role in HIV Prevention in the state. Peer Educators of PNGO (implementing TI Projects) CBO of Malisahi, Bhubaneswar were trained on Female Condom Programme at Puri which enables them to generate awareness in the community level.

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Behavioral Survey (BSS): Sex with non regular partners within 12 months is 5.5% in 2006, it is less but it has been increased; condom use with last non regular partners has increased to 38% and it is less. Easy availability of condom in the area has decreased to 81.5%, which should be more than 90%. When the IPC and correct knowledge about HIV and transmission was considered it was found that the receipt of IPC within last 12 months was 18.7 and correct knowledge about HIV and transmission was 16.3 which is very less and inadequate.

High risk Group Population in Orissa: Table 8 shows the enumerated HRG population by ORG Marg during 2004 and Community need assessment by the NGO partners. It shows that there is different mode of transmission of HIV in different districts of Orissa. In Anugul district there is a lot of MSM population in the town ship as well as nearby villages within three to five kilometer radius. (Enumeration by State Epidemiologist Orissa state) There is IDU and MSM population in Puri district. There is a lot of migrant laborers in the Ganjam, Balasore and Nuapada district according to ORG Marg study and also the secretary laborer commission. In Bolangir and Titilagarh town number of MSM population is 400 according to enumeration by the TI partner with the officers of Orissa SACS In Baragarh the IDU population is more than 300 according to enumeration of TI partner and officers of Orissa SACS and it has become a sentinel site in the sentinel surveillance 2007. During 2007, FSW sites have been opened in Bhubaneswar, Khurda district, Balasore, in a scheduled tribe population of a mining area in Jajpur district, Rayagada district, an industrial area of Sundergarh district. During 2007, IDU sites have been opened in Puri, Baragarh district, MSM sites in Anugul district and Bolangir district.

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1.7.

External Quality Assurance: (EQAS)

In order to maintain the quality of the laboratory services being provided through ICTC and Blood Banks, EQAS is followed. In Orissa there are three State Reference Laboratories (SRL) namely, the Microbiology departments of SCB Medical College, Cuttack; MKCG Medical College, Berhampur, Ganjam and VSS Medical College of Burla, Sambalpur. The SRL supply samples of unknown sera twice a year to cross check the HIV tests performed in the ICTC and Blood Banks. HIV Testing Centers also send 20% HIV+ve samples, all indeterminate samples and 5% of all HIV_ve samples to the corresponding SRL as part of EQAS.

1.8

Mainstreaming:

HIV/AIDS is not a health issue alone the causes and impact are multi-sectoral therefore the interventions for preventing spread of the virus need coordinated efforts by various sectors and departments. The focus of all organizations in mainstreaming is to adapt their core areas of work to respond to the challenges of HIV/AIDS.

Mainstreaming is usually understood as a process whereby an organization analyses how HIV/AIDS can impact it now and in the future, and subsequently considers how policies, decisions and actions may influence the longer term development of the epidemic.

The HIV/AIDS Mainstreaming Project under NACP III is a key initiative taken up with UNDP support for mainstreaming of HIV/AIDS into the ongoing policies, programmes and activities of relevant government departments, private sector and civil society organizations including through involvement of networks of positive people.

The project covers 25 districts in 5 states (Orissa, Bihar, Chhatisgarh, Rajasthan & Uttar Pradesh). A State Mainstreaming Unit (SMU) has been set up in Orissa since August 2007 to coordinate activities of the project.

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The underlying principles of GIPA (Greater Involvement of Persons Living with HIV/AIDS) and gender equity are cross-cutting in all mainstreaming initiatives.

A State level Council on AIDS presided by Honble Minister, Health and Family Welfare, has been established to give policy direction and guidance to efforts of various Departments in the context of HIV prevention and Control. The first meeting was held on 31st October 2007 attended by Secretaries and other senior officials of the Govt.

