District HIV/AIDS Epidemiological Profiles

India’s voice against AIDS Ministry of Health & Family Welfare, Government of India

6th & 9th Floors, Chandralok Building, 36, Janpath, New Delhi - 110001www.naco.gov.in

National AIDS Control Organisation

FACT SHEETSGujarat

District HIV/AIDS Epidemiological Profilesdeveloped through Data Triangulation

District HIV/AIDS Epidemiological Profilesdeveloped through Data Triangulation

FACT SHEETSGujarat

VERSION 1.0 GOI/NACO/SIM/DEP/011214

Published with support of the Centers for Disease Control and Prevention under Cooperative Agreement No. 3U2GPS001955 implemented by FHI 360



December 2014


district HIV/AIDS Epidemiological Profilesdeveloped through Data Triangulation

FACT SHEETS

Gujarat

(Dr. Ashok Kumar)iii

FOREWORDThe national response to HIV/AIDS in India over the last decade has yielded encouraging outcomes in terms of prevention and control of HIV. However, in recent years, while declining HIV trends are evident at the national level as well as in most of the States, some low prevalence and vulnerable States have shown rising trends, warranting focused prevention efforts in specific areas.

The National AIDS Control Programme (NACP) is strongly evidence-based and evidence-driven. Based on evidence from ‘Triangulation of Data’ from multiple sources and giving due weightage to vulnerability, the organizational structure of NACP has been decentralized to identified districts for priority attention.

The programme has been successful in creating a robust database on HIV/AIDS through the HIV Sentinel Surveillance system, monthly programme reporting data and various research studies. However, the district level focus of the programme demands consolidated information that helps better understand HIV/AIDS scenario in each district, to enable effective targeting of prevention and treatment interventions to the vulnerable population groups and geographic areas.

Information collected and analysed during the extensive data triangulation exercise conducted during 2009-10 and 2010-11 and updated data from recent years has been the basis for this technical document on District HIV Epidemiological Profiling. For each district it consists of a brief narrative report on the district background, the HIV/ AIDS epidemic profile of the district based on the updated information compiled from all the available sources, and key recommendations based on the identified information gaps and areas for programme interventions. I strongly feel that this document will be highly useful for programme managers at district, State and national levels.

The major outcomes of this exercise were systematic compilation of the available data for a district at one place, identification of information gaps for effective strategic planning at district level, and development of a framework for re-prioritisation of districts under the programme. The other key achievements were institutional strengthening, capacity building of programme staff in data analysis and data use, and involvement and ownership of staff of service delivery units in the entire process.

We congratulate the efforts made by the National Technical Team, the State AIDS Control Societies, and the State Coordinating agencies and all the district level personnel involved in the process. The technical & financial support provided by our partner agencies UNAIDS, USAID, BMGF and PHFI for this exercise is gratefully acknowledged. Special thanks to the officers from CDC, FHI 360, WHO, UNAIDS & JSI for their efforts in finalizing the individual factsheets. The efforts of the Officers of Data Analysis & Dissemination Unit at NACO for planning, coordinating & successfully completing this process and bringing out this valuable document, are appreciated.

Dr. Ashok Kumar, M.D.F.I.S.C.D & F.I.P.H.A

Dy. Director GeneralTele : 91-11-23731956Fax : 91-11-23731746E-mail : [email protected]

AcknowledgementUnder the project ‘District Epidemiological Profiling’ using Data Tringulation, the National AIDS Control Organisation had undertaken a systematic compilation and analysis of all the available data for 539 districts of the country from multiple sources, including surveillance data and programme data, to derive meaningful inferences. This document is an outcome of the Data Triangulation excercise and provides the district-wise HIV epidemic summary and programme response.

This enormous task would not have been possible without the involvement and ownership of district level programme managers and staff of service delivery units. The contributions of the District AIDS Prevention and Control Unit teams (Programme Managers, M&E Officers), ICTC Supervisors, Counselors, Targeted Intervention staff, ART Research Officers, NRHM District Programme Officers and others who were actively involved in the entire process, are highly appreciated.

The collaborative effort of the State Coordinating Agencies and the State AIDS Control Societies (SACS) involved in identifying programme questions, performing quality checks and data validation, preparation of data tables and compiling data for development of district profile reports, is sincerely acknowledged. The efforts of Deputy Director (M&E), State Epidemiologists and M&E Officers of SACS who implemented this exercise under the guidance and leadership of the Project Directors and Additional Project Directors are also appreciated.

The efforts made by the National Technical Team members who developed guidelines and tools for undertaking this project, and the teams involved in finalizing the database for each district and in preparing the district factsheets, are highly commendable.

The technical & financial support provided by our partner agencies UNAIDS, USAID, BMGF and PHFI for this exercise is gratefully acknowledged. Special thanks to the officers from CDC, FHI 360, WHO, UNAIDS & JSI for their sincere efforts in finalizing the individual district database and factsheets.

Role of Officers of Data Analysis & Dissemination Unit at NACO are deeply appreciated for planning, coordinating & successfully completing this process and bringing out this valuable document.

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Contents

v

Introduction ............................................................. 1

Methodology ........................................................... 2

Specific Notes on Fact sheets .................................... 6

District Map of Gujarat ........................................... 9

1. Ahmedabad ................................................... 10

2. Amreli ............................................................ 12

3. Anand ............................................................ 14

4. Banaskantha .................................................. 16

5. Bharuch ......................................................... 18

6. Bhavanagar ................................................... 20

7. Dahod ........................................................... 22

8. Gandhinagar ................................................. 24

9. Jamnagar ...................................................... 26

10. Junagadh ...................................................... 28

11. Kutch ............................................................. 30

12. Kheda ............................................................ 32

13. Mahesana ..................................................... 34

14. Narmada ....................................................... 36

15. Navsari .......................................................... 38

16. Panchmahals ................................................. 40

17. Patan ............................................................. 42

18. Porbandar ...................................................... 44

19. Rajkot ............................................................ 46

20. Sabarkantha ................................................... 48

21. Surat .............................................................. 50

22. Surendranagar ............................................... 52

23. The Dangs ...................................................... 54

24. Vadodra ......................................................... 56

25. Valsad ............................................................ 58

Foreword ............................................................................................................................................. iii

Acknowledgement .............................................................................................................................. iv

Contents ........................................................................................................................................... v

Acronyms ........................................................................................................................................... vi

Glossary ............................................................................................................................................... vii

Acronyms

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AIDS Acquired Immune Deficiency Syndrome

ANC Antenatal Clinic

ART Anti-Retroviral Therapy

BSS Behavioral Surveillance Survey

CCC Community Care Centre

CMIS Computerised Management Information System

DEP district Epidemiological Profile

DIC Drop-in-Centre

DLHS district Level Health Survey

DLN district Level Network for HIV positive people

FSW Female Sex Workers

HIV Human Immunodeficiency Virus

HRG High Risk Group

HSS HIV Sentinel Surveillance

IBBA Integrated Biological and Behavioral Assessment

IBBS Integrated Biological and Behavioral Survey

ICTC Integrated Counseling and Testing Centre

IDU Injecting Drug Users

IEC Information Education & Communication

LAC Link ART Centre

MSM Men who have Sex with Men

NACO National AIDS Control Organisation

NACP National AIDS Control Programme

NFHS National Family Health Survey

PLHIV People Living with HIV

PPTCT Prevention of Parent to Child Transmission

RRC Red Ribbon Club

RTI Reproductive Tract Infection

SACS State AIDS Control Society

SCA State Coordinating Agency

STD Sexually Transmitted Disease

STI Sexually Transmitted Infection

TB Tuberculosis

TI Targeted Interventions

Glossary1. ART Centre: Free first line and second line Anti-Retroviral Treatment (ART) is provided to clinically eligible PLHIV

at designated centres across the country. As soon as the persons are detected to be HIV positive at ICTC, they are referred to the ART centre for pre-ART registration. At the time of registration, all the baseline investigations are done including CD4 count. If these persons are clinically eligible for treatment, they are started on first line ART. Otherwise, PLHIV are followed up every six months for CD4 count. The number of PLHIV on ART mentioned in the document refers to those on first line ART at NACO-supported ART centres. Another 30,000 PLHIV are estimated to be receiving ART in the private sector.

2. Blood Safety: Under the Blood Safety programme, Blood Banks across the country are supported by NACO and voluntary blood donation is strongly promoted to ensure that every blood unit collected is screened and is free from HIV and other infections.

3. Community Care Centres (CCC): CCC have been set up in the non-government sector with the objective of providing PLHIV with psychosocial support, counseling for drug adherence and nutrition, treatment of opportunistic infections, home-based care, referral and outreach services for follow up, besides tracing patients lost to follow up and those missing anti-retroviral drugs as per schedule.

4. Condom Promotion: The condom promotion strategy under NACP focuses on two aspects: ensuring availability of and creating demand for condoms. There are two channels of condom supply by the Government, namely free and socially marketed. Under the programme, free condoms are distributed to High Risk Groups through TI projects and service delivery outlets such as ICTCs, STI clinics, etc. Under the Targeted Condom Social Marketing Programme, condoms are provided at subsidized rates for HRG as well as general population through traditional and non-traditional condom outlets, rural outlets, and outlets at TIs and truck halt points.

5. Core Composite TI: Targeted Interventions providing HIV prevention services to more than one High Risk Group.

6. Counseling and Testing Services: Integrated Counseling and Testing Centre (ICTC) is a place where a person is counseled and tested for HIV on his/her own volition (Client-Initiated) or as advised by a health service provider (Provider-Initiated) in a supportive and confidential environment. These centres are the entry points for reinforcing HIV prevention messages and linking HIV positive people to HIV care, support and treatment services. There are several contexts for providing HIV testing services - voluntary counseling and testing, prevention of parent to child transmission, screening of TB patients and diagnostic testing of symptomatic patients.

7. Drop-in-Centre (DIC): DIC is a platform to provide PLHIV psycho-social support, linkages with services counseling on drug adherence, nutrition, livelihood and legal issues. They have been set up in the high prevalent districts and are managed primarily by PLHIV networks.

