'Red Ribbon Express' Project Reaches Millions

RRE Clipping 2
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India launches world’s largest social mobilization campaign against HIV

Sonia Gandhi flags off the Red Ribbon Express on World AIDS Day

Seven coaches carrying HIV prevention messages will traverse over 27,000 km making 180 halts, covering 166 districts across the country, reaching out to crores of people in over 50,000 villages for scaling up ground level mobilization activities.

New Delhi, 1 December 2007: World’s largest mass mobilization drive, the Red Ribbon Express (RRE) was launched at New Delhi’s Safdarjung Railway Station, on the World AIDS Day today. The Red Ribbon Express, a specially designed seven-coach train, endeavors to generate a national movement against the HIV epidemic. The train, the icon of this mass mobilization campaign, was flagged off today by Smt. Sonia Gandhi, Hon’ble Chairperson, Rajiv Gandhi Foundation and United Progressive Alliance in the presence of Shri Lalu Prasad, Hon’ble Minister of Railways and Dr. Anbumani Ramadoss, Hon’ble Minister of Health and Family Welfare and several dignitaries.

Conceptualized by the Rajiv Gandhi Foundation, and implemented by NACO, the Red Ribbon Express is a multi-sectoral project aimed at spreading awareness on HIV, promoting safe behavioural practices and fighting stigma and discrimination against people living with HIV. Ministry of Railways, Nehru Yuva Kendra Sangathan (Ministry of Youth Affairs and Sports) and UNICEF are the other main partners in this initiative. Over its yearlong journey, the train will traverse over 27,000 km covering 180 stations holding programmes and activities in over 50,000 villages across the country. Traveling with the train will be two exhibition buses and cycle caravans that will cover the peripheries of the districts reaching out to crores of people in the rural hinterland.

Commending the multisectoral effort, Smt. Sonia Gandhi, Chairperson of the Rajiv Gandhi Foundation and the UPA, cautioned the gathering on the social, economic and developmental implications of HIV. “No disease has had such a catastrophic impact on the lives of so many millions in so short a time.” Smt. Gandhi urged, “On this day we must resolve to do everything we can, in whatever manner, to save lives and reach out to all those who are living with this infection”.

There are an estimated 25 lakh people living with HIV in India. The National AIDS Control Organization has undertaken specific actions to control and reverse the epidemic and its efforts have yielded significant results as is evident by declining HIV prevalence rates. The RRE has been put into action by NACO to consolidate these early gains. This multi-sectoral initiative on wheels, it is envisaged, will bring together peoples’ representatives, programme functionaries, opinion leaders, media, civil society and citizens to offer a coordinated response to the HIV epidemic in India.

Signifying its commitment towards people living with HIV, the government also announced provision of free 2nd line treatment in two centres of the country. “Our commitment to reach one lakh persons on Anti-retroviral therapy has been achieved. We are now getting ready to provide second-line treatment to those who have may have developed resistance to first-line drugs,” declared Dr. Anbumani Ramadoss, Union Minister for Health and Family Welfare. Tambaram Hospital in Chennai and JJ Hospital in Mumbai would provide free of cost second-line drugs to those below the poverty line. As we gain confidence in providing good quality care, access to second line treatment will be expanded.”

Pledging the support of the Ministry of Railways to the Red Ribbon Express campaign, Hon’ble Union Minister for Railways, Shri Lalu Prasad said, “The Indian Rail network serves as the ideal route to roll-out a mass mobilization initiative intended to reach every nook and corner of the nation. We stand proud and committed to be partners in this initiative that is unprecedented in its scale and well conceived in its objective of raising awareness against the HIV epidemic.”

The Red Ribbon Express Campaign has been designed to include, on-platform and off-site communication activities for maximum outreach and impact. The gamut of activities include publicity to mobilize people will be carried out through radio, TV, newspapers, outdoor activities three days prior o the train’s arrival at the station. On platform activities, include a welcome ceremony, an exhibition and cultural performances on the platforms in addition to the media interactions for putting the state of the local epidemic and preventive measures undertaken.

Over the last six months, not only have more than 500 people worked relentlessly from the government and partner agencies to make RRE a reality but during the passage of the train a vast human resource base will be trained along its route. These include 65,000 key influencers with outreach to the communities, 8,500 implementers including district collectors and block development officers, and 5,000 youth volunteers who would be working at mobilizing the communities on the ground. Cycle and bus caravans will travel along with the train to cover the far-flung areas. During halts, cultural troupes traveling in the train will disperse in six groups to selected villages in the districts. Over 30,000 local cultural performances reaching out to more than 30 million people are scheduled to be witnessed by rural population across 24 twenty states in nine languages.