Mainstreaming in Government sector:

In Orissa following Departments are being taken up on a priority basis Women and Child Development, Panchayati Raj, Housing and Urban Development, Home, Rural

Development, ST and SC and Minorities Development, Tourism, Higher Education, School and Mass Education, Youth and Sports Affairs, Labour, Industries and Steel and Mines. A State level Steering Committee has been formed to review the activities of Mainstreaming on a quarterly basis. Information and Counselling stalls were set up in partnership with the ST and SC Development Department and the Panchayati Raj Department, respectively, at the state level Adivasi Mela and the Sisir Sara mela in Bhubaneswar in December 2007 and January 2008. Training of Anganwadi workers, ASHAs and ANMs (Auxilliary Nurse midwife) has started in the district of Ganjam by trained CDPOs, Block Extension Educators and trainers of ICDS programme. The Labour and Employment Department, Govt of Orissa, has made an amendment to the Orissa Motor Transport Workers Rules, wherein clauses related to HIV related stigma and discrimination, health care benefits, work rights and redundancy issues and awareness for motor transport workers have been included.

Mainstreaming in Corporate Sector: Worldwide, industry is losing a huge chunk of its productive workforce to HIV unless we take positive steps to mitigate it now, Orissa could be losing out a significant portion of its workforce to HIV.
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Orissa has a rapidly growing services sector while we address the traditional industries like mineral and agro-based industries, there certainly needs to be a focus on the service sector. A consultation was held in November 2007 where heads of major private and public sector undertakings and federations of Indian industry (CII, UCCI) participated. As an outcome of the meeting, Confederation of Indian Industry (CII) has agreed to partner with OSACS in setting up a corporate Anti-RetroViral centre in the state in 2008.

With the rapid industrialization foreseen for the state in the coming years, corporate sector HIV mainstreaming would need significant strengthening, if we are to consolidate the development gains from industrialization without HIV/AIDS affecting industry negatively. A meeting with Trade unions was held on 16th April 2008 in collaboration with Hindustan Latex Family Planning Promotion Trust (HLFPPT) and OXFAM, wherein all the major central trade Unions committed themselves to HIV prevention and Control.

Mainstreaming in Civil Society:

The focus of Mainstreaming in civil society is to encourage community development which takes into account the causes and impact of the HIV epidemic.

A coordination meeting for Greater Involvement of People living with HIV/AIDS was organized. To mainstream HIV/AIDS in Civil Society Sector, two workshops were conducted involving NGOs working in development sector other than the Health sector, NRHM partners in RCH II Project in category A & B districts of the state were involved. The main objectives of the workshop were to discuss & develop a specific strategy and related coordinated mechanism among all the organizations /agencies working in the Civil Society.

The SMU will focus its activities at the state level as well as in six high prevalence districts (Ganjam, Balasore, Bhadrak, Khurda, Angul and Bolangir) for Mainstreaming of HIV/AIDS.

1.8.1. Partnerships:

Interagency Collaboration
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A donor coordination steering Committee has been set up at OSACS in 2008, which aims at institutionalizing the coordination mechanism between OSACS and donor agencies/ development partners working in the state on HIV/AIDS.

OSACS has partnered with all funding agencies both international & national operating in the state like UNICEF, UNDP, DFID, OXFAM, HLFPPT, Lepra Society, CONCERN World Wide, KIIT Deemed University, Population Services International, Parivar Seva Sanstha, Action Aid, Satyam Foundation, Orissa AIDS Solidarity Forum, etc. have come together into one platform and determined to fight against HIV/AIDS in an intensive manner in the arena of PREVENTION, CARE, SUPPORT & TREATMENT on HIV/AIDS.

Collaboration with SATYAM Foundation

In the collaboration with SATYAMs Social Wing at their Bhubaneswar site, OSACS developed some of the IEC Materials to create awareness among the youth & general public. Satyam in its endeavor proposed to conduct sensitization workshops/ meeting in all the Management Colleges / Institutes, IT Development sectors of the state. The International AIDS Candle light Memorial Day observed on 16.05.08 at 6.00 PM at Satyam Computer Services Ltd. S-1, Maitree Vihar, Chandrasekharpur, Bhubaneswar in collaboration with Satyam Foundation. The main objective of the campaign is to honour all those who have been affected by the HIV/AIDS pandemic. About 500 people gathered from various sectors (NGO, CBO, INP+, OSACS, Corporate Sector). The agency has also supported OSACS in developing its website.