8. High Risk Groups (HRG): Populations with high risk behaviour for contracting HIV, include Female Sex Workers (FSW), Men who have Sex with Men (MSM) and Injecting Drug Users (IDU). The other risk groups identified as Bridge Population (between the General population and HRG) include the Single Male Migrants and Long Distance Truckers.

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IntroductionThe National AIDS Control Programme under National AIDS Control Organisation has a strong focus on district level planning, implementation and monitoring of interventions for prevention and control of HIV/AIDS. This approach requires consolidated information for each district to understand the HIV epidemic scenario and to identify programme areas for priority attention.

During the past few years, greater information related to HIV has become available for a substantial number of districts in the country in the form of monthly programme reports, mapping and size estimations of risk groups, data from HIV Sentinel Surveillance, behavioural surveys research studies, and etc.

In view of this context, the Department of AIDS Control had undertaken a project titled “Epidemiological Profiling of HIV/ AIDS Situation at district and Sub-district Level using Data Triangulation”/“district Epidemiological Profiling (DEP)” in 25 states (539 districts) in two phases during 2009-10 and 2010-11.

The exercise of district Epidemiological Profiling involved two broad components – Descriptive Analysis and Data Triangulation. The former part is guided by thematic areas and describes the ‘what, who, when & where’ of the HIV epidemic, while the latter ‘Triangulation’ part explains the ‘how and why’ of it by synthesizing data from multiple sources into a meaningful framework. The available epidemiological data, behavioural/ vulnerability data and programme data for the district level were compiled and analysed to get a comprehensive picture of the HIV/AIDS epidemic scenario, in order to guide programme decisions appropriately in each district.

The important outcomes of the district Epidemiological Profiling exercise included the generation of reports describing the HIV profile and programme response in each district, identification of information gaps for planning strategic information activities, capacity building of district level personnel in data management, institutional strengthening and fostering linkages between programme units and academic institutions for addressing strategic information needs in the programme.

This technical document consists of the epidemiological profile summary along with the available updated information for each district of the State. Each district summary highlights the key epidemiological features of the district and key recommendations based on these findings. The document would be useful to programme managers, academicians and researchers as a quick reference for the HIV/AIDS situation in a district.

Introduction9. Link ART Centres: In order to facilitate the delivery of ART services nearer to the homes of beneficiaries, the Link ART Centres (LAC), located mainly at ICTC in the district/Sub-district level hospitals, were set up and linked to nodal ART centres within accessible distance.

10. PLHIV Networks: Networks of HIV positive persons have been formed at the national, state and district levels. Such networks act as platforms for People Living with HIV/AIDS (PLHIV) to share their concerns, and seek support and legal aid. They address stigma and discrimination-related cases among their members and also provide social support for those isolated by their family and community. The networks are encouraged to advocate and promote the utilisation of HIV related services.

11. Prevention of Parent to Child Transmission (PPTCT): Mother to child transmission of HIV may take place during pregnancy, during childbirth or through breast feeding. To prevent this, under the PPTCT programme every pregnant woman visiting antenatal clinics or visiting hospital at the time of delivery is tested for HIV infection. A pregnant woman found positive for HIV infection is closely followed up to ensure institutional delivery. At the time of delivery, the pregnant woman and the new-born baby are given a single dose of Nevirapine to prevent mother to child transmission of HIV.

12. Red Ribbon Clubs: Red Ribbon Clubs (RRC) formed in colleges provide a forum for students to come together to share information on HIV/AIDS and safe behaviours, to discuss related issues and also motivate them to participate in voluntary blood donation.

13. STI/RTI Services: Sexually Transmitted Infections/Reproductive Tract Infections increase the risk of HIV transmission significantly. STI/RTI services are aimed at preventing HIV transmission and promoting sexual and reproductive health under the National AIDS Control Programme and the Reproductive and Child Health programme of the National Rural Health Mission (NRHM).

14. Targeted Intervention: Targeted Interventions (TI) are peer-led preventive interventions focused on HRG and bridge populations, implemented by Non-Government Organisations and Community-based Organisations in a defined geographic area. They provide prevention services such as behavioural change communication, condom distribution, STI/RTI services, needle and syringe exchange, Opioid substitution therapy, referrals and linkages to health facilities providing HIV/AIDS services, community mobilisation and creating enabling environment.

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District HIV/AIDS Epidemiological Profiles : Gujarat | 1

IntroductionThe National AIDS Control Programme under National AIDS Control Organisation has a strong focus on district level planning, implementation and monitoring of interventions for prevention and control of HIV/AIDS. This approach requires consolidated information for each district to understand the HIV epidemic scenario and to identify programme areas for priority attention.

During the past few years, greater information related to HIV has become available for a substantial number of districts in the country in the form of monthly programme reports, mapping and size estimations of risk groups, data from HIV Sentinel Surveillance, behavioural surveys research studies, and etc.

In view of this context, the Department of AIDS Control had undertaken a project titled “Epidemiological Profiling of HIV/ AIDS Situation at district and Sub-district Level using Data Triangulation”/“district Epidemiological Profiling (DEP)” in 25 states (539 districts) in two phases during 2009-10 and 2010-11.

The exercise of district Epidemiological Profiling involved two broad components – Descriptive Analysis and Data Triangulation. The former part is guided by thematic areas and describes the ‘what, who, when & where’ of the HIV epidemic, while the latter ‘Triangulation’ part explains the ‘how and why’ of it by synthesizing data from multiple sources into a meaningful framework. The available epidemiological data, behavioural/ vulnerability data and programme data for the district level were compiled and analysed to get a comprehensive picture of the HIV/AIDS epidemic scenario, in order to guide programme decisions appropriately in each district.

The important outcomes of the district Epidemiological Profiling exercise included the generation of reports describing the HIV profile and programme response in each district, identification of information gaps for planning strategic information activities, capacity building of district level personnel in data management, institutional strengthening and fostering linkages between programme units and academic institutions for addressing strategic information needs in the programme.

This technical document consists of the epidemiological profile summary along with the available updated information for each district of the State. Each district summary highlights the key epidemiological features of the district and key recommendations based on these findings. The document would be useful to programme managers, academicians and researchers as a quick reference for the HIV/AIDS situation in a district.

Introduction9. Link ART Centres: In order to facilitate the delivery of ART services nearer to the homes of beneficiaries, the Link ART Centres (LAC), located mainly at ICTC in the district/Sub-district level hospitals, were set up and linked to nodal ART centres within accessible distance.

10. PLHIV Networks: Networks of HIV positive persons have been formed at the national, state and district levels. Such networks act as platforms for People Living with HIV/AIDS (PLHIV) to share their concerns, and seek support and legal aid. They address stigma and discrimination-related cases among their members and also provide social support for those isolated by their family and community. The networks are encouraged to advocate and promote the utilisation of HIV related services.

11. Prevention of Parent to Child Transmission (PPTCT): Mother to child transmission of HIV may take place during pregnancy, during childbirth or through breast feeding. To prevent this, under the PPTCT programme every pregnant woman visiting antenatal clinics or visiting hospital at the time of delivery is tested for HIV infection. A pregnant woman found positive for HIV infection is closely followed up to ensure institutional delivery. At the time of delivery, the pregnant woman and the new-born baby are given a single dose of Nevirapine to prevent mother to child transmission of HIV.

12. Red Ribbon Clubs: Red Ribbon Clubs (RRC) formed in colleges provide a forum for students to come together to share information on HIV/AIDS and safe behaviours, to discuss related issues and also motivate them to participate in voluntary blood donation.

13. STI/RTI Services: Sexually Transmitted Infections/Reproductive Tract Infections increase the risk of HIV transmission significantly. STI/RTI services are aimed at preventing HIV transmission and promoting sexual and reproductive health under the National AIDS Control Programme and the Reproductive and Child Health programme of the National Rural Health Mission (NRHM).

14. Targeted Intervention: Targeted Interventions (TI) are peer-led preventive interventions focused on HRG and bridge populations, implemented by Non-Government Organisations and Community-based Organisations in a defined geographic area. They provide prevention services such as behavioural change communication, condom distribution, STI/RTI services, needle and syringe exchange, Opioid substitution therapy, referrals and linkages to health facilities providing HIV/AIDS services, community mobilisation and creating enabling environment.

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2 | District HIV/AIDS Epidemiological Profiles : Gujarat

MethodologyFramework of district Epidemiological Profiling (DEP): DEP has two broad components Descriptive Analysis and Data Triangulation.

Descriptive analysis of different datasets is organized into the following four thematic areas (Fig.1):

1. Current state of HIV epidemic (levels, trends, differentials and burden of HIV; profle of PLHIV)

2. Drivers of the epidemic (size and profle of risk groups; vulnerabilities STI, risk behaviour, Migration, contextual factors/regional vulnerabilities)

3. Programme response and gaps

4. Information gaps

Data Triangulation may be of information on same data element from different data sources or of information on different data elements. Triangulation may be done in the time plane or geographical plane. Triangulation synthesizes the data on the following three elements to explain the inferences arrived at in the descriptive analysis and provides answers to the programmatic questions.

1. Information on HIV and STIs in different population groups (epidemiological data)

2. Information on vulnerabilities (mapping and behavioural data on Risk Groups, district vulnerabilities)

3. Information on programme response (programme data)

Table 1: Components of district Epidemiological Profiling

Fig. 1: Thematic Areas of district ProfilingEpidemiological Framework of HIV/AIDS Scenario in the district

Componentsof district

ProlingWhat it Does?

GuidingElements

Action To Do Output

DescriptiveAnalysis

Describes(What? Who? When?