For additional information, please contact:
Mayank Agarwal, Joint Director, IEC Division, NACO
(Mobile) 9868100731;mayanknaco[at]gmail[dot]com

Minister for Health & Family Welfare, Dr. Anbumani Ramadoss launched the third Phase of the National AIDS Control Programme (NACP), here today. Speaking on the occasion, he said that there are an estimated 2 million to 3.1 million people infected with HIV/AIDS with a prevalence level of about 0.36%. He was optimistic of the country’s ability to win the battle against AIDS.
Smt. Panabaka Lakshmi, Minister of State for Health & Family Welfare, Shri Naresh Dayal, Secretary, H&FW, Ms. K. Sujatha Rao, AS&DG (NACO) and Representatives of the UN Group, World Bank, DFID, GFATM, USAID and Private Foundations also attended the function.

The following is the text of the Minister’s speech:

“I am indeed very happy to be here today with you all to launch the Third Phase of the National AIDS Control Programme. Today is a momentous day for all of us present here as it brings us to the end of one critical phase in the evolution of our battle against HIV AIDS. The strategies and approaches outlined in the NACP III indicate the maturity of the epidemic and the vast improvement in our knowledge of this disease which continues to challenge our ability to find a cure. I am also happy to note that the NACP III is founded on the important principle of equality and inclusion, demonstrated by giving primary focus to prevention and behaviour change among the high risk groups through a process of empowerment.

There is one other reason to be happy today. Many of you know how we have always been found fault with for underestimating the seriousness of the epidemic. That was a disturbing allegation as we were and continue to be very committed to containing and reversing the HIV AIDS epidemic. Today we have with us a far more reliable estimate of the burden of HIV disease in India. These estimates are based mainly on two important sources of data. First, we continue to have the data from our sentinel surveillance, now expanded to 1122 sites from the earlier 703 sentinel sites. This year we have the additional inputs from the National Family Health Survey, which is a country wide community based household survey.

Experts from India and round the world were consulted and after a lot of hard work and outstanding support from the WHO, UNAIDS, CDC and other partners, we have been able to arrive at robust figure that all our experts feel is as correct an estimate as we can get. The results show that there are an estimated 2 million to 3.1 million people infected with HIV/AIDS with a prevalence level of about 0.36%. While the prevalence appears to be less than the previous estimate of 0.9%, these figures are not comparable. By using the same methodology for the past years that we used this year, there is only a marginal reduction in the prevalence. Moreover, in terms of human lives affected, the numbers are still large and worrying. There is no doubt in my mind that we cannot let down our vigil but continue to work hard to ensure that the HIV/AIDS are under total control.

If I am sounding optimistic of our ability to win this battle, it is because the programme has achieved its aim of keeping the HIV sero-prevalence below 5% in the high prevalence states and below 3% in the moderate prevalence states and below 1-2 % in the other states. A case in point is Tamil Nadu which has shown a consistent decline in HIV prevalence in the last 5 years. The surveillance reports of 2006 reinforce the fact that expected outcomes of NACP were broadly accomplished.

Major policy initiatives were launched in NACP II. Initiatives such as the National AIDS Prevention and Control Policy, National Blood Policy, provision of Antiretroviral Therapy (ART), strategy for Greater Involvement of People with HIV/AIDS (GIPA) were initiated during the NACP II. Programmatically, we achieved good results. 1033 Targeted Interventions were implemented through NGOs among high risk groups and bridge populations. Facilities providing voluntary counseling and testing (VCT) and prevention of parent to child transmission services (PPTCT) were remodeled as ‘Integrated Counseling and Testing Centres’ (ICTC).

NACP II saw a massive scale up of counselling and testing services and today more than 10 million people have been counseled and tested in more than 4000 ICTCs spread throughout the country. The NACP III now envisages expansion of testing sites to 5000 and establishing another 10,000 through a system of franchising by forging partnerships with the private sector. Such expansion is necessary to achieve 42 million tests by the end of NACP-III. Launching the provider initiated testing and counseling for patients referred from clinics treating tuberculosis, STD or pregnant women in high risk areas will also help us identify persons infected by this virus. These measures will not only strengthen the prevention and control of HIV/AIDS but also be beneficial to the health outcomes of people living with HIV/AIDS.