Collaboration with UNDP India:

Apart from the ongoing UNDP supported mainstreaming project, OSACS has partnered with UNDP on a source-destination Migration project. OSACS has helped development of Identity Card -cum-Information Pocket Booklet to be distributed among migrant labourers of Ganjam who migrate specifically to Gujarat.
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For the first time in Orissa, a Photography training of Commercial Sex Workers (CSW) was conducted to give them additional livelihood/ vocational options and to enhance their self esteem and confidence.

UNDP has also launched the Leadership and Managerial Proficiency (LAMP) programme along with Xavier Institute of Mangement, Bhubaneswar to build leadership skills and managerial capacities among PLHAs across the country, in an endeavour to strengthen networks of positive persons.

Collaboration with OXFAM:

For the first time to finalize workplace intervention strategies a workshop was organized with the participation of industrial houses , UN Agencies, Education institutions, NGOs etc. Orissa is the first low prevalent state in the country to have this kind of workshop organized.

OSACS trained to the HIV/AIDS Counselors in two batches through the experts of most prestigious institute of the Country i.e. TISS, Mumbai.

As a result of collaboration OXFAM has provided kits and Drugs as and when required by OSACS.

Collaboration with UNICEF:

For the first time in Orissa, UNICEF has approved its annual action plan for conducting the HIV/AIDS prevention programme with a total budget of 150000 USD on dated 29.12.06.

District level training programme for the PPTCT Teams i.e., Medical Officer, O & G deptt. Micro-biology deptt. & Pediatrics deptt., Staff Nurse & HIV/AIDS Counselor of all districts have been conducted by OSACS.

As a result of inter-sectoral collaboration, UNICEF has agreed to provide kits and drugs for PPTCT Centres of Orissa.
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IEC information catalogue on HIV/AIDS has been developed with support of UNICEF containing various IEC materials developed (both print & electronic) by the agencies till date. This will help in developing the IEC strategy for the state on HIV/AIDS

UNICEF has agreed to set up a PPTCT unit within OSACS in early 2008.

Indian Oil Corporation has organized sensitation workshops on HIV/AIDS for Truckers for which, OSACS gives technical support including IEC materials.

Collaboration with Clinton Foundation:

Training programme for Private Doctors has been completed for 333 Private Doctors in five districts i.e. Ganjam (Berhampur), Sambalpur (Rourkela), Bhadrak, Dhenkanal, Cuttack, Jajpur Road (Cuttack) & Puri and has planned to take up training programme on HIV/ AIDS in other districts like Koraput, Rayagada, Jagatsinghpur, Kalahandi, Sambalpur, Sundargarh & Mayurbhanj.

CD4 Testing of Blood of People Living with HIV/AIDS (PLHA) and Child Living With HIV/AIDS (CLHA) of the state was conducted in 17 sites during the month of December, 2007, thorugh a partnership with Clinton Foundation and its partner, Ranbaxy Laboratories Limited. A larger plan of action is being launched soon for the state by Clinton Foundation.

Collaboration with Orissa State Road Project (OSRP):

The Orissa State Road Project (OSRP) functioning under Works department has planned to implement the HIV/AIDS prevention Programme in 906 kilometers on State Highway Nos. 4, 5, 6, 7, 9, 9A, 16, 17, 18, 19, 37, 49 and 53 for which technical supports from OSACS will be given by way of helping OSRP in designing its PIP, Programme strategy for the project in a comprehensive manner so that overlapping of activities on HIV/AIDS could be avoided with the HIV/AIDS prevention programme implemented by OSACS.
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1.8.2.

Adolescence Education Programme (AEP):

Under Adolescence Education Programme, during the financial year 2005- 06 OSACS had covered 2390 No. of Schools in ten districts (Angul, Balasore, Bolangir, Gajpati, Ganjam, Kendrapada, Khurda, Koraput, Puri & Sundargarh).

During the year 2006 07; as per decision of National AIDS Control Organization, MHRD, NCERT, New Delhi the School Adolescence Education Programme has been undertaken by Department of School & Mass Education of the State with a view to cover all the Government Secondary & Higher Secondary Schools (+2 Colleges); which includes formation of Red Ribbon Clubs (RRCs) in the Educational institutions. In the first phase, teachers and peer educators of all Govt. High Schools have been trained and funds have been placed for carrying out Red Ribbon Activities. A National Review Meeting (Annual

Planning Meeting of AEP & NPEP) of the Programme for Orissa and other 8 states was held in Bangalore from 3rd -6th July, 2007 to decide further course of action and strategy to be adopted. During this year NACO has approved to conduct the AEP in 1824 Schools indicating that, the refresher training programme, Monitoring & Evaluation & Red Ribbon Club Activities are to be conducted during this financial year 2007-08.

