Tamil Nadu State AIDS Control Society

Goals and Objectives

Objective 1:

Reduce new infections by 50% (2007 Baseline of NACP III)

Objective 2:

Comprehensive care, support and treatment to all persons living with HIV/AIDS

[SDG – Sustainable Development Goal]

Towards ending the epidemic of AIDS by 2030

TANSACS, since its establishment from the year 1993, has pioneered many successful projects through its innovative approaches and joint partnerships with various stake holders. Over the years TANSACS has successfully reduced the prevalence of HIV in the state [0.83 in 2003, 0.35 in 2008 and 0.27 in 2015 among antenatal mothers which is a proxy indicator for general population prevalence] and this was possible because of the tremendous support provided by both State and Central Governments. The OVC Trust for Orphan and Vulnerable Children, Transgender Welfare Society, are standing examples for the commitment from the state government in this regard.

To further march towards the national goal of zero new infections, zero stigma and zero HIV related deaths, TANSACS has come out with a series of innovative initiatives in the last one year, like 1) Development of a mobile app to bridge awareness with access to services, 2) User-friendly cost effective real-time supply chain management system, 3) Bio-metric centralized patient monitoring system at Anti-Retroviral Treatment centres to enhance access to treatment across the state for People Living with HIV [abstract on this was accepted for poster presentation in the recently held international AIDS conference-2016 at Durban, S. Africa], 4) Usage of a popular FM radio for awareness, 5) Pilot initiative for saturated service provision in block levels.

TANSACS has already started working in alignment to the ambitious goal “90-90-90” — set by the Joint United Nations Programme on HIV/AIDS (UNAIDS) — to have 90 percent of the population screened, 90 percent identified with HIV are put on treatment and 90 percent viral suppression among the PLHIV who are on treatment by 2020.

HIV is transmitted in 4 modes and they are a) Parent to Child, b) Sexual route, c) sharing of injecting equipment d) contaminated blood transfusion. TANSACS has been addressing all these in a fast track mode.

PPTCT (Prevention of Parent to Child) mode of transmission

The HIV prevalence among the Ante-natal mothers has been reduced over the period of years in Tamilnadu (from 0.83 % in 2003 to 0.27% in 2015) and we have also achieved ‘zero’ new infection among Ante-natal mothers in some of the districts of our state, which is very significant in marching towards ensuring ‘zero’ transmission in this PPTCT route in the near future.

The activities to achieve zero transmission through PPTCT are:

a) Ensuring all the pregnant mothers (100%) are provided with counselling and testing services. The birth rate of Tamilnadu is 15.6 and we may have 11,23,200 ante-natal mothers in a year. To ensure all these 11. 2 lac mothers are provided with counselling and testing services; we need to scale up the number of testing service centres both in public and private health facilities.

b) The notification of ‘HIV’ identified among ante-natal mothers, to the respective district health units by all private labs and private hospitals should be made mandatory and strictly monitored so as to provide allied care, support and treatment services to the positive mother and prevention services to the new-born child.

c) Stringent monitoring of follow-up services provided to the positive mothers and the new-borns at field level.

d) The private sector participation in eradicating the Parent to child mode of transmission also needs to be widely expanded.

e) Ensuring 100% partner / spouse testing at all testing centres in the state.

Sexual mode of transmission

Sexual mode of transmission is the highest mode of transmission and it accounts for more than 85% of the HIV infection. Safe sex practice is the only way to prevent transmission of HIV through this mode. Consistent correct usage of condoms is the best way to prevent HIV transmission. Sexual route of HIV transmission happens through, heterosexual, homo-sexual, penile-oral sex, anal intercourse.

TANSACS is presently providing prevention to care continuum services to 43,500 female sex workers, 32,000 men who have sex with men and 3,700 transgender who have been registered with the 74 targeted intervention projects and 15 Link workers projects in the state. 22.5 lakh condoms per month as per the demand is also regularly supplied and the incidence among these high risk group has significantly reduced and we are well below the national average of the HIV prevalence among the HRGs.