Blood safety was a major area of focus in NACP II and modernization of blood banks and installation of blood component separation centres were taken up. Through these efforts, we have brought down the transmission of HIV infection through contaminated blood to less than 2%. But we have a long way to go in this area. We have yet to satisfactorily address the critical issues of volume, access and quality of blood. There is a lot of private blood collection and also a shortage of blood. This year, we will be initiating action to establish 4 centers of excellence in the four metros that will have a capacity to collect and process one lakh units of blood annually.

To address the various issues related to blood collection, storage, distribution and supply, we are working on a regulatory framework to establish a Blood Transfusion Authority on the lines of the FDA. I am confident that in the next couple of years, we will be able to have a world class system of blood collection and distribution. This will help bringing down blood transmissible diseases such as HIV and Hepatitis B etc.

Condoms, as you know, are the only prophylaxis we have with us to check transmission of sexually transmitted infection. Its promotion is essential in India as it has multiple uses – it can avert unwanted pregnancies as well as stop the spread of sexually transmitted diseases. Though some work was done to promote the use of condoms, it is inadequate. I am pleased to learn that under NACP III, condom availability and use will be significantly scaled up. I am happy to learn that the Gates Foundation is providing us funding support to establish a professional group to help us expand the market for condoms. Promoting condom use is important. Thailand is now facing the possibility of a resurgence of the HIV epidemic because they gave up prevention and condom promotion and focused only on treatment. So also China. Non-emphasis on condoms is resulting in the gradual increase of HIV due to unsafe sex. This is the same story in Nagaland where we neglected the promotion of the condom and are today facing the spread of HIV on account of unsafe heterosexual behaviour.

With young men and women bearing the brunt of the disease burden, it is essential that we educate our youth on healthy lifestyles. While good work was done under NACP II in training 2 teachers and 2 students in all the 1.4 lakh high schools we need to do more. We are therefore, currently working on coming up with a health education package that will focus on healthy lifestyle which will say no to unsafe sexual behaviour, no to tobacco, no to alcohol and no to drugs. We hope to harness the abundant energies of youth, as has been done in Tamil Nadu, in combating HIV/AIDS.

While, prevention will continue to be the mainstay of the NACP III, strategy and focus on saturating coverage of an estimated 4 million high risk groups, continued attention will also be on providing care, support and treatment to the infected. The ART programme which was launched in 2004 brought hope and expectation in lives of thousands of people living with HIV/AIDS. The ART programme has been rapidly scaled up. Today about 80,000 patients are accessing free treatment in 127 centers. This year another 36 centers are going to be established. Efforts are being made to identify centers closer to the community level to make it easier for patients to get their refill of drugs and save them time and money spent on coming all the way to the ART center. Such decentralization of drug distribution will greatly enhance adherence, reduce loss to follow up and alleviate the economic hardship of the PLHA’s. I do hope these centers attached to the ART centers will come up soon.

India was a global leader in coming out with the treatment protocols for children. Since the launch of the Pediatric AIDS Initiative on 30th November, we have more than 6000 children on treatment and 12,000 diagnosed.

I would also like to reiterate that HIV/AIDS is not just a public health problem. It is a disease that is the result of deeply rooted socio-economic conditions and cultural beliefs, practices, attitudes and vulnerabilities. The virus spread in India mainly through the heterosexual route. Sexual behaviours and choices are an intensely private matter and difficult to change. At one level we have easy access to information though internet, rapidly changing values and attitudes as depicted in modern cinema and the TV, greater mobility etc. and greater impoverishment and unmatched aspirations at another level are factors that contribute to enhancing risk and increasing vulnerability to this infection. We cannot, therefore, let our guard down. We need to understand the significance of the presence of the virus in some 20 to 30 lakh people in the country against the backdrop that we also have a very high population of young and sexually active persons.

Of utmost importance is fighting stigma and discrimination. Even as we are celebrating our successes, we need to also feel a sense of shame that we as a society continue to lack compassion and stigmatize those who have the misfortune of being affected by this disease. Be it the incident of little children in Kerala being denied admission or the one in Meerut being denied medical care, it is indeed unfortunate. I would like on this occasion to appeal to all my fellow colleagues in the medical profession to live upto their oath of treating all those who suffer disease and sickness on equal grounds. I appeal to all faith based organizations and civil society organizations to come forward and help us to fight irrational attitudes of stigma against PLHAs.

I would like to thank all the media, the donor partners, the PLHA networks and the NGO’s for all the support that they have been giving us in our fight against HIV /AIDS. We value their support and understanding that they have extended to us. I do hope that this partnership will continue and the NACP III will be implemented successfully”.

