sikkim state aids control society
what we do
In 1992, the Government of India launched the first National AIDS Control Programme (NACP-I) which was implemented during 1992-1999 with an objective to slow down the spread of HIV infections, so as to reduce, morbidity and mortality and impact of AIDS in the country. Under the directives from National AIDS Control Organization (NACO), the Department of Health and Family Welfare established AIDS Cell in the year 1991-92 with the guidelines and strategies laid down by NACO.
In April, 1999 the programme entered into Phase II and during the same time Sikkim State AIDS Control Society was also constituted with a Governing body (Apex body) under the Chairmanship of the Chief Secretary with various Departmental Secretaries as members and Project Director as the member secretary. Further, an Executive Committee under the Chairmanship of Secretary, Health Care, Human Services and Family Welfare Department to implement the programme as per the guidelines of NACO was also constituted. In 2007 NACP Phase III was started which lasted till March 2012 with a goal to halt and reverse the epidemic. The first HIV case detected in the state of Sikkim was in the year 1995, since then there has been a steady increase in the rate of cases.
NATIONAL AIDS CONTROL PROGRAMME IV
National AIDS Control Programme IV started in 2012 to halt and reverse the rapid spread of HIV around the country. The main goals and objectives of NACP IV are:
1. To prevent infections through saturation of coverage of high-risk groups with targeted interventions (TIS) and scale up interventions in the general population.
2. To provide greater care, support and treatment to larger number of PHLA.
3. To strengthen the infrastructure, systems and human resources in prevention, care, support and treatment programmes at district and national level.
4. To strengthen the nationwide strategic information management system.
Component 1: Intensifying and Consolidating Prevention services with a focus on HRG and vulnerable populations
This component will support the scaling up of TIs with the aim of reaching out to the hard to reach population groups who do not yet access and use the prevention services of the program, and saturate coverage among the HRGs. In addition, this component will support the bridge population, i.e. migrants and truckers. Component 1 includes the following two subcomponents:
1.1 Scaling up coverage of TIs among HRG
The interventions under this sub-component will include: (i) the provision of behavior change interventions to increase safe practices, testing and counseling, and adherence to treatment, and demand for other services;(ii) the promotion and provision of condoms to HRG to promote their use in each sexual encounter; (iii) provision or referral for STI services including counseling at service provision centers to increase compliance of patients with treatment, risk reduction counseling with focus on partner referral and management; (iv) needle and syringe exchange for IDUs as well as scaling up of Opioid Substitution Therapy (OST) provision. This sub-component also includes the financing of operating costs for about 25 State Training Resource Centers as well as participant training costs over a period of 5 years.
1.2 Scaling up of interventions among other vulnerable populations
The activities under this subcomponent will include: (i) risk assessment and size estimation of migrant population groups and truckers at transit points and at workplaces; (ii) behavior change communications (BCC) for creating awareness about risk and vulnerability, prevention methods, availability and location of services, increase safe behavior and demand for services as well as reduce stigma;(iii) promotion and provisioning of condoms through different channels including social marketing; (iv) development of linkages with local institutions, both public and NGO owned, for testing, counseling and STI treatment services;(v) creation of “peer support groups” and “safe spaces” for migrants at destination; (vi) establishment of need-based and gender-sensitive services for partners of IDUs; and(vii) strengthening networks of vulnerable populations with enhanced linkages to service centers and risk reduction interventions, specifically condom use.
Component 2: Expanding IEC services for (a) general population and (b) high risk groups with a focus on behavior change and demand generation
IEC has been an important component of the NACP. With the expansion of services for counseling and testing, ART, STI treatment and condom promotion, the demand generation campaigns will continue to be the focus of the NACP-IV communication strategy. IEC will remain an important component of all prevention efforts and will include:
- Behavior change communication strategies for HRGs, vulnerable groups and hard to reach populations
- Increasing awareness among general population, particularly women and youth.
Component 3: Comprehensive Care, Support and Treatment
NACP IV will implement comprehensive HIV care for all those who are in need of such services and facilitate additional support systems for women and children affected and infected with HIV / AIDS. It is envisaged that greater adherence and compliance would be possible with wide network of treatment facilities and collaborative support from PLHIV and civil society groups. Additional Centers of Excellence (CoEs) and upgraded ART Plus centers will be established to provide high-quality treatment and follow-up services, positive prevention and better linkages with health care providers in the periphery.
With increasing maturity of the epidemic, it is very likely that there will be greater demand for 2nd line ART, OI management. NACP IV will address these needs adequately. It is proposed that the comprehensive care, support and treatment of HIV/AIDS will inter alia include: (i) anti-retroviral treatment (ART) including second line (ii) management of opportunistic infections and (iii) facilitating social protection through linkages with concerned Departments/Ministries. The program will explore avenues of public-private partnerships. The program will enhance activities to reduce stigma and discrimination at all levels particularly at health care settings.
Component 4: Strengthening institutional capacities
The objective of NACP IV will be to consolidate the trend of reversal of the epidemic seen at the national level to all the key districts in India. Programme planning and management responsibilities will be strengthened at state and district levels to ensure high quality, timely and effective implementation of field level activities and desired programmatic outcomes.