Activities to achieve zero incidences through sexual route of transmission

a) To ensure complete saturation of the HRGs through prevention services, a mapping exercise needs to be done to arrive at the number of HRG population; present coverage is based on the mapping done by IMRB in the year of 2007. As sex work population is a dynamic one, the mapping needs to be done periodically and coverage to be saturated as per the requirement.

b) The number of targeted intervention projects in the state to be scaled up as per the enumerated HRG population in mapping exercise.

c) Present interventions among the high risk group are through centrally sponsored funds. A corpus fund by the state government to ensure regular fund distribution for ensuring sustained prevention activities among the HRGs may be planned. This corpus can be recouped with the central funds as and when released.

d) Wide spread and sustained awareness and IEC activities on HIV/AIDS to the general population are imperative as the latest NFHS data shows the “comprehensive knowledge about HIV/AIDS among women in Tamilnadu is 16.4% and that among men is 10.6%’. These figures augment for a multi-fold scale up of IEC and awareness activities in the state.

e) Presently 34% of the women population is getting tested for HIV as per the latest NFHS data (2015-16) and this indicates the need for expansion of testing facilities both at public and private health care settings and also strengthening the outreach activities so as to increase referrals to HIV testing services. We need to aim to test 90% of the population and ensure 90% of the population knows their HIV status.

f)Awareness and knowledge on STI among the women as per the DLHS is 9.6% and on the other hand the STI symptoms identified among women has gone up to 10% (2012-2013) from 7.1% in the previous DLHS study (2007-2008).This argues for expansion of STI services both at public and private health care settings and also strengthening of awareness programs on STI among the general population exponentially.

g) The awareness, access, availability of condoms across the state needs to be strengthened so as to ensure safe sex practices.

h) Inclusion of HIV /AIDS awareness sessions at all Colleges across the state once in 6 months may be thought of so as to impart knowledge on basic facts of HIV /AIDS among the younger generations.

i) Expanding the use of technology for awareness and mass campaigns across the state twice in a year, in a sustained manner to reach out to all the population may be planned.

Sharing of injecting equipments

The transmission through ‘Sharing of injecting equipments’ is 2.8% as per the published studies and in our state we have 516 injecting drug users (IDU) in coverage, and we did not have any positivity in the last 2 years.

Activities to achieve zero incidence through ‘sharing of injecting equipments’ mode of transmission.

a) To further strengthen prevention of HIV transmission through this mode, sensitization of college students on safe needle practices and awareness on “one needle for one” needs to be done in a sustained manner

b) Sensitization of the general public on safe needle practices and use of ‘disposable syringes” is very important to prevent transmission of HIV through this mode of injecting equipments.

c) Use of all sorts of media with IEC materials to reach out to the general population on safe injecting practices.

d) Sensitization of health care providers on safe injecting practices and needle stick injuries.

e) Ensuring awareness about PEP (post exposure prophylaxis) among the health care providers and making available of the PEP across both public and private health care settings.

f) Ensuring monitoring of drug peddling points so as to curb the availability of injecting drugs.

Contaminated Blood transfusion mode

HIV transmission through transfusion of contaminated blood products is 1% as per the 2012-13 published data by NACO. In our state the incidence through this mode is almost ‘nil’. TANSACS has strengthened the blood transfusion services division by capacitating the blood bank medical officers and also by strengthening the daily reporting systems of all the blood banks.

Also the www.tngovbloodbank.in has been modified so as to be more user-friendly and informative to the general public.

Activities to achieve zero incidence through ‘contaminated blood transfusion’ mode of transmission.

a) Strengthening the awareness on non-remunerated voluntary blood donation among the younger generations so as to ensure adequate availability of blood and blood products.

b) Sensitizing the health care providers at public and private health care settings on rational use of blood and blood products.

c) Ensure proper testing protocols are adhered to at all the public and private blood banks so as to filter out contaminated / infectious blood units.

d) Sustained awareness on ‘blood transfusion mode of HIV transmission’ among general public.

These activities aim to transform the vision of securing Zero new HIV infections, Zero discrimination and Zero AIDS-related deaths into concrete milestones.

These new activities would need to be reached by 2020 and the subsequent expansion in investment in prevention will be critical for the hope of ending AIDS in 2030.

Zero discrimination is a key target grounded in human rights based on an approach of ‘leaving no one behind’, which, if achieved, would significantly improve health outcomes of the state and to this effect TANSACS is implementing a new initiative "Technology to achieve zero stigma and discrimination" with the support of the state planning commission.