National Adolescent Health Consultation

7th – 9th January 2014

New Delhi

HIV and Adolescents

Dr. Ashok Kumar, M.D.
Dy. Director General,
Department of AIDS Control,
Ministry of Health and Family Welfare,
Government of India, New Delhi
 Contents of Presentation
1. Demography and Health Care infrastructure in India

2. Overview of HIV epidemic and burden of Adolescents living

with HIV in India

3. Major Risk Factors for HIV amongst Adolescents

4. National AIDS Control Programme (NACP) Response

5. Key Challenges
 HIV & Adolescents
 Globally, It is estimated that 2.1 million adolescents are living with HIV
in 2012 and there were 107,000 AIDS related deaths (WHO 2012)

 The road from childhood to adulthood is a perilous trajectory for young

people, and for young women in particular, and the risk that they will
become infected with HIV en route is high

 Early sexual debut, early pregnancy and early experiences with drug
use - all increase the risks for HIV infection.

 In the current scenario, in India around 20% of the clients (excluding

pregnant women) availing HIV counseling and testing services under
NACP are in the age group of 15 to 24 yrs
 India: Demography
 Population: 1.21 Billions

 Population:
 India Vs World : 17%

 India Vs SEAR : 67%

 Urban - 31.2%

 States & UTs - 35

 Districts Units - 671

 Blocks ~6700

 Villages:~ 0.64 million The Estimated

Adolescent Popn. in
India is 243 Million
( 21.2% of the Popn.)
 Health Care Infrastructure in India
Number of Facilities
Health Facility Norm for Establishment
(March 2012)

Allopathic Medical Colleges - > 380

One per district
District Hospital 725
(671)
Depending on size of
Sub Divisional Hospital 987
District
Community Health Centre 80,000-120,000
4,917
(CHC) Popn.
20,000-30,000
Primary Health Centre (PHC) 24,049
Popn.
Sub-centre 3,000-5,000 Popn. 1,48,366
Village
Accredited Social Health One per 1000 Popn. 8,00,819
Activist (ASHA)
The Adolescent Friendly Health Services are envisaged to be covered at all levels of Health Care
Source: Rural Health Statistics in India 2012-MOHFW/GoI
 Concentrated Epidemic at low levels
HIV Epidemic in India

Bridge Population General Population

High risk groups
(Migrant workers & (Low risk Men & New born Children
(FSW, MSM, IDU, TG)
Truckers) Women)

Estimated Adult HIV Prevalence & No. of PLHIV, India

25.0 0.33 0.35
0.31 0.30
0.28 0.30

Adult HIV Prevalence (%)

Number of PLHIV (Lakhs)
0.27
20.0
0.25
15.0 0.20
22.5 21.9 21.4 21.1 20.9 0.15
10.0
0.10
5.0
0.05

0.0 0.00
2007 2008 2009 2010 2011
Number of PLHA (Lakhs) Adult HIV Prevalence (%)

FSW: Female Sex Workers; MSM: Men who have sex with Men; IDU: Injecting Drug Users;
TG: Transgender/ Hijras
Source: Technical Report India HIV Estimates 2012, NACO & NIMS
 Estimated HIV Prevalence Among Children &
Young Population in India (2007 - 2011)
Age: 15 – 24 years Age: < 15 years

0.16 0.045
0.15 0.04 0.04 0.04 0.04 0.04
0.14 0.13 0.12 0.04
0.12 0.11 0.035
0.1
0.11 0.03
Percent

Percent
0.08 0.025
0.02
0.06
0.015
0.04
0.01
0.02
0.005
0
0
2007 2008 2009 2010 2011
2007 2008 2009 2010 2011

In India, the estimated HIV prevalence among

children has remained stable whereas amongst
young population is showing a declining trend

Source: Technical Report India HIV Estimates 2012, NACO & NIMS
 Major Risk Factors Amongst Adolescents for
HIV
• Biologically and physiologically young people are more
vulnerable, especially the females
• Lack of correct information and tendency for unsafe
sexual experimentation
• Taboo & Inadequate guidance by the educational
institutions and families
• Particularly vulnerable are those out of school / college
group, mobile / migrant population, adolescents in sex
work, young injecting drug users and street children
• High Proportion of Child / Adolescent Marriage

This Rashtriya Kishor Swasthya Karyakram (RKSK) will now facilitate in

increasing the access to adolescent health care services in India
 National AIDS Control Programme - Response

Advocacy Communication & Social Mobilization

 Adolescence Education Programme in more

than 83,000 schools
 Red Ribbon Clubs in more than 14,000
colleges
 Out of School Youth Activities
 Large Scale Involvement of mass media, mid
– media and inter personnel communication
 National AIDS Control Programme - Response

Services Provided For

 Counseling and Testing for HIV

 Care, Support and Treatment for PLHIV

(including Adolescents)

 STI Diagnosis and Treatment

Services provided through General Health Care System

 HIV Testing and Treatment Facilities (Dec
2013)
HIV Testing Facilities HIV Care Facilities

Stand Alone ICTC ART centres

4,537 380
(CHC and above) (Primarily at District level)

Facility Integrated ICTC Link ART centres

9,196 (Primarily at CHC and above for
(PHC / Dispensary / CHC)
decentralized ARV distribution 1,023
only)
PPP-ICTC 1,805

Total 15,538 Total 1,403

These services are being further scaled up in the 12th F Y Plan (2012-17)
to increase the access
 Key Challenges
• Data segregation for adolescent age group
• Increasing accessibility & utilization of
adolescent friendly services
• Ensuring efficient service delivery by the
public health system
• Collaboration and linkage with different
ministries like HRD, Youth Affairs & Sports,
WCD, Social Justice & Empowerment, Health &
Family Welfare, etc
• With regard to HIV, Policy issues like consent
from parent / guardian for clients less than 18
years of age
Thank You