Epidemiology of HIV/AIDS

and
National AIDS and STD Control Program
(NACP)
 Session Objectives
By the end of the session the participant will understand:
• Epidemiology of HIV
o Modes of transmission
o Pathogenesis and Progression
o Global and Indian scenario
• National AIDS and STD Control Program (NACP)
o Evolution of India’s NACP
o India’s progress on 95-95-95 targets
o Current Goals and Objectives of NACP Phase -V
o Strategies under NACP-Phase V
 What is HIV

• HIV stands for human immunodeficiency virus

• HIV can lead to acquired immunodeficiency syndrome, or AIDS, if not treated

• HIV attacks the body’s immune system, specifically the CD4 cells (T cells), which help the

immune system fight off infections

• Untreated, HIV reduces the number of CD4 cells (T cells) in the body, making the person

more likely to get other infections or certain cancers

 Modes of HIV Transmission

Semen and Vaginal Fluids Sharing Needles Needle Stick

& Syringes Injury

Through Infected Blood & blood During Pregnancy Breast Feeding

products or Birth
 HIV Transmission Risk
Exposure Route HIV Transmission
Blood transfusion >98%
Perinatal without any intervention 20-40%
Sexual intercourse 0.1 to 1%
Vaginal 0.05-0.1%
Anal 0.065-0.5%
Oral 0.005-0.01%
Injecting drugs use 0.67%
Needle stick exposure 0.3%
Mucous membrane splash to eye, oro-nasal 0.09%
 QUIZ-1

Question: Risk of HIV transmission is highest by __________. Choose the

correct option to fill in the blank.
A. Perinatal route
B. Blood transfusion
C. Injecting drug use
D. Sexual intercourse
Answer: B- Blood Transfusion
Path of the HIV Transmission in the host
Day 0 Exposure to HIV at mucosal
surface (sex)

Day 0-2 Virus collected by dendritic

cells, carried to lymph node

Day 4-11
HIV replicates in CD4 cells,
released into blood

Day 11 Virus spreads to other

onwards organs
Image Courtesy Kahn JO, Walker BD. NEJ Med.1998; 339: 33-39
Stages of Untreated HIV Infection
Viral transmission

Acute retroviral syndrome: 2-3 weeks

Seroconversion: 2-20 weeks

Asymptomatic chronic HIV infection: 8 yrs. (Avg.)

Symptomatic HIV infection/AIDS: 1.3 yrs. (Avg.)

 How Does HIV Affect the Body?
HIV weakens the immune system by attacking our soldiers-CD4
HIV makes the CD4 cell its home and uses it like a factory to reproduce
more baby HIV viruses
CD4 cells are destroyed when the new viruses leave their home
This leads to decrease in CD4 cell count and function
CD4 cells the soldiers of our body fails to protect us from infection germs
entering our body
Infected individual has higher risk to develop opportunistic infections or OI
When HIV infection is not treated in time
result in AIDS- severe immune deficiency due to HIV infection
Typical Course of untreated HIV infection

Acute HIV 10^6

800 HIV antibodies

CD4 Asymptomatic
count HIV
cells/µl RNA
Minor HIV-related Copies
symptoms /ml

Virologic set-point
Varies from patient to Opportunistic
200
patient infections
10^2
Death
1 3 Wk about 6mths // 5yrs 10 yrs
Time Duration
 Patterns of HIV Progression if untreated
Type of HIV Proportion CD4 cells Characteristic
Progression among drop features
PLHIV
Typical 50-70% 35-50 CD4 Develop end-stage disease within 8-10 years
progression cells/year after seroconversion

Rapid 50 CD4 Develop symptoms of AIDS or end-stage HIV

progression 10% cells/month disease within 2-3 years after infection;
especially in infants & children
Slow 5-15% Very slow Remain free of symptoms of AIDS for more
progression than 10-15 years
Living with HIV for >15 years and have stable
Long term 5-10% Stable CD4 CD4+ counts of ≥ 500 cells/mm³ blood.
Non-progression count No HIV related diseases and can live longer
without ART
 Quiz-2
Question: One of the following statements about “Acute Retroviral Syndrome” is
False. Select the incorrect statement.
A. Acute retroviral syndrome occurs when the virus is disseminated in blood usually
after 2-3 weeks of exposure
B. HIV Viral load is always “not detectable” during this stage
C. Serological Tests for HIV antibodies are negative
D. Infected individual might have fever, rash, lymphadenopathy or sore throat like
any other viral infections
Answer: B
Global summary of the AIDS epidemic
Adults and children estimated to be living with HIV 2020
 Quiz-3

Question: India has the estimated_______ largest number of PLHIV in the

world, about 24.01 Lakh.
Choose the correct option.
a) Fourth
b) Second
c) Third
d) Fifth
Answer: Second
 HIV Epidemic in India