RTS/SK/NACP - 68

As part of its continuous efforts to know its epidemic better, the National AIDS Control Organization (NACO) leads an annual process, together with national and international expert groups, including UNAIDS and WHO to estimate the number of adults living with HIV/AIDS in India (HIV prevalence). From 4-6 June, 2007, NACO convened a meeting of the Core Technical Working Group on Estimates and Projections, which provides guidance on the methods and assumptions used to develop national HIV prevalence estimates. This year the estimates would provide a more accurate picture of the epidemic because of availability of more information based on population based surveys and improved data from high risk groups. The Working Group is still in the process of analyzing the data to develop an updated estimate of national HIV prevalence and these figures will be available by the first week of July.

Some trends can already be identified from the analysis of existing sentinel data. Although prevalence in antenatal clinics has shown a decline in some southern states, high levels of infection among the groups at higher risk, such as Men who have Sex with Men (MSM), and Injecting Drug Users (IDU) are of concern. Similarly, while data does suggest that the HIV prevalence levels are declining among sex workers in areas where targeted interventions have been implemented, particularly in the southern states, yet overall prevalence levels among this group continue to be high necessitating focused prevention interventions. Experience shows that where these groups are themselves engaged in prevention efforts they become strong leaders in prevention. Finally, the 2007 sentinel data clearly validates the prevention strategy being implemented by NACO.

KR/SK/Statement on HIV - 63

National AIDS Control Organization will be launching a month-long campaign in six high-prevalent states, namely Andhra Pradesh, Tamilnadu, Karnataka, Maharashtra, Manipur and Nagaland focussing on the linkage between HIV and TB. The campaign will be conducted through the mass media including electronic and print. It is pertinent to remember that the HIV virus lowers the immunity of the person, easily exposing him to opportunistic infections of which TB is the most common infection. An HIV positive person has 60% high risk of contracting tuberculosis and hence, prevention of TB attains paramount importance.

TB can be completely cured by taking DOTS regularly which is made available by the Government free of cost across the country. The HIV positive people are advised to undertake tests for tuberculosis periodically so that they may take treatment in time to lead healthy lives. The tests for both HIV and TB are also available free of cost at Government hospitals and medical clinics.

It is expected that the campaign will raise awareness levels about HIV - TB linkage and help in promoting the services being provided by the Government for the benefit of the HIV positive people.

KR/kc/health –linkage between HIV& TB - 7

V. Mohan Rao

HIV/AIDS is one of the fourteen major communicable diseases that affect the population in India, which had an estimated 5.21 million HIV infected people by the end of 2005 as against 5.13 million in 2004 and 5.10 million in 2003. The government has formulated the National AIDS prevention and control policy with the objectives and goals: to prevent the spread of HIV infection and reduce any adverse economic and social impact, to generate a feeling of ownership among all the participants at government and non-government levels to make it a national effort, to create an enabling socio-economic environment for prevention of HIV/AIDS. The policy also aims at providing care and support to people living with HIV/AIDS and to ensure protection/promotion of their human rights. Efforts are also being made at promoting better understanding of HIV infection among people, especially students, youth and other sexually active sections to generate greater awareness about the nature of its transmission and to adopt safe behavioural practices for prevention.

Mode of AIDS Transmission

The probable mode of transmission among the reported number of AIDS cases has been observed to be sexual mode of transmission, transmission from mother to child, blood and blood products and Injecting drug users. The adult prevalence of HIV infection in the country has been observed to be 0.9 per cent. However, the disease has a heterogeneous distribution with higher prevalence among high-risk population groups —commercial sex workers. The core strategy being implemented to prevent the spread includes Targeted Interventions (TI) among High Risk Groups (HRG) i.e., Commercial Sex Workers, Injecting Drug Users, Truckers, Migrant Labourers, Condom Promotion Treatment for Sexually Transmitted Infection, referrals for Counselling and Testing facilities, provision of safe blood, Anti Retro Viral Treatment, Treatment for Opportunistic Infections, Community Care Centres, Drop in Centres. Under the NACP phase-II, as many as 1040 NGOs are implementing 1088 Targeted Intervention among High Risk Groups and 107 NGOs are running 122 Community Care Centres (CCCs) across the country. The funding of NGOs for HIV/AIDS prevention and control has been decentralized to the respective State AIDS Control Societies and the States are given funds by National AIDS Control Organization (NACO) as per the approved action plan annually.