1.8.3. College /University Talk AIDS:

Indian Red Cross Society, Orissa State Branch, has been funded by OSACS for conducting the Red Ribbon Club Activities under University Talk AIDS in degree colleges & universities. Till October, 2007; 295 Colleges have been funded @ Rs.5, 000/- each with a guidelines to carry out Red Ribbon Club activities in the college by the youths.

1.8.4. Health NGOs, Development CBOs & PRIs:

Training of 240 staff of health NGO (RCH Mother NGO) in 7 batches has been imparted by OSACS.

1.8.5. OSACS participated in formulation the Advocacy Strategy for sensitizing different Target Audience like, PRI Members, Media Representatives, Health Service providers,
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Representatives of SHGs, Members of Rogi Kalyan Samiti & Village Health & Sanitation Mission, ASHA/ANM/AWW, Civil Society, for advocacy activities under NRHM during April, 2007.

Component: 2:

CARE & SUPPORT

2.1.

Opportunistic Infection Management & PEP

People Living With HIV/AIDS (PLWHA) are prone to different Opportunistic Infections like TB, Diarrhea, Cough, Fever and other malignancies. Medicines for such opportunistic infections are available in all the hospitals and given to the patient free of cost. As per the decision of the state government patients are allowed to reimburse up to Rs.2, 000/- for medicines prescribed by Doctors beyond the free available medicines per course of treatment of the disease per person. Anti-retroviral Medicines are provided to each District Head Quarter Hospital & Medical Colleges for Post Exposure Prophylaxis. 3 types of Antiretroviral Drugs are supplied for course of 4 weeks (28 days).

2.2

Community Care Centers:

OSACS has established four Community Care Centers (CCC) in the state through NGOs like OVHA in Bhubaneswar of Khurda district, USS at district head quarter at Cuttack, TSRDS at Berhampur, Ganjam district and Lepra Society in district head quarter Koraput district.

The Community Care Centers provide care to the People Living with HIV/AIDS in the State. PLHAs receive treatment for opportunistic infections, nutrition, counseling and care in these centres. The NGO takes up the treatment and care of 10 PLHA for a period of maximum 15 days. After 15 days the committee (Project Dirctor, Clinic Doctor, NGO member) decide on whether to extend the patients stay or not.

During 2007 -08 (Till September, 2007):

687 PLHA have been registered in four

Community Care Centers, and 476 have been treated for opportunistic infection. OSACS has rehabilitated to 3 PLHAs; one at the Stitching Centre at Rourkela & another two (Mother &
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baby) are staying at the destitute home of HOINA LEPRA SOCIETY at Muniguda of Rayagada district for vocational training.

Component: 3.

TREATMENT

Anti Retroviral Treatment (ART) Centre: One Anti Retroviral Treatment (ART) Centre is functional at MKCG Medical College, Berhampur from 26/9/06. Drugs for AIDS patients are available in the ART centre. There are 1,414 no of patients ever treated till April, 2008. Apart from ART, drugs for Opportunistic Infections and condoms are available in the ART center. Three more ART centers would be functional in 2008 one in SCB Medical College, Cuttack, second in VSS Medical College, Burla and third in Koraput.

It has been proposed that persons coming to the ART centres for antiretroviral treatment as well as CD4 testing would be reimbursed their travel costs, since it has been observed that a number of cases are lost to follow up due to lack of funds to travel to the ART centre.

Component: 4.