Where?)Themes

Analyse Data &Describe the Themes

Descriptive Section ofdistrict Report

TriangulationExplains

(How? Why?)Questions

Triangulate Data &Answer the Questions

Synthesis Section ofdistrict Report

Current State of Epidemic

ProgrammeResponse &

Gaps

InformationGaps

Drivers ofEpidemic

districtProfile

Concept of Data Triangulation: Data Triangulation is an Analytical Approach that synthesizes data from multiple sources to improve the understanding of a public health issue and guide programmatic decision-making to address the issue (Fig. 2). By putting different bits of information from different sources into a meaningful framework, it explains and improves the understanding of HIV/AIDS scenario in the district. By providing answers to vital programme questions, it helps in taking effective decisions for planning and implementation of HIV prevention and control efforts. It helps to understand the gap between need and programme response and also helps to identify the information gaps that hinder effective planning.

The basic principle of Data Triangulation is “to analyse and interpret a dataset in the light of information emerging from other datasets, so that the synthesis offers a better understanding of the issues than what will be inferred from a single dataset.” Triangulation involves compilation, examination, comparison and collective interpretation of data from multiple independent data sources, followed by reasonable explanation of facts pertaining to the issue under consideration (Fig. 3). The explanation is aimed towards developing a comprehensive picture of the issue, building an epidemiological framework that depicts the possible interplay among various factors and answering some pre-specified questions.

Fig. 2: Conceptual Framework of Data TriangulationSynthesis of Epidemiological, Behavioural and Programme Data

Fig. 3: Schematic representation of processes involved in Data Triangulation

HIV & STIsin Different

Groups

TRIANGULATION

Size &Vulnerability

of RiskGroups

ProgrammeResponse


MethodologyFramework of district Epidemiological Profiling (DEP): DEP has two broad components Descriptive Analysis and Data Triangulation.

Descriptive analysis of different datasets is organized into the following four thematic areas (Fig.1):

1. Current state of HIV epidemic (levels, trends, differentials and burden of HIV; profle of PLHIV)

2. Drivers of the epidemic (size and profle of risk groups; vulnerabilities STI, risk behaviour, Migration, contextual factors/regional vulnerabilities)

3. Programme response and gaps

4. Information gaps

Data Triangulation may be of information on same data element from different data sources or of information on different data elements. Triangulation may be done in the time plane or geographical plane. Triangulation synthesizes the data on the following three elements to explain the inferences arrived at in the descriptive analysis and provides answers to the programmatic questions.

1. Information on HIV and STIs in different population groups (epidemiological data)

2. Information on vulnerabilities (mapping and behavioural data on Risk Groups, district vulnerabilities)

3. Information on programme response (programme data)

Table 1: Components of district Epidemiological Profiling

Fig. 1: Thematic Areas of district ProfilingEpidemiological Framework of HIV/AIDS Scenario in the district

Componentsof district

ProlingWhat it Does?

GuidingElements

Action To Do Output

DescriptiveAnalysis

Describes(What? Who? When?

Where?)Themes

Analyse Data &Describe the Themes

Descriptive Section ofdistrict Report

TriangulationExplains

(How? Why?)Questions

Triangulate Data &Answer the Questions

Synthesis Section ofdistrict Report

Current State of Epidemic

ProgrammeResponse &

Gaps

InformationGaps

Drivers ofEpidemic

districtProfile

Concept of Data Triangulation: Data Triangulation is an Analytical Approach that synthesizes data from multiple sources to improve the understanding of a public health issue and guide programmatic decision-making to address the issue (Fig. 2). By putting different bits of information from different sources into a meaningful framework, it explains and improves the understanding of HIV/AIDS scenario in the district. By providing answers to vital programme questions, it helps in taking effective decisions for planning and implementation of HIV prevention and control efforts. It helps to understand the gap between need and programme response and also helps to identify the information gaps that hinder effective planning.

The basic principle of Data Triangulation is “to analyse and interpret a dataset in the light of information emerging from other datasets, so that the synthesis offers a better understanding of the issues than what will be inferred from a single dataset.” Triangulation involves compilation, examination, comparison and collective interpretation of data from multiple independent data sources, followed by reasonable explanation of facts pertaining to the issue under consideration (Fig. 3). The explanation is aimed towards developing a comprehensive picture of the issue, building an epidemiological framework that depicts the possible interplay among various factors and answering some pre-specified questions.

Fig. 2: Conceptual Framework of Data TriangulationSynthesis of Epidemiological, Behavioural and Programme Data

Fig. 3: Schematic representation of processes involved in Data Triangulation

HIV & STIsin Different

Groups

TRIANGULATION

Size &Vulnerability

of RiskGroups

ProgrammeResponse


Other key features of the process of Data Triangulation are as follow:

1. It gives importance to every bit of information

2. It helps overcome limitations and biases inherent in each dataset

3. It adds value to each dataset and improves their utility

4. It gives high importance to quality analysis of data and undertakes thorough quality checks and validation

5. Indicates the level of reliability in any inference or conclusion

Table 2: Data Sources used for district Epidemiological Profiling

Thematic areas for HIV Epidemiological Profling

Major Sources

HIV Levels, Trends and Differentials HIV Sentinel Surveillance (HSS); Integrated Biological &Behaviroual Assessment (IBBA); ICTC data; PPTCT data; Bloodbank data; NFHS-III; Any other HIV prevalence studies

STI Levels, Trends and Differentials Behaviroual Surveys (IBBA); STI Clinic data; TargetedIntervention (TI) data; NFHS-I,II & III; DLHS-I ,II & III;Other Behavioral studies

HIV burden in the district HIV estimations

Size Estimates of General Population and Other Risk Groups

Census Population Projections; Mapping of HRG; TI data

Profile, Turn-over & Migration of key risk groups

HSS ;IBBA; BSS; Mapping of HRG ;ICTC data; STI Clinic data; TI data; Other Studies on High Risk Groups; DLHS

Size & Patterns of Migration amongGeneral Population

Census data; Mapping of Migrants; Population Council studies;Other studies on migrants

Risk Behaviours and Prevention Practices among key risk groups and general population

BSS; IBBA; DLHS; TI data; Mapping of HRG; Other published/unpublished data

Profile of PLHIV HSS; IBBA; ICTC data; PPTCT data; ART data; Positive personnetworks; Blood Bank Data; NFHS-III; Any other HIV prevalence studies

District Vulnerabilities Local Knowledge; Open sources such as Wikipedia; districtWebsites; State Government Websites; etc.

Programme Response Programme reporting through CMIS

Process of district Epidemiological Profiling: The process starts with identifying a broad set of important, actionable and appropriate questions that the programme wants to find answers to, in a given region, and revisits and refines the questions at every step of the process. The process of DEP has the following steps:

1. Understanding thematic areas and questions for district Profiling and Triangulation

2. Review of data sources and assessment of data availability in the district

3. Decision on themes to be described and questions to be answered for the district

4. Compilation of secondary data

5. Quality check for completeness, correctness and consistency

6. Data validation, adjustments and filling data gaps

7. Preparation of data tables with clean data for analysis

8. Data analysis, interpretation and inferences; describe thematic areas

9. Data Triangulation (hypotheses building; answer triangulation questions)

10. Preparation of district and State reports

11. Discussions and consultation with SACS, local experts, district level programme managers and service delivery functionaries on draft reports

12. Presentation and discussion of draft reports with the National Technical Team

13. Finalisation of district Epidemiological Profile reports

Important Outcomes of district Epidemiological Profiling include:

1. Cleaning and validation of programme data (since 2004)

2. Systematic compilation of all data related to HIV for each district at one place for routine use

3. district reports describing the profile of HIV epidemic and programme response in each district

4. Development of framework for re-prioritisation of districts under the programme

5. Prioritisation extended upto Sub-district/Block level with high priority blocks identified

6. Identification of information gaps at district and state level for planning strategic Information activities

7. Capacity building of district level programme managers and staff of service delivery units in handling and analyzing data, enabling them to understand the importance of the data they generate and the need for ensuring its quality, and appreciate the use of data for programme review, decision-making and effecting improvements.

8. Enhanced understanding among the programme managers of HIV epidemic and response in the state and different districts

9. Better use of data in developing district and State Annual Action Plans

10. Institutional strengthening (building state level resource pools) and fostering linkages between programme units and academic institutions for addressing Strategic Information needs in the programme


Specific Notes on Fact sheets 1. Each district fact sheet has two parts: a narrative part consisting of background along with a map, HIV epidemic

profile and key recommendations, and a tabular part consisting HIV levels and trends, PLHIV profile, block-level details, vulnerabilities and programme response. While the narrative part gives an overview of the district HIV/AIDS profile, the table provides detailed information about the HIV/AIDS scenario in the district.

2. ‘Background’ gives a brief overview of the district with respect to its geographic location, key demographic information like total population with male-female distribution, literacy status – based on 2011 Census. The section also describes the district characteristics or contextual factors that makes it vulnerable to spread of HIV.

3. ‘Epidemic profile’ describes the thematic areas mentioned above (under the data sources) for each district based on available information.

4. From DLHS-III, percentages of ever married women aged 15-49 years who have heard of HIV/AIDS and RTI/STI have been taken as awareness indicators among women for HIV and RTI/STI respectively.

5. ‘Key recommendations’ is the final section of the factsheet where ‘Triangulation’ of data is attempted to highlight the key programme priorities for the district based on the HIV epidemic profile and programme gaps. Any future potential for spread of infection, if indicated by any information or results, is highlighted and appropriate action to address the situation is suggested. On the basis of this analysis, recommendations for improving existing programme, and the need for initiation of new programmes, etc. are highlighted. The recommendation section also highlights information gaps, if any.

6. Data on ANC utilization mentioned in the table refer to the proportion of women who received at least three or more antenatal checkups (Data source: DLHS-III).

7. HIV positivity rates among HSS-ANC, PPTCT and Blood Bank attendees are used to represent levels and trends of HIV Infection among general population. Level is interpreted as high (HIV positivity ≥1%), moderate (HIV positivity between 0.5-1%) or low (HIV positivity ≤ 0.5%). HIV trend is interpreted as rising, stable or declining.