Mother-To-Child Transmission

Under prevention services, counseling and testing facilities at 3394 Centres with the provision of prophylaxis treatment for HIV infected pregnant women to prevent mother to child transmission, treatment of sexually transmitted infections at 974 hospitals and provision of free condoms to prevent new infections are being provided in all public facilities viz medical colleges, district hospitals, government health centers etc. This is besides free anti-retroviral treatment is being provided through 96 government hospitals. Free CD4 test to assess the immune status is provided to children below poverty line. Medical Colleges and district hospitals are provided one lakh rupees each for treatment of opportunistic infections in HIV infected persons. 122 Community Care Centres have been established for providing treatment against opportunistic infections. Financial assistance of Rs.65.36 crore and Rs.99.06 crore has been provided to states for care, support and treatment of AIDS patients during 2005-06 and 2006-07 respectively.

Strategy to Check Unsafe Sex

In order to check any scope of getting sexually transmitted infections on account of unsafe sex, NACO is promoting the A-B-C strategy – Abstinence, Be Faithful and Condom Use. Besides this, there is also a focus on Life Skill Education to keep youth away from drugs and unsafe behavioural practices. The condom use among high-risk population is promoted through Targeted Intervention Projects. The accessibility and availability of condoms, which is the only prophylaxis is being promoted through the social marketing approach. In its unprecedented efforts to combat the dreaded disease, the government has launched an ambitious programme Youth United for Victory on AIDS,(YUVA). The five-year programme is aimed at creating awareness among the people, particularly the young. The main feature of the programme is the involvement of Panchayati Raj Institutions, volunteers from youth organizations and NGOs. The target is to cover 50 per cent of young people by 2007, 65 per cent by 2008, 75 per cent by 2009 and 90 per cent by 2010.

Against Discrimination of HIV/AIDS Victims

The government proposes to bring HIV/AIDS Bill with the following objectives: to prohibit discrimination, ensure right to disclosure of information on HIV status, right to access for testing, treatment and counseling, right to safe working environment, promotion of strategies for reduction of risks, right to information and education on HIV/AIDS, formulation of appropriate social security scheme and appointment of Health Ombud. As many as 49,840 persons in the age group of 15-29 have been reported as AIDS cases since 1993, accounting for 31.1 per cent of total reported AIDS cases in the country as on October 2006. Based on the results of HIV prevalence in different population groups, six states (Tamil Nadu, Andhra Pradesh, Karnataka, Maharashtra, Manipur and Nagaland) have been declared as high prevalence states, where HIV prevalence among ante-natal mothers has been observed to be more than one per cent. The NACP has adopted a Rights based approach and thus no children of the affected families will be denied the right of education or employment.

Public Health Law

HIV/AIDS presents major challenges to human survival, human rights and human development with implications far beyond the health sector. The social and economic consequences of the epidemic are perhaps one of the most serious threats to sustainable human development and the UNDP therefore, promotes and advocates for HIV as a developmental issue. In India, the government is engaged in the preparation of a draft Public Health Emergencies Bill to replace the existing Epidemic Diseases Act. As this Act is very old and there have been considerable advances in the epidemiological concepts towards prevention and control of epidemic diseases. Moreover, newer diseases such as HIV/AIDS, Avian Influenza etc have emerged as major potential challenges to tackle the public health emergency situations in the country arising as result of disasters and bio-terrorism incidents besides dangerous epidemic diseases by instituting appropriate public health measures.

Major Achievements of NACP

As on October 2006, a total of 1162 Sentinel Sites for HIV Trends have been established and 255 major blood banks and 883 district blood banks modernized. The awareness among people is over 80 per cent. More than 93,000 schools have been covered under the HIV/AIDS awareness programme. (PIB Features)
Disclaimer: The views expressed by the author in this feature are entirely his own and not necessarily reflect the views of PIB.

Lok Sabha

The National AIDS Control Organisation with support from National Institute of Health and Family Welfare and National Institute of Medical Statistics (ICMR), conducts Sentinel Surveillance every year among high-risk populations, STI patients and Antenatal mothers. Based on the results of HIV prevalence in different population groups, six states have been declared as high prevalence states where HIV prevalence among antenatal mothers has been observed to be more than one per cent. These States are Tamil Nadu, Andhra Pradesh, Karnataka, Maharashtra, Manipur and Nagaland.

National AIDS Control Programme has adopted a Rights based approach and thus no children of affected families will be denied the right of education or employment.

This information was given in the Lok Sabha today by Smt. Panabaka Lakshmi, Minister of State in the Ministry of Health and Family Welfare in a written reply to a question by Shri Asaduddin Owaisi.

SRK/ska