INSTITUTIONAL STRENGTHENING

Under Training component, during the year 2006 07, 6,819 participants of different categories have been trained that includes Medical Officers, Blood Bank Officers, Counselors, Bus Owners Association, CRPF Personnel, HIV+ve People, NGO/CBO, NSS Team, PRI Members / Dist. Health Officials, Private Practitioner, Staff Nurse, Laboratory Technicians, Leaders of Disabled persons and STS & STLS and Laboratory Technicians and Beauty Parlor people, Ayurvedic Medical Officers etc. Training programme on HIV/AIDS for District Program Manager of National Rural Health Mission, Block Extension Educator, CDPO, Deputy MEIO, FNGO, Mother NGO, Partner NGO of 10 districts have been completed through State Institute of Health & Family Welfare, Orissa, Bhubaneswar. Capital Hospital Bhubaneswar has been declared by NACO as Regional Training Center for Training of Blood Bank staffs.
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During the year 2007-08 (Till October, 2007): There are 2,215 Medical Officers, Staff Nurse, Laboratory Technicians, Pharmacists, Counselors, Deputy MEIO of 30 districts, District Nodal Officers (AIDS), NGO, CBO etc. have been trained. Apart from that, 239 Ayurvedic Medical Officers of 12 districts (Keonjhar, Mayurbhanj, Bhadrak, Balaosre, Dhenkanal, Angul, Bargarh, Sambalpur, Deogarh, Nuapada, Jharsuguda & Sundargarh) have been trained on HIV/AIDS. 435 Govt. Medical Officers & Private practitioners have been trained on ART, STD, and STI/RTI in 13 batches covering 25 districts of the state in collaboration with OXFAM India Trust, New Delhi. In collaboration with UNICEF; OSACS has been conducting 5-days PPTCT Training programme on HIV/AIDS for the ICTC Team (Medical Officer I/C, O& G Specialist, Female Counsellor & LT of ICTC, Labour room Staff Nurse of O& G deptt.) of the DHH, SDH, / Area Hospital & CHC etc. of 29 ICTCs. Full site sensitization workshop on HIV/AIDS has been conducted for the Medical Officers, Staff Nurse, Pharmacist, LT, Counselors of DHH, SDH, Area Hospital and CHC level of 3 Medical Colleges & 7 high prevalent districts of state.

As per the direction of NACO, 12-days training programme on HIV/AIDS for ICTC Counsellors is taken up by OSACS at Jayprakash Institute of Social Change, Kolkata. The training programme of the counselors is scheduled to be completed by January, 2008. 22 Laboratory Technicians of OSACS working with Blood Banks have been trained on HIV testing policy at VSS Medical College, Burla, Sambalpur (INDUCTION TRAINING OF LTs).

III.

Memorandum of Understanding with Gujarat SACS:

In Orissa, the districts having higher rates of migration is Ganjam and many peoples have migrated to Surat & Alang of Gujarat to work in Textile Mills, the diamond cutting industry and Shipyards without adequate knowledge on the availability of health care facilities at destination sites and their other entitlements for which they are unable to have access to proper health care facilities available and are exposed to hazards and exploitation at their workplaces. Considering the above-mentioned issues a Memorandum of understanding has been signed between Gujarat SACS and Orissa SACS for a period of five years i.e. from
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January, 2007 to January 2011. UNDP has set up 14 ICT Kiosks in various high migration blocks in Ganjam and also near the Berhampur railway station. UNDP has also set up 5 ICT Kiosks of 5 blocks of Nayagarh district, with the specific purpose for developing and disseminating information on HIV/AIDS and other facilities related to HIV/AIDS using multimedia films at the ICT Centre to migrants, women self help groups and PRI members through Community level workshops. UNDP has also agreed to set up similar kiosks in Surat and Alang. It is also agreed by both the SACS there would be intermittent joint reviews on filed visit at places of Oriya Migrant concentrations in Gujarat on the implementation of activities under MoU at least once in 6 months and during the first month of the succeeding year, there would be a joint annual review by OSACS and GSACS on implementation of MoU for modification if any.

In Collaboration with UNDP; ICT Kiosks (Help-Desks) has also been established at Berhampur and Balugaon Railway stations where, the pre-departure information as well as counseling on HIV/AIDS and distribution of IEC Materials to be provided to the outmigrants.

IV. Letter of Undertaking

A letter of undertaking has been signed between NACO, Project Director Orissa State AIDS Control Society & Govt. of Orissa vide letter no. 5061 dated 10.09.07. For effective implementation of World Bank Fund during NACP III. This has been effective for NACP III (2007 2012).

V. FINANCE: The approved annual action plan for the financial year 2007-08 is given in Annexure 2

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