8. HIV positivity rates among HSS-HRG, HSS-STD and ICTC general clients disaggregated by sex and nature of client (direct walk-in and referred) are used to represent levels and trends of HIV Infection among high risk groups and vulnerable population. Level is interpreted as high (HIV positivity ≥ 10%), moderate (HIV positivity between 5-10%) or low (HIV positivity ≤ 5%). HIV trend is interpreted as rising, stable or declining.

9. Positivity at HSS, PPTCT, Blood bank and ICTC sites is presented only for those years where the sample size is valid i.e. HSS-ANC: ≥ 300 tested, HSS-HRG/STD: ≥ 187 tested, ICTC (male + female/direct walk-in + referred): ≥ 600 tested, PPTCT and BB: ≥ 900 tested.

10. HIV positivity among PPTCT and ICTC attendees at sub-district level wherever data is available is presented under block level details.

11. Size, demographic and risk profile of PLHIV in a district is inferred from three data sources: ICTC data, ART Registration data and data from the PLHIV Network in the district.

12. Information on major vulnerabilities that are influencing the epidemic/high risk behaviour i.e drivers of the epidemic is included under the “vulnerabilities” section. It includes:

a. Size and Profile of HRG

b. STIs – levels and trends

c. Migration patterns

d. District Vulnerabilities/ Contextual Factors

13. Information on size and profile (demographic or sub-typology) of HRG is available from mapping data. Size of HRG as a proportion of the districts population has been stated wherever available, for comparison purposes. The Taluks/Blocks with high concentration of different HRGs have been given under block level details, wherever available. Targeted Intervention (TI) targets and coverage of HRG population are also mentioned, wherever available under “HRG size”.

14. Based on CMIS-STI data, number of episodes of STI/RTI managed using syndromic approach and VDRL/RPR test results for syphilis in the district are given under “STI/RTI”.

15. Wherever possible, an attempt has been made to describe the male out-migration patterns in the district based on Census 2001 data. The table also includes the proportion of male migrants going to other states (inter-state) along with top five destination districts.

16. The section on programme response describes the number of facilities offering HIV services under NACP and services provided in the district till 2012. This covers both prevention interventions and care, support and treatment interventions.

17. The number of TIs mentioned in the document includes only NACO-supported TIs. Migrant TIs include source, transit and destination TIs.

18. All maps used in this document have been prepared from the Survey of India.

19. The district wise factsheets include updated information till 2012. Therefore, the districts newly created after 2012 have not been shown as separate districts. The districts with insufficient data are also not included in this report.


District Map of Gujarat


AhmedabadBackground:

Ahmedabad district comprises the city of Ahmedabad, the 7th largest city of India located in the central part of the state of Gujarat. It is the most populous district of Gujarat and the eighth most populous district in India with a population of 72.08 lakh, a sex ratio of 903 females per 1,000 males; female literacy rate of 80.29%, with an overall literacy rate of 86.65% (Census 2011). Ahmedabad is an industrial hub for textiles and is popularly known as the ‘Manchester of India’. Ahmedabad is developing excellent urban infrastructure for services economy which is largely an urban phenomenon. Ahmedabad is the center of Gujarati cultural activities and diverse traditions of different ethnic and religious communities. The district is home to one of the famous World Heritage Site, the Adalaj Vav (Stepwell), and other tourist spots. National Highway 8 passes through the district connecting it to major industrial centers.

HIV Epidemic Profile:

• Basedon2012HSS-ANCdata,HIVprevalencewaslowat0.25%amongtheANCattendees,representingafluctuatingtrend.

• Accordingto2012PPTCTdata,HIVpositivitywaslowat0.20%amongthePPTCTattendees,withastabletrend.

• Accordingto2012BloodBankdata,HIVpositivitywaslowat0.12%amongtheBloodBankdonors,withastabletrend.

• Accordingto2010HSS-FSWdata,HIVprevalencewaslowat3.21%amongtheFSWs.Accordingto2010HSS-MSMdata,HIVprevalencewas low at 3.02% among the MSM.

• In2012,HIVpositivityamongICTCattendeeswas lowamongmale(2.95%)andfemale(2.09%)clients,aswellasamongreferred(2.05%) and direct walk-in (3.33%) clients. A decreasing trend was observed over a period of five years among all the ICTC clients

• AccordingtoHRGmappingdata,MSM(6,526)represent51.58%ofthetotalHRGpopulationinthe)inthedistrictfollowedbyFSW(5,667) representing 44.79% , while IDU (460) represent the remaining 3.64%. 96% of the mapped MSM are married.

• In2012,87,760STI/RTIepisodesweretreatedandthesyphilispositivityrateamongSTIclinicattendeeswas0.39%.

• Asperthe2001Census,6.21%ofthemalepopulationweremigrants;amongthem15.56%migratedtootherstatesand41.59%migrated to other districts within the state.

• Thetoptwodestinationsforout-ofstatemigrationwereThaneandMumbai(Suburban),Maharashtra.

• AccordingtoDLHS-IIIdata,theHIVandSTI/RTIawarenessrateamongwomenwas67.1%and37.4%,respectively.

• In2012,ninetargetedintervention(TI)siteswereoperationalinthedistrict.

Key Recommendations:

• GiventhenumberofmappedHRGsandHIVprevalenceamongvulnerablegroups,increasethenumberofTIsitesinthedistrict.Conductsocio-demographic analysis and necessary outreach for HIV prevention delivery to spouses or partners of HRG also, and support their linkage to services.

• Conduct socio-demographic analysis of HSS-ANC data to ascertain risk factors, considering fluctuating prevalence among HSS-ANCattendees.

• districtneedstocontinueattentiontodecreaseandlimitthespreadofHIVinfectionfurtheramongbothgeneralandHRGpopulation.

• ConsideringhighrateofmigrationtohighHIVprevalentdistricts,strengthenoutreachprogrammethroughawarenesscampaignsaroundsource and transit points like railway stations and bus stands.

• AnalyzethepopulationsizeandprofileofFSW’sclients,includingmigrantsandtruckers,tobetterunderstanddistrictvulnerabilities.

• AvailabilityofARTorDLNdatawouldhelpinbetterunderstandingofdistrictvulnerabilities.

Ahmedabad District


Ahm

edabadDistrict Population: 72,08,200 (11.94%

of Gujarat Population); Fem

ale Literacy1: 80.29%

; ANC Utilization

2: 67.3%

2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

00

00.25

0.500.25

NT

4400

400400

400400

400

PPTCTPP

--

0.430.31

0.370.24

0.190.20

NT

--

1174734752

4706858861

6578556042

Blood BankPP

--

0.220.18

0.240.21

0.150.12

NT

--

301759239776

157718163782

175822183157

HSS-STDPP

4.8018.00

-22.00

--

NT

250250

-250

--

HSS-FSWPP

--

-6.43

3.21-

NT

--

-249

249-

HSS-MSM

PP-

--

4.173.02

-N

T-

--

216232

-

HSS-IDUPP

--

--

--

NT

--

--

--

ICTC Male

PP-

--

6.385.04

2.842.75

2.95N

T-

--

3144727603

4471754626

42648

ICTC Female

PP-

--

5.864.97

1.862.18

2.09N

T-

--

1796914482

3193029103

28465

ICTC ReferredPP

--

-5.42

3.892.55

2.362.05

NT

--

-14168

2209436803

4056840078

ICTC Direct W

alk-inPP

--

-6.50

6.262.32

2.723.33

NT

--

-35248

1999139844

4316131035

Total tested at ICTCs

5 N

T-

-11747

84168103728

135508149514

127155

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (20068)24

960

6211

DLN (N

A)-

--

--

Block-Level Details

No. HRG

-FSW-

- -

- -

- -

- -

No. HRG

-MSM

- -

- -

- -

- -

- N

o. HRG- IDU

- -

- -

- -

- -

-

% Pos;

ICTC

Taluka 1 Ahm

eda-bad 3.64

Taluka2 Dascroi

0

Sanand 3.23

Bavla 7.5

Dholka 4.44

Viramgam

0

- Kadi Kalol

2.13M

ehsana 15.79

% Pos;

PPTCT

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

1854)87.59

1.943.34

1.563.83

1.73

HIV Levels and Trends

3

* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years w

here sample size is valid (HSS-AN

C ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); 4 PP =

percent positive, N

T = num

ber tested; 5 General clients & pregnant w

omen.

STI/RTI2009

20102011

2012

No. episodes treated

-53022

8530787760

% Syphilis positivity

-1.10

1.100.39

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

11

11

22

23

3M

SM TIs

11

11

32

35

5IDU TIs

--

--

11

11

-Com

p. TIs-

--

--

11

11

ICTCs-

--

1627

4475

7893

Blood Banks15

1518

2222

2422

2324

STI clinics-

--

55

56

78

ART centres-

11

11

12

22

Link ART centres-

--

--

--

-1

PLHIV Netw

orks-

22

22

22

22

Red Ribbon Clubs-

--

--

3030

140148

Comm

. care centres-

--

12

33

11

Drop-in-centres-

-2

33

33

33

Condom outlets

--

--

--

--

-

VulnerabilitiesM

ale Migration, 2001 Census

Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

19070829683

7931181714

% of m

ale pop.

6.210.97

2.582.66

% total

migration

10015.56

41.5942.85

Top 5 districts for inter-state out-migration

Thane, M

aharash-tra

Mum

bai (Suburban)

, Maha-

rashtra

Pune, M

aharash-tra

Mum

bai, M

aharash-tra

Sirohi, Rajasthan

HRG Size

FSWM

SMIDU

Size Est., (Mapping,

Year: NA)

56676526

460

% Total HRG

44.7951.58

3.64

% Total Pop.