India has the second largest estimated number of PLHIV in the world
(Source: Sankalak: Status of National AIDS Response, Fourth Edition, 2022)
National Summary of the HIV/AIDS Epidemic in 2021
Indicator
Adult (15–49 years) Prevalence
Number of people living with HIV
New HIV Infections
AIDS-related deaths
PMTCT need
Final MTCT Rate of HIV
Value
Total 0.21%
Male 0.22%
Female 0.19%
Total 24,01,284
Adult (>15 years) 23,31,476
Women (>15 years) 10,50,251
Children (<15 years) 69,808 (Source : India HIV
estimates 2021; Fact
Young people (15–24 years) 1,70,403 Sheet NACO; available at
Total 62,967 http://naco.gov.in/sites/de
Adult (>15 years) fault/files/India%20HIV
Women (> 15 years) 24,550 %20Estimates
Young people (15–24 years) %202021%20_Fact
%20Sheets__Final_Shar
Total 41,968 ed_24_08_2022.pdf
Adults (> 15 years) 39,462
Women (>15 years) 11,258
Children (<15 years) 2506
Young people (15–24 years) 1118
Total 20,612
24.25 %
Adult HIV Prevalence (in %) in India, by States 2021
Mizoram has the highest HIV
prevalence of 2.7%

(Source: Sankalak: Status of National AIDS Response, Fourth Edition, 2022)

 HIV Prevalence in different population groups
• India has a concentrated HIV epidemic which means HIV prevalence is consistently over 5% in 1 or more
sub-population groups (FSW, MSM, PWID, TG/Hijra)

*ANC- Antenatal clinic, FSW-Female Sex Worker, MSM-Men who have sex with men, IDU-Injecting drug users,
H/TG-Hijra/Transgender, SMM-Single Male migrant, LDT-Long distance trucker

(Source: Sankalak: Status of National AIDS Response, Fourth Edition, 2022)

Proportional distribution of PLHIV in India by State, 2021

40% of the burden of

PLHIV in India comes
from the 3 states of
Maharashtra, Andhra
Pradesh, and
Karnataka

(Source: Sankalak: Status of National AIDS Response, Fourth Edition, 2022)

National AIDS and STD Control Program (NACP)
Evolution of the National HIV/AIDS response

(Source: Sankalak: Status of National AIDS Response, Fourth Edition, 2022)

NACP V –(2021-2026) Anchoring the National response
towards ending the AIDS epidemic
Goals of NACP V

Project Prashiksha - Classroom Training of ART Care Coordinator 2022

 Specific objectives of the NACP Phase-V
A. HIV/AIDS prevention and control B. STI/RTI prevention and
control
1. 95% of people who are most at risk of acquiring HIV 1. Universal access to
infection use comprehensive prevention quality STI/RTI services
2. 95-95-95 targets: 95% of HIV positive know their status, to at-risk and
95% of those who know their status are on treatment vulnerable populations
and 95% of those who are on treatment have suppressed 2. Attainment of
viral load elimination of vertical
transmission of syphilis
3. 95% of pregnant and breastfeeding women living with
HIV have suppressed viral load towards attainment of
elimination of vertical transmission of HIV
4. Less than 10% of people living with HIV and key
populations experience stigma and discrimination

24
 What are the 95-95-95 targets?
NACO has adopted the 95-95-95 target set by UNAIDS to achieve the following by 2030:
• 95% of PLHIV should know their status
• Out of those who know their status, 95% should be on treatment
• Out of those on treatment, 95% should be virally suppressed
Trend in progress on 95-
95-95 and Treatment
Cascade in % (2018-19 to
2021-22)

(Source: Figure-14; Sankalak: Status of National AIDS Response, Fourth Edition, 2022)
Elimination of vertical transmission of HIV and Syphilis
(EVTHS): key strategies under NACP-V

(Source: Figure-65; Sankalak: Status of National AIDS Response, Fourth Edition, 2022)
 Continued Targeted Interventions strategies: NACP V

HIGH RISK
GROUPS Clinical
Services

Provision of Behaviour
commodities Change
CORE BRIDGE Communication
HRGs
POPULATION POPULATION
Enabling
Referrals &
Environment
Linkages
Female Sex Men Having Injecting Hijra/ Community
Workers Sex With Drug Users Transgend Migrants Truckers Mobilization
(FSWs) Men (MSM) (IDUs) ers (H/TGs)

NACP Phase V will pilot and scale up ‘One-Stop Centre’ among HRGs offering integrated services to meet a
wide range of healthcare needs of the population group including mental health, drug deaddiction, social
protection, etc.
Prevention Strategy Condom Promotion

• Source of image:
https://www.facebook.com/NACOIndia/phot
os/a.159111051110726/701141943574298/?
type=3&eid=ARCSQMKyq8uf8g_40eefNpE
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Prevention by Safe Blood Transfusion Services
Prevention – Needle Syringe Exchange Program

• Source of image:
https://www.unodc.org/documents/sout
hasia/publications/sops/needle-syringe-
exchange-program-for-injecting-drug-
users.pdf
 Focus on STI/RTI Programmes (STI/RTIs)