The planning processes and systems will be further strengthened to ensure that the annual action plans are based on evidence, local priorities and in alignment with NACP IV objectives. Sustaining the epidemic response through increased collaboration and convergence, where feasible, with other departments will be given a high priority during NACP IV. This will involve phased integration of the HIV services with the routine public sector health delivery systems, streamlining the supply chain mechanisms and quality control mechanisms and building capacities of governmental and non-governmental institutions and networks.
Component 5: Strategic Information Management Systems (SIMS)
The roll-out of SIMS is ongoing and will be firmly established at all levels to support evidence based planning, program monitoring and measuring of programmatic impacts. The surveillance system will be further strengthened with focus on tracking the epidemic, incidence analysis, identifying pockets of infection and estimating the burden of infection. Research priorities will also be customized to the emerging needs of the program. NACP IV will also document, manage and disseminate evidence and effective utilization of programmatic and research data. The relevant, measurable and verifiable indicators will be identified and used appropriately.
Blood Transfusion Services constitute a crucial part of health care delivery system. Adequate and safe supply of blood and blood components is essential to enable a wide range of critical care procedures to be carried out in hospitals. Unfortunately, blood transfusion can be a cause of illness like transmission of dreaded viruses like HIV etc. While the vast majority of HIV infections in India are attributed to the sexual route of transmission, we are mindful that the transfusion of unsafe blood and blood products account for 2.07 percent of the HIV infections in the country in 2004-2005. When viewed against the fact that in 1999 unsafe blood and blood products accounted for over 9 percent of AIDS cases, this drop to 2.07 percent is certainly encouraging.
Access to safe blood is maintained by law, and is the primary responsibility of NACO.
The specific objective of the blood safety programme is to ensure reduction in the transfusion associated with HIV transmission to 0.5 percent, while making available safe and quality blood within one hour of requirement in a health facility. Ensuring the widespread availability of safe and quality blood is a critical component of the National AIDS Prevention and Control Programme [NACP].
The state has 2 Government blood banks namely Central Blood Bank at STNM Hospital, Gangtok and District level Blood Bank at District Hospital, Namchi. These two blood banks are supported by NACO. The Blood Bank in Central Referral Hospital, Tadong under Sikkim Manipal Institute of Medical Sciences is a private blood bank. CBB, STNM Hospital is also identified as Regional Blood Transfusion centre (RBTC) to oversee the blood collection. All the blood banks in the state are licensed to supply whole human blood. Sikkim also has a State Reference Laboratory to conduct validation of the results of HIV positive and negative blood samples from various reporting unit (blood banks and ICTCs/PPTCS) on quarterly basis.
Red Ribbon is the symbol of solidarity, hope and support for those living with HIV. IT is also a symbol for the continuing education to those who are not infected and for maximum efforts to find treatment. Most significantly it is the symbol if awareness for HIV/AIDS.
Red Ribbon Clubs intends to be youth centric (targeting the age group 15-29 year) thus focusing on educating, informing and empowering young people on the issue of HIV/AIDS. In turn, these youths acts as a change agent in spreading the message on HIV/AIDS, STI, Life skills and Voluntary Blood Donation to other peers in campus and communities. The RRC scheme by National AIDS Control Organization targets youth and covers all educational institutions and non academic areas. Through RRC, youths are encouraged to learn about safe and healthy lifestyle.
As youths are considered to be one of the most vulnerable group the inception of Red Ribbon Club was necessitated and during the year 2008-2009, Sikkim State AIDS Control Society formed a total of 16 RRCs in colleges and community level. As of now there are 90 RRCs in the State and these clubs are an integral part of Sikkim SACS and play a major role in generating awareness among youth groups.
The main objectives of RRC are:
- To reduce new HIV infection among youth by raising their risk perception through awareness on sex.
- To induce among youth the spirit to help and support People Living with HIV/AIDS (PLHAs) thereby reducing stigma and discrimination against PLHAs.
- To motivate youth and capacitate as peer educators and change agents by developing their skills on leadership, negotiation and team building.
- To promote voluntary non-remunerated blood donation among youth.
One of the key prevention strategies of National AIDS Control Organization is Mainstreaming. HIV/AIDS is not merely a health concern but a developmental issue. It has been realized with time that it is essential to push the issue out of the closet and invite participation and deliberation from all sections of the society. The fact that HIV does not discriminate calls for every member of the society, politicians, bureaucrats and other stake holders to join hands to fight AIDS. With these perspectives in mind, mainstreaming as an important component of Prevention and Control strategy was initiated in Sikkim State AIDS Control Society in the year 2008.
Since then a number of advocacies, orientation, workshops, training and sensitization programmes targeting all sections of the society is being conducted every year.
Sikkim is a low prevalence state. The number of HIV+ cases here is less compared to other states of India. However, the number of positive cases detected from Integrated and Counseling Testing Centres (ICTC) has been increasing over the years which necessitate the needs for continuous care, treatment and support service available in the state. The state has one Anti Retroviral Therapy Centre (ART) housed at the Sikkim SACS building, Near STNM Hospital Complex, Gangtok. Patients from different districts are registered and followed up with clinical assessment and CD4 counting. Majority of the patients on ART are from the East district.
The ART Centre was established in the year 2005and the main focus of the Centre is to improve the quality of life of People Living with HIV/AIDSand reduce the morbidity and mortality rate.