0.080.09

0.01

Program Target

NA

NA

NA

Program Coverage

--

-

Typology

Home

based-16.13%

;

Brothel based-

27.42%;

Street based-

56.45%

Kothi-79.71%

;

Panthi-N

A;

Double decker-20.29%

Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.16.94

8.00-

% M

arried-

96.00-


AmreliBackground:

Amreli is located in the western part of Gujarat, near the Gulf of Khambhat: an inlet of the Arabian Sea along India’s western coast. Amreli city is the district headquarters of Amreli. It has a population of 15.13 lakh that is largely rural (74.51%), a sex ratio of 964 females per 1,000 males; female literacy rate of 66.97%, with an overall literacy rate of 74.49% (Census 2011). The economy of Amreli depends upon agriculture. The district is a non-industrial area. Amreli is home to many wild life sanctuaries including the Gir Lion Sanctuary, the only abode to Asiatic Lions in the world, and Paniya and Mityala wildlife sanctuaries which are tourist attractions. National Highway 8E passes through the district connecting it to Junagadh and Bhavnagar district.


• Basedon2012HSS-ANCdata,HIVprevalencewaslowat0.25%amongtheANCattendees,withafluctuatingtrend.



• In2012,HIVpositivityamongICTCattendeeswasrelativelylowamongmale(2.39%)andfemale(0.88%)clients,aswellasamongreferred (1.80%) and direct walk-in (1.29%) clients. ICTC male clients experienced a fluctuating trend, female and direct walk-ins had a declining trend, whereas referred clients observed a stable trend with a rise in 2011.

• AccordingtoHRGmappingdata,FSW(210;53.98%ofthetotalHRG)wasthelargestHRGinthedistrictfollowedbyMSM(179;46.02%of the total HRG).


• Accordingtothe2001census,outoftheoverallpopulation,16.35%ofmalesweremigrants;amongthem3%migratedtootherstatesand 70.36% migrated to other districts within the state.

• Thetoptwodestinationsforout-of-statemigrationwereMumbai(Suburban)andThane,Maharashtra.

• Accordingto2012ICTCdata,HIVtransmissionsthroughfromparenttochildaccountedfor5.16%ofthetotalHIVtransmissionsinthedistrict.


• ThereweretwocompositeTIsinthedistrictin2012.


• Conductsocio-demographicanalysisofHSS-ANCdatatoascertainriskfactorsofHIVtransmissionandthoseaffectinghealthserviceretention.

• ContinueattentiontodecreaseandlimitthespreadoftheHIVinfection,furthereventhoughHIVprevalenceamongANCattendeeshasbeen reported at low levels.

• Conductin-depthanalysisofICTCdatatounderstandtheprofileofattendees,astheparenttochildtransmissionratewashigh.Establishmechanisms for increasing HIV testing among pregnant women.

• ConsideringthatFSWrepresentthelargestproportionofHRGinthedistrict,conductinganassessmentofthesizeandprofileoftheFSWclients’ population including migrants and truckers will help in improving the understanding of district vulnerabilities.

• AvailabilityofHRGtypologydatawouldhelpinanalyzingriskfactors.

Amreli District


Am

reliDistrict Population: 15,13,614 (2.51%



; ANC Utilization

2: 63.8%

2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

-0

1.000.52

1.010.25

NT

4-

398400

382398

400

PPTCTPP

--

0.800.20

0.140.13

0.070.12

NT

--

9964586

80346357

1461610610

Blood BankPP

0.590.48

0.910.21

0.080.16

0.060.04

NT

31953973

36295765

63266806

71657155

HSS-STDPP

--

--

--

NT

--

--

--

HSS-FSWPP

--

--

--

NT

--

--

--

HSS-MSM

PP-

--

--

-N

T-

--

--

-

HSS-IDUPP

--

--

--

NT

--

--

--

ICTC Male

PP-

--

5.812.71

2.386.81

2.39N

T-

--

18923325

38676521

4565

ICTC Female

PP-

--

3.471.99

1.340.66

0.88N

T-

--

12952819

30715947

5202

ICTC ReferredPP

--

-2.71

1.571.66

5.221.80

NT

--

-1991

36244284

72595664

ICTC Direct W

alk-inPP

--

-8.44

3.532.34

2.001.29

NT

--

-1196

25202654

52094103


5 N

T-

-996

777314178

1329527084

20377

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (1058)66

884

6615

DLN (N

A)-

--

--

Block-Level Details

No. HRG

-FSW-

- -

- -

- -

- -

No. HRG

-MSM

- -

- -

- -

- -

-

No. HRG

- IDU-

- -

- -

- -

- -

% Pos;

ICTCAm

reli, 6.3

Babra, 20

Bagasara, 29.4

Dhari, 21.7

Lathi, 20.7

Liliya, 14.3

Rajula, 16.7

Sk, 34.8

Jafrabad, 33.3

% Pos;

PPTCT-

- -

- -

- -

- -

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

155)88.39

2.581.29

05.16

2.58


3




percent positive, N

T = num


omen.

STI/RTI2009

20102011

2012


19985137

53795565


-0.65

0.800.50

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

--

--

--

--

-M

SM TIs

--

--

--

--

-IDU TIs

--

--

--

--

-Com

p. TIs-

--

-2

22

22

ICTCs-

--

68

818

4444

Blood Banks1

11

11

11

11

STI clinics-

--

11

11

11

ART centres-

--

--

-1

11

Link ART centres-

--

-1

21

11

PLHIV Netw

orks-

--

--

--

--

Red Ribbon Clubs-

--

--

--

55

Comm

. care centres-

--

--

--

11

Drop-in-centres-

--

--

--

--

Condom outlets

--

--

--

--

-

VulnerabilitiesM


Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

1147003444

8069930557

% of m

ale pop.

16.350.49

11.514.36

% total

migration

1003.00

70.3626.64


Mum

bai (Suburban)

, Maha-

rashtra

Thane, M

aharash-tra

Diu, Dam

an & Diu

Mum

bai, M

aharash-tra

-

HRG Size

FSWM

SMIDU


Year: NA)

210179

-

% Total HRG

53.9846.02

-

% Total Pop.

0.010.01

-

Program Target

NA

NA

NA

Program Coverage

--

-

Typology

Home

based-N

A;

Brothel based-

NA;

Street based-

NA

Kothi-N

A;

Panthi-N

A;

Double decker-

NA

Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.-

--

% M

arried-

--


AnandBackground:

Anand district, popularly known as Charotar, is located near the Gulf of Cambay in the southern part of Gujarat. It is bounded by Kheda district to the north, Vadodara district to the east, Ahmedabad district to the west, and the Gulf of Khambhat to the south. The district has a population of 20.9 lakh witha sex ratio of 921 females per 1,000 males, female literacy rate of 77.76%, with an overall literacy rate of 85.79% (Census 2011). Focus industry sectors are: food and agriculture, engineering and auto-parts, chemicals, port and ship building, minerals, and cement. The largest dairy cooperative of India is situated in the district. Famous Tourist places of the district include: Amul Dairy Cooperative Museum, Flo -Art, Khambhat and Anklavadi. National Highway (NH) 8 passes through the district connecting Anand to Vadodara and Kheda district.


• Basedon2012HSS-ANCdata,HIVprevalencewaslowamongtheANCattendees,withadecliningtrendinthelastthreerecordings.


• Accordingto2012BloodBankdata,thelevelofHIVpositivitywaslowat0.10%amongtheBloodBankdonors,withastabletrend.

• In2012,HIVprevalenceamongICTCattendeeswaslowamongmale(1.84%)andfemale(1.44%)clients,andalsoamongreferred(1.47%) and direct walk-in (2.23%) clients. Male, female and referred clients represented a stable trend, though male and referred clients had observed a steep rise in the positivity in 2011. Direct walk-in clients had a declining trend.

• AccordingtoHRGsizemappingdata,MSM(4,889;59.97%ofthetotalHRG)wasthelargestHRGinthedistrictfollowedbyFSW(3,264;40.03% of the total HRG).


• Accordingtothe2001census,outoftheoverallpopulation,5.31%ofmalesweremigrants;amongthem4.10%migratedtootherstatesand 22.91% migrated to other districts within the state.

• Thetoptwodestinationsforout-of-statemigrationwereThaneandMumbai(Suburban),Maharashtra.

• Accordingto2012ICTCdata,HIVtransmissionsfromparenttochildaccountedfor8.03%ofthetotalreportedHIVtransmissionsinthedistrict.


• In2012,therewereonlytwocompositetargetedintervention(TI)sitesinoperationinthedistrict,whiletherewereover8,000mappedHRGs in the district.


• ConsideringthelargenumberofHRGsmappedinthedistrict,strengthenTIsforMSMandFSWsinthedistricttoprovideHIVpreventiveand referral services. Considering the large proportion of married HRG, secure HIV prevention services also for spouses or partners of HRG’s, and support linkage to HIV treatment and care services, as needed.

• GiventhehighlevelofparenttochildtransmissionofHIV,moreneedstobedonetounderstandtheprofileoftheattendeesthroughin-depth analysis of ICTC data. Measures to increase voluntary HIV testing of pregnant women and early detection are also needed.

• Thoughdatareflectsalowlevelepidemic,thedistrictneedstocontinueattentiontoavertandlimitthespreadoftheinfectionfurtherasvulnerability and risk factors exist.

• StrengthenoutreachactivitieswithHIVpreventionmessagesformigrantsatsourceanddestinationsitesandamonggeneralpopulation,especially women.

Anand District


Anand

District Population: 20,90,276 (3.46%of G

ujarat Population); Female Literacy

1: 77.76%; AN

C Utilization2: 68.5%

2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

-0.25

0.250.25

00

NT

4-

400400

399400

400

PPTCTPP

**

*0.30

0.310.19

0.110.12

NT

**

*1578

954711415

1052113285

Blood BankPP

0.270.15

0.110.16

0.120.11

0.130.10

NT

75058928

925915058

2336527685

2707425821

HSS-STDPP

--

--

--

NT

--

--

--

HSS-FSWPP

--

--

--

NT

--

--

--

HSS-MSM

PP-

--

--

-N

T-

--

--

-

HSS-IDUPP

--

--

--

NT

--

--

--

ICTC Male

PP-

--

3.873.20

2.2212.69

1.84N

T-

--

61496995

94005924

8476

ICTC Female

PP-

--

2.341.85

1.320.63

1.44N

T-

--

47855576

69944605

6471

ICTC ReferredPP

--

-2.65

2.071.28

9.221.47

NT

--

-9013

1045212967

768611136

ICTC Direct W

alk-inPP

--

-5.78

5.243.94

2.532.23

NT

--

-1921

21193427

28433811


5 N

T678

500747

1251222118

2780921050

28232

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (NA)

--

--

-

DLN (N

A)-

--

--

Block-Level Details

No. HRG

- FSW

- -

- -

- -

- -

-

No. HRG

- M

SM-

- -

- -

- -

- -

No. HRG

- IDU

- -

- -

- -

- -

-

% Pos;

ICTC-

- -

- -

- -

- -

% Pos;

PPTCT-

- -

- -

- -

- -

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

249)85.54

1.202.41

08.03

2.81


3




percent positive, N

T = num


omen.