• Quality standardized Sexual & Reproductive Health services

provided at all levels, through Designated STI Clinics “Suraksha
Clinics” for general population
• DSRC offers syndromic management of STI/RTI through its two
arms i.e. obstetrics & gynecology OPD and STI OPD under
dermato-venereology clinics.
• Phase V will focus on newer initiatives such Sampoorna
Suraksha Strategy to cover ‘at-risk’ HIV negative but non-TI
population through a cyclical and comprehensive package of
services as per their needs to keep them HIV free.
 DISHA Strategy
District Integrated Strategy for HIV/AIDS (DISHA) initiated to reach the unreached
population not covered under DAPCUs . Mix of DAPCU and Cluster Based Approach
Newer Interventions
- one-stop centres
- Sampoorna Suraksha Kendras
- Leveraging dual test kits (HIV & Syphilis)
- Addressing linkage loss at all levels
- Differentiated care model
-Prioritize SRH services
- Private sector engagement
- Community system strengthening
 Sampoorna Suraksha Strategy
Aim: Comprehensive HIV care services for the at risk population
Population “At Risk” for HIV & STIs is defined as ‘any individual
who is at risk of acquiring HIV or STI due to risky behavior of
self or partners.
At Risk Population includes:
• Self-Initiated Client at ICTC and DSRC with risky behavior.
• Social and Sexual network of the individuals mentioned
above
• Youth and Adolescents who are at risk.
• Individuals having casual sexual relation with non-regular
partner.
• Population on virtual platforms with risk
 Information Education & Communication
Objectives
Behaviour Change – Demand Generation – Reduction of Stigma & Discrimination

Multi-Media Approach Flagship initiatives

Mass Media Social Media On ground Mobilization & IPC

 Red Ribbon Express -3
phases reached to 2.5
 Adolescent Education
crore people directly
Programme in more than
 National Toll-free AIDS
48,538 schools
Helpline-1097-average
 Red Ribbon Clubs in monthly calls approx.
colleges in 12,609 college 66,000
 Out of School  Digital Resource centre
Youth/college at state with 1,112 resources
level  North East Campaign in
all 8 states
 Face book with 30,000
Likes
 Quiz-4

Question: The National Toll-free AIDS Helpline number is_______.

Choose the correct option to fill in the blanks.
A. 1800-88-109
B. 1093
C. 1036
D. 1097
Answer: D
 Community System Strengthening (CSS)

Main Objectives of CSS:

• Greater meaningful involvement of Community in planning,
monitoring, evaluation and implementation of the program
• Developing structured systems of Community engagement
Implementation through Community Champions
Community Championship: aims to bring forth Community
voices, create opportunity across different typologies of key
populations, vulnerable groups and PLHIV and create structured
engagement processes
 Collaboration With National Health Mission (NHM)
• Mainstreaming of HIV testing data reported
through NHM portal i.e., health management Mainstreaming
of Data
information system (HMIS) and reproductive and HMIS / RCH
child health (RCH) portal Portal

• Screening and Management of STI/RTI services Rashtriya

among Adolescent through RKSK Kishor
RMNCH +A NACP Swasthya
Karyakram
• Screening and management of cervical cancer (RKSK)
among WLHIV and FSWs through NCPDCS
• Develop a case reporting system for Syphilis
exposed children. NCPDCS
Scale-up of HIV Counselling and Testing Services (HCTS)
Integrated Counselling and Testing Services (ICTC) are renamed as HIV Counselling and
Testing Services (HCTS)

• These are divided into two groups:

• Screening Facilities (F-ICTCs, PPP-ICTCs, TI-ICTCs, OPD, IPD, Emergency wards, Labor
rooms etc.)
• Confirmatory Facilities (Stand Alone –ICTCs and mobile ICTCs)

(Source: Sankalak: Status of

National AIDS Response, Fourth
Edition, 2022)
 Treatment: Care and Support Services

National Operational Guidelines for ART Services, 2021

 CST Services: Referrals & Linkages
RNTCP (HIV-TB collaborative activities)

Centres of
ICTC Link ART ART Centre Excellence / ART P
• Counselling &
Centre • CD 4 testing Centres
• Monitoring and • Initiation of ART Tertiary care
Testing dispensation for • Follow up
• New detection stable PLHIV on • Viral Load Testing
ART

Care & Support Centres

 Key Points
• A person once infected with HIV carries the virus for life
• The most common mode of HIV transmission in India is through sexual route.
• If the HIV infection is not treated, it can lead to Acquired Immunodeficiency Syndrome
or AIDS
• India has the second largest estimated number of PLHIV in the world
• Injecting drug users have the highest prevalence of HIV
• NACO is working towards ensuring universal access to comprehensive HIV care
• NACO has adopted 95-95-95 targets set by UNAIDS to end "To end HIV as a Public Health
threat by 2030
• HCTS is the entry point for providing care and support to the HIV infected people
• Numerous prevention strategies have been initiated under NACP-V
Thank You