STI/RTI2009

20102011

2012


7485216819

58266490


-0.55

0.210.26

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

11

1-

--

--

-M

SM TIs

--

--

--

--

-IDU TIs

--

--

--

--

-Com

p. TIs-

--

-2

22

22

ICTCs-

--

78

815

1921

Blood Banks4

45

56

66

66

STI clinics-

--

22

22

33

ART centres-

--

--

--

--

Link ART centres-

--

-1

11

11

PLHIV Netw

orks-

-1

11

11

11

Red Ribbon Clubs-

--

--

3535

8686

Comm

. care centres-

--

--

--

--

Drop-in-centres-

--

--

--

--

Condom outlets

--

--

--

--

-

VulnerabilitiesM


Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

515972118

1182337656

% of m

ale pop.

5.310.22

1.223.87

% total

migration

1004.10

22.9172.98


Thane, M

aharash-tra

Mum

bai (Suburban)

, Maha-

rashtra

Jaipur, Rajasthan

Mum

bai, M

aharash-tra

-

HRG Size

FSWM

SMIDU


Year: NA)

32644889

-

% Total HRG

40.0359.97

-

% Total Pop.

0.160.23

-

Program Target

NA

NA

NA

Program Coverage

--

-

Typology

Home

based-36.18%

;

Brothel based-49.1%

;

Street based-

14.73%

Kothi-48.76%

;

Panthi-N

A;


Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.22.22

32.08-

% M

arried76.23

59.12-


BanaskanthaBackground:

Banaskantha district’s administrative headquarters is Palanpur which is also its largest city. The district is located in the Northeast of Gujarat and is presumably named after the West Banas River which runs through the valley between Mount Abu and Aravalli Range, entering into the plains of Gujarat in this region and flowing towards the Rann of Kutch. It has a population of 31.16 lakh that is largely rural (86.73%), with a sex ratio of 936 females per 1,000 males; female literacy rate of 52.58%, with an overall literacy rate of 66.39% (Census 2011). The economy of the district is based on agro and food processing, tourism, textile and mineral based industries (ceramics). The district is famous for two pilgrim sites: the Ambaji temple and the Balaram temple which draw many tourists. National highway 14 and 15 and many other state highways pass through the district connecting it to other states and districts.


• Basedon2010HSS-ANC,HIVprevalencewaslowat0.25%amongtheANCattendees.



• Accordingto2010HSS-FSWdata,HIVprevalencewaslowamongFSWsat1.21%,butduetolackofpreviousyear’sdata,atrendcouldnot be determined.

• In2012,HIVpositivityamong ICTCattendeeswas lowamongmale (1.48%)andfemale (1.26%)clientsaswellasamongreferred(0.79%) and direct walk-in (2.21%) clients, with an overall declining trend.

• AccordingtoHRGsizemappingdata,MSM(785;60.02%ofthetotalHRG)wasthelargestHRGinthedistrictfollowedbyFSW(523;39.98% of the total HRG).


• Thetoptwodestinationsforout-of-statemigrationwereMumbai(Suburban),MaharashtraandSirohi,Rajasthan.

• Accordingto2012ICTCdata,HIVtransmissionsfromparenttochildaccountedfor10.32%ofthetotalreportedtransmissionsinthedistrict.


• In2012,thereweretwocompositetargetedintervention(TI)sitesinoperationinthedistrict,whiletherewerearound1,300mappedHRGs in the district.


• EstablishTIsitesexclusivelyforMSMandFSWstoprovideHIVpreventiveandreferralservices,consideringtheirsignificantpresenceinthedistrict. Considering the high proportion of married HRG in the district (62.45% for FSW and 83.38% for MSM) HIV prevention services for spouses or partners of HRGs’ are also needed in addition to HIV treatment and care services.

• ThoughHIVpositivityamongICTCattendeesisatlowlevels,thedistrictneedstocontinuefocusondecreasingandlimitingthespreadof HIV infection further.

• Conductin-depthanalysisofICTCdatatounderstandtheprofileofICTCattendeesgiventhehighparenttochildtransmissionrate(2012ICTC data).

• ConductoutreachcampaignonHIVandSTIawarenessandsexualriskreductionmessagesespeciallyamongwomen.

• Betterassessmentofthesizeandprofileofmigrantswillfurtherimproveunderstandingofdistrictvulnerabilities.

Banaskantha District


BanaskanthaDistrict Population: 31,16,045 (5.16%



; ANC Utilization

2: 28.7%

2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

-1.00

00

0.25-

NT

4-

400400

399400

-

PPTCTPP

-*

**

0.290.16

0.180.17

NT

-*

**

1462621943

4227424136

Blood BankPP

0.170.09

0.140.05

0.130.11

0.090.11

NT

60425547

85278430

2392627981

3076332195

HSS-STDPP

0.402.00

0.95-

1.60-

NT

250250

210-

250-

HSS-FSWPP

--

--

1.21-

NT

--

--

248-

HSS-MSM

PP-

--

--

-N

T-

--

--

-

HSS-IDUPP

--

--

--

NT

--

--

--

ICTC Male

PP-

--

4.462.73

1.981.53

1.48N

T-

--

720410787

1561423460

18844

ICTC Female

PP-

--

4.702.75

2.061.30

1.26N

T-

--

43627029

1026616110

15543

ICTC ReferredPP

--

-3.09

1.901.51

1.070.79

NT

--

-8128

1202215853

2128220116

ICTC Direct W

alk-inPP

--

-8.00

4.452.79

1.862.21

NT

--

-3438

579410027

1828814271


5 N

T-

56336

1205232442

4782381844

58523

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (2230)53

1045

3710

DLN (N

A)-

--

--

Block-Level Details

No. HRG

-FSW-

- -

- -

- -

- -

No. HRG

-MSM

- -

- -

- -

- -

-

No. HRG

- IDU-

- -

- -

- -

- -

% Pos;

ICTC-

- -

- -

- -

- -

% Pos;

PPTCTAm

irgadh, 1.09

Bhabhar, 0.97

Danta, 2.69

Deesa, 6.84

Deodar, 0.99

Dhanera, 2.16

Kankrej, 2.03

Palanpur, 7.25

Tharad, 2.45

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

475)88.00

1.260.42

010.32

0


3




percent positive, N

T = num


omen.

STI/RTI2009

20102011

2012


216606733

63596778


-1.45

1.301.18

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

--

--

--

--

-M

SM TIs

--

--

--

--

-IDU TIs

--

--

--

--

-Com

p. TIs-

--

--

22

22

ICTCs-

--

716

2870

111112

Blood Banks4

44

89

109

910

STI clinics-

--

22

22

33

ART centres-

--

--

-1

11

Link ART centres-

--

-1

11

23

PLHIV Netw

orks-

--

-1

11

11

Red Ribbon Clubs-

--

--

4040

1717

Comm

. care centres-

--

--

--

11

Drop-in-centres-

--

--

--

--

Condom outlets

--

--

--

--

-

VulnerabilitiesM


Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

--

--

% of m

ale pop.

--

--

% total

migration

--

--


Mum

bai (Suburban)

, Maha-

rashtra

Sirohi, Rajasthan

Thane, M

aharash-tra

Jalor, Rajasthan

Mum

bai, M

aharash-tra

HRG Size

FSWM

SMIDU


Year: NA)

523785

-

% Total HRG

39.9860.02

-

% Total Pop.

0.020.03

-

Program Target

NA

NA

NA

Program Coverage

2.974.45

N.A

Typology

Home

based-44.66%

;

Brothel based-

35.97%;

Street based-

19.37%

Kothi-30%

;

Panthi-N

A;

Double decker-70%

Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.14.62

20.63-

% M

arried62.45

83.38-


BharuchBackground:

Bharuch is located in the southern part of Gujarat, near the Gulf of Khambhat an inlet of the Arabian Sea along the west coast of India. The district has a population of 15.50 lakh, with a sex ratio of 924 females per 1,000 males; female literacy rate of 76.79%, with an overall literacy rate of 83.03% (Census 2011). Bharuch is a formidable industrial base in sectors as diversified as chemicals and petrochemicals, textiles, drugs and pharmaceuticals, and ports and ship building. There are a large number of industrial estates in the district’s Special Economic Zones (SEZ). Centrally located with in the industrial belt. Dahejport is an ideal location in Asia to serve north, west and central India and international destinations such as the Middle East, Africa, Europe and North America. National Highway 8 passes through the district, connecting it with Ahmedabad and Mumbai.


• Basedon2012HSS-ANCdata,HIVprevalencewasmoderateat0.75%amongtheANCattendees,withanincreasingtrendoverthelastfour data recordings.

• Accordingto2012PPTCTdata,thelevelofHIVpositivitywaslowat0.15%amongthePPTCTattendees,withastabletrend.


• In2012,HIVprevalenceamongICTCattendeeswaslowamongmale(3.23%)andfemale(1.92%)clients,aswellasamongreferred(1.03%) and direct walk-in (3.82%) clients. While male and referred clients had a fluctuating trend, female and direct walk-ins had a declining trend.

• AccordingtoHRGsizemappingdataFSWs(272;74.11%ofthetotalHRG)wasthelargestHRGinthedistrict.ThemajortypologyforFSWs was street-based (68.41%).



• Thetoptwodestinationsforout-of-statemigrationwereMumbai(Suburban)andThaneinMaharashtra.

• Accordingto2012ICTCdata,HIVtransmissionsfromparenttochildaccountedwas9.18%andthroughbloodtransfusionaccountedfor7.65% of the total transmissions in the district.


• In2012,onlyonecompositeTIwasoperationalinthedistrict.


• ConsideringrisingHIVprevalenceamongHSS-ANCattendees,thedistrictneedstocontinueattentiontodecreaseandlimitthespreadofthe infection further.

• GiventhehighrateofparenttochildtransmissionofHIVinthedistrict,itisnecessarytostrengthenthePPTCTprogramcoverageinthedistrict including early HIV detection.

• Conductin-depthanalysisofICTCdatatobetterunderstandtheprofileofHIVpositiveindividuals.ThisisalsointhecontextoftheHIVtransmission rate through blood transfusion (ICTC data 2012) .

• Consideringthelevelofmalemigration,strengthenoutreachprogrammesthroughHIVawarenesscampaignsaroundsourceandtransitpoints such as railway stations and bus stands. Conduct special awareness campaign especially among pockets of out-migrants transit points and around truck halting points and highways in the district.

Bahruch District


BharuchDistrict Population: 15,50,822 (2.57%



; ANC Utilization

2: 64.6%

2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

-0.75

00

0.250.75

NT

4-

400400

400398

399

PPTCTPP

-*

0.370.36

0.140.14

0.170.15

NT

-*

10791651

57295106

100047454

Blood BankPP

--

0.230.17

0.150.20

0.170.20

NT

--

1197413599

1340415992

1694516685

HSS-STDPP

--

--

--

NT

--

--

--

HSS-FSWPP

--

--

--

NT

--

--

--

HSS-MSM

PP-

--

--

-N

T-

--

--

-

HSS-IDUPP

--

--

--

NT

--

--

--

ICTC Male

PP-

--

5.684.92

2.685.30

3.23N

T-

--

13561972

28715451

3995

ICTC Female

PP-

--

4.575.10

2.441.71

1.92N

T-

--

8751195

22124037

3483

ICTC ReferredPP

--

-2.32

3.111.70

4.391.03

NT

--

-1164

19632002

39853209

ICTC Direct W

alk-inPP

--

-8.43

8.063.15

3.333.82

NT

--

-1067

12043081

55034269


5 N

T-

3271079

38828896

1018919492

14932

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (946)56

935

298

DLN (N

A)-

--

--

Block-Level Details

No. HRG

-FSW-

- -

- -

- -

- -

No. HRG

-MSM

- -

- -

- -

- -

-

No. HRG

- IDU-

- -

- -

- -

- -

% Pos;

ICTC-

- -

- -

- -

- -

% Pos;

PPTCTAnklesh-w

er, 7.83Bharuch,

3.97Am

od, 14.51

Vagra, 20

Jambusar,

21.05Valiya, 18.18

Hansot, 57.14

Zagdia, 30

-

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

196)72.45

4.087.65

4.089.18

2.55


3




percent positive, N

T = num


omen.

STI/RTI2009

20102011

2012


46367328

84286530


-1.79

1.381.49

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

--

--

--

--

-M

SM TIs

--

--

--

--

-IDU TIs

--

--

--

--

-Com

p. TIs-

--

--

11

11

ICTCs-

--

55

66

2227

Blood Banks1

12

22

22

22

STI clinics-

--

11

11

11

ART centres-

--

--

--

11

Link ART centres-

--

-1

11

--

PLHIV Netw

orks-

--

--

--

--

Red Ribbon Clubs-

--

--

--

99

Comm

. care centres-

--

--

--

--

Drop-in-centres-

--

--

--

--

Condom outlets

--

--

--

--

-

VulnerabilitiesM


Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

712253195

2417643854

% of m

ale pop.

9.980.45

3.396.15

% total

migration

1004.49

33.9461.57


Mum

bai (Suburban), M

aharash-tra

Thane, M

aharash-tra

Nandurbar

,Maharash-

tra

Mum

bai, M

aharash-tra

Dadra & N

agar Haveli,

Dadra & N

agar Haveli

HRG Size

FSWM

SMIDU


Year: NA)

27295

NA

% Total HRG

74.1125.89

-

% Total Pop.

0.020.01

-

Program Target

NA

NA

NA

Program Coverage

--

-

Typology

Home

based-14.73%

;

Brothel based-

16.86%;

Street based-

68.41%

Kothi-70.95%

;

Panthi-N

A;


Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.14.25

32.57-

% M

arried33.25

85.20-


BhavanagarBackground:

Bhavnagar, located near the Gulf of Khambat along India’s western coast, is a part of the Saurashtra peninsula in the central part of Gujarat. Bhavnagar shares borders with Ahmedabad and Botad districts to the North, the Gulf of Khambatto the East and South, and Amreli and Rajkot districts to the West. It has a population of 28.77 lakh, a sex ratio of 931 females per 1,000 males; female literacy rate of 66.92%, with an overall literacy rate of 76.84% (Census 2011). Focus industry sectors are diamond cutting and polishing, cement and gypsum, inorganic salt-based and marine chemicals, ship building, ship-repairs, etc. Some sections of the society depend upon agriculture for their livelihood (58.99% of the total population resides in rural areas, Census 2011). World’s largest ship breaking yard is at Alang in the district. National Highway 8E passes through the district connecting it to Junagadh and Amreli districts.


• Basedon2012HSS-ANCdata,HIVprevalencewasmoderateat0.50%amongtheANCattendees.

• Accordingto2012PPTCTdata,thelevelofHIVpositivitywaslowat0.09%amongthePPTCTattendees,withastabletrendinthelastthreerecordings.


• Accordingto2010HSSdata,HIVprevalenceamongFSWsandMSMwasatsimilarratesof4.02%and4%respectively.

• In2012,HIVprevalenceamongICTCattendeeswasrelatively lowamongmale(2.12%)andfemale(0.88%)clients,aswellasamongreferred (1.86%) and direct walk-in (1.13%) clients. While male and referred clients had a fluctuating trend, female and direct walk-ins had a declining trend.

• AccordingtoHRGmappingdata,MSM(4,889;representing59.97%ofthetotalHRG)wasthelargestHRGinthedistrictfollowedbyFSW(3,264; 40.03% of the total HRG). 65% of the FSWs are home-based.


• Accordingtothe2001census,11.05%ofmalepopulationwasmigrants;amongthem5.91%migratedtootherstatesand55.35%migratedto other districts within the state.

• Thetoptwodestinationsforout-of-statemigrationwereThaneandMumbai(Suburban)inMaharashtra.


• In2012,therewereseventargetedintervention(TI)sitesinoperationinthedistrict(2MSMTI,2FSWTI,and3compositeTI),cateringfor8,000 mapped HRGs.


• PresenceoflargenumberofMSMshouldbeconsideredforincreaseinthenumberofMSM-TIsitesinthedistrict.

• Conductsocio-demographicanalysisofHSS-ANCattendeestounderstandriskfactorsforHIVepidemicamonggeneralpopulation.

• FocusontheoutreacheffortsforhomebasedFSWs(65%ofthetotalFSWsinthedistrict)tokeepHIVprevalenceamongthematlowlevel.

• FocusedIECforgeneralpopulationwithHIVawarenessandsexualriskreductionmessagesisrecommended.OutreachprogramsforHIVprevention among spouses and partners of HRG is recommended (to limit the spread of HIV infection), particularly if case of sero-discordant couple is known.

• StrengthenTIinterventionsfortheIDUpopulation,asthelevelofpositivityamongHSS-IDUattendeeswashigh.

Bhavnagar District


BhavnagarDistrict Population: 28,77,961 (4.77%



; ANC Utilization

2: 58%

2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

-0.75

00

0.500.50

NT

4-

400400

392400

400

PPTCTPP

0.880.45

0.480.52

0.230.11

0.060.09

NT

20461782

10492889

1713920052

4471030290

Blood BankPP

0.200.30

0.300.10

0.190.13

0.100.10

NT

951910767

1331514379

2806232593

3621437999

HSS-STDPP

4.69-

6.905.94

--

NT

213-

203202

--

HSS-FSWPP

--

-2.02

4.02-

NT

--

-248

249-

HSS-MSM

PP-

--

5.624.00

-N

T-

--

249250

-

HSS-IDUPP

--

--

--

NT

--

--

--

ICTC Male

PP-

--

8.073.43

2.346.05

2.12N

T-

--

655715069

1818516138

16309

ICTC Female

PP-

--

5.212.34

1.040.35

0.88N

T-

--

443410850

1510816947

16448

ICTC ReferredPP

--

-4.05

3.212.19

5.211.86

NT

--

-5037

628611032

1590016414

ICTC Direct W

alk-inPP

--

-9.34

2.901.53

1.201.13

NT

--

-5954

1963322261

1718516343


5 N

T2046

17821049

1388043058

5334577795

63047

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (3372)47

1079

6014

DLN (N

A)-

--

--

Block-Level Details

No. HRG

- FSW

- -

- -

- -

- -

-

No. HRG

- M

SM-

- -

- -

- -

- -

No. HRG

- IDU

- -

- -

- -

- -

-

% Pos;

ICTC-

- -

- -

- -

- -

% Pos;

PPTCT-

- -

- -

- -

- -

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

491)89.21

3.263.67

02.85

1.02


3




percent positive, N

T = num


omen.

STI/RTI2009

20102011

2012


4023136796

4108239303


-0.25

0.110.19

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

--

--

-2

22

2M

SM TIs

--

--

-2

22

2IDU TIs

--

--

--

--

-Com

p. TIs-

--

--

33

33

ICTCs-

--

1318

3644

6767

Blood Banks5

56

77

77

77

STI clinics-

--

22

22

33

ART centres-

--

-1

11

11

Link ART centres-

--

--

-4

55

PLHIV Netw

orks-

11

11

11

11

Red Ribbon Clubs-

--

--

5050

3232

Comm

. care centres-

--

-1

11

11

Drop-in-centres-

--

-1

11

11

Condom outlets

--

--

--

--

-

VulnerabilitiesM


Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

1409588326

7802654606

% of m

ale pop.

11.050.65

6.124.28

% total

migration

1005.91

55.3538.74


Thane, M

aharash-tra

Mum

bai (Subur-ban),

Maharash-

tra

Mum

bai, M

aharash-tra

Nashik,

Maharash-

tra

Dadra & N

agar Haveli,

Dadra & N

agar Haveli

HRG Size

FSWM

SMIDU


Year: 2008, 2009)3264

4889-

% Total HRG

40.0359.97

-

% Total Pop.

0.110.17

-

Program Target

NA

NA

NA

Program Coverage

--

-

Typology

Home

based-65%

;

Brothel based-25%

;

Street based-10%

Kothi-79.59%

;

Panthi-N

A;


Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.-

--

% M

arried-

--


DahodBackground:

Dahod is the eastern gateway of Gujarat. It was carved out of Panchmahal district in 1979. This district is bound by Panchmahal district to the west, Chhota-udepur district to the south, and shares borders with districts of two states: Jhabua district and Alirajpur district of Madhya Pradesh State to the east and southeast respectively, and Banswara district of Rajasthan State to the north and northeast. The district has a population of 21.26 lakh, a sex ratio of 986 females per 1,000 males; female literacy rate of 49.02%, with an overall literacy rate of 60.60% (Census 2011). Dahod is predominantly an agricultural region and the prime share of revenue in the district comes from agriculture-based products (91.01% of the total population reside in rural areas, Census 2011). Focus industry sectors are food products, rubber and plastic products, and mineral based industries. Tourist Destinationsinclude Chhab Lake, Aurangzeb’s Fort, the Shiva Temple at Bavka, Ratanmahal Sanctuary, etc. The district’s tribal culture and the tribal folklores are anothertourist attraction. National Highway (NH) 59, 8E and State Highway (SH) 2 pass through the district.


• Basedon2012HSS-ANCdataHIVprevalencewaslowandhasseenaconsistentdeclineoverthepast3rounds.

• According to2012PPTCTdata,HIVpositivitywas lowat0.06%among thePPTCTattendees,witha stable trend in the last threerecordings.

• Accordingto2012BloodBankdata,HIVpositivitywaslowat0.04%amongtheBloodBankdonors.

• In2012,HIVprevalenceamongICTCattendeeswaslowamongmale(0.78%)andfemale(0.48%)clients,aswellasamongreferred(0.54%) and direct walk-in (0.76%) clients. While male and referred clients had a fluctuating trend, female clients had a stable trend and direct walk-ins observed a declining trend.

• Accordingto2008HRGsizemappingdata,FSW(223;representing76.63%ofthetotalHRG)wasthelargestHRGinthedistrict.Themajor typology of FSWs was street-based (80.6%).


• According to the2001census,3.66%ofmalepopulationwasmigrants;amongthem4.36%migrated tootherstatesand49.38%migrated to other districts within the state.

• Thetoptwodestinationsforout-of-statemigrationwereBanswara,Rajasthan;andNashik,Maharashtra.

• Accordingto2012ICTCdata,HIVtransmissionsfromparenttochildaccountedfor5.29%ofthetotaltransmissionsinthedistrict.



• DistrictneedstocontinueattentiontodecreaseandlimitthespreadofHIVinfectionfurtherconsideringthevulnerabilityandriskfactors,even though both, ANC HIV prevalence and HIV positivity detected at ICTC are low. Parent to child transmission rate was high, thus more needs to be done to reduce the transmission. Understanding the profile of the attendees through in-depth analysis of ICTC data is required

• OutreachprogramsfocusonearlyHIVdetectionandHIVtestingfocusedonspecificpopulation,isneeded.

• FocusonoutreacheffortsforstreetbasedFSW(80.6%ofthetotalFSWinthedistrict)todecreaseandlimitHIVtransmissionamongthem and to their clients to lower levels.


Dahod District


Dahod

District Population: 21,26,558 (3.52% of G


1: 49.02%; AN


2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

-1.38

0.751.50

0.500

NT

4-

363400

399399

400

PPTCTPP

-*

0.360.35

0.06-

0.070.06

NT

-*

13991709

14073-

2663722152

Blood BankPP

00

00

0.030

0.040.04

NT

11545277

31879613

1161211100

1089511049

HSS-STDPP

--

--

--

NT

--

--

--

HSS-FSWPP

--

--

--

NT

--

--

--

HSS-MSM

PP-

--

--

-N

T-

--

--

-

HSS-IDUPP

--

--

--

NT

--

--

--

ICTC Male

PP-

--

3.541.90

0.974.23

0.78N

T-

--

26866831

1150122620

15059

ICTC Female

PP-

--

2.861.19

0.540.36

0.48N

T-

--

21677453

1082020015

15009

ICTC ReferredPP

--

-2.61

1.080.56

3.880.54

NT

--

-3450

938615951

2188218064

ICTC Direct W

alk-inPP

--

-4.78

2.411.26

0.860.76

NT

--

-1403

48986370

2075312004


5 N

T-

4601399

656228357

2232169272

52220

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (578)42

1684

6516

DLN (N

A)-

--

--

Block-Level Details

No. HRG

- FSW

- -

- -

- -

- -

-

No. HRG

- M

SM-

- -

- -

- -

- -

No. HRG

- IDU

- -

- -

- -

- -

-

% Pos;

ICTC-

- -

- -

- -

- -

% Pos;

PPTCT-

- -

- -

- -

- -

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

189)93.12

1.060

05.29

0.53


3




percent positive, N

T = num


omen.

STI/RTI2009

20102011

2012


10832533

45386556


-0.74

1.040.72

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

--

--

--

--

-M

SM TIs

--

--

--

--

-IDU TIs

--

--

--

--

-Com

p. TIs-

--

--

11

11

ICTCs-

--

413

2051

5252

Blood Banks1

12

34

44

44

STI clinics-

--

11

11

22

ART centres-

--

--

--

-1

Link ART centres-

--

--

11

1-

PLHIV Netw

orks-

--

--

11

11

Red Ribbon Clubs-

--

--

--

--

Comm

. care centres-

--

--

--

--

Drop-in-centres-

--

-1

11

11

Condom outlets

--

--

--

--

-

VulnerabilitiesM


Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

301711314

1489813959

% of m

ale pop.

3.660.16

1.811.69

% total

migration

1004.36

49.3846.27


Banswara,

Rajasthan

Nashik,

Maharash-

tra

Thane, M

aharash-tra

--

HRG Size

FSWM

SMIDU


Year: 2008)223

68-

% Total HRG

76.6323.37

-

% Total Pop.

0.010

-

Program Target

NA

NA

NA

Program Coverage

--

-

Typology

Home

based-13.6%

;

Brothel based-5.9%

;

Street based-80.6%

Kothi-57.45%

;

Panthi-N

A;


Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.-

--

% M

arried-

--


GandhinagarBackground:

Gandhinagar district is an administrative division of Gujarat, India, whose headquarters are at Gandhinagar, the state capital. It was organized in 1964. The district has a population of 13.87 lakh, with a sex ratio of 920 females per 1,000 males; female literacy rate of 77.37%, with an overall literacy rate of 85.78% (Census 2011).

A major section of the working population of Gandhinagar is employed in public sector services. Small scale industry sectors such as textiles, electronics, mineral based, wood products and engineering are the supporting pillars of the economy, providing direct and indirect employment to over 40,000 people in the district. National Highway (NH) 8 and 8C runs through the district connecting it with major cities of the State as also with the rest of India.


• Basedon2012HSS-ANCdata,HIVpositivitywaslowamongtheANCattendeesat0%,withadecliningtrend.



• In2012,HIVpositivityamongICTCattendeeswas lowamongmale(1.69%)andfemale(0.80%)clients,aswellasamongreferred(0.83%) and direct walk-in (2.14%) clients. Male clients observed a fluctuating trend but female, referred and direct walk-in clients had a declining trend.

• Accordingto2008HRGmappingdata,MSM(365;representing66.36%ofthetotalHRG)wasthelargestHRGinthedistrictfollowedby FSW (185; 33.64% of the total HRG).



• Thetoptwodestinationsforout-of-statemigrationwereGanganagar,Rajasthan;and,Mumbai(Suburban),Maharashtra.

• Accordingto2012ICTCdata,HIVtransmissionsthroughunknownroutesaccountedfor7.19%ofthetotaltransmissionsinthedistrict.


• In2012,onecompositeTIwasoperationalandtherewereover500individualsclassifiedasHRGinthedistrict.


• ThoughHIVprevalenceislow,thedistrictneedstocontinueattentiontodecreaseandlimitthespreadofHIVinfectionfurther.

• ImprovecounselingatICTCs,sincetherateofunknownHIVtransmissionisnotedhigh.

• AvailabilityofDLNdatawouldhelpinbetterunderstandingofdistrictvulnerabilities.


• SincethelargestHRGwasMSM,betterassessmentofthesizeandprofileofMSMandpartnerpopulationwillhelpinbetterunderstandingof district vulnerabilities.

Gandhinagar District


Gandhinagar



1: 77.37%; AN


2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

-0.50

01.25

0.250

NT

4-

400400

400400

400

PPTCTPP

-0.20

0.300.20

0.230.17

0.080.14

NT

-979

18365599

993612019

1970414468

Blood BankPP

0.120.35

0.140.13

0.170.19

0.130.09

NT

33182856

49444768

1183213155

1514714811

HSS-STDPP

--

--

--

NT

--

--

--

HSS-FSWPP

--

--

--

NT

--

--

--

HSS-MSM

PP-

--

--

-N

T-

--

--

-

HSS-IDUPP

--

--

--

NT

--

--

--

ICTC Male

PP-

--

4.532.84

1.705.00

1.69N

T-

--

30684330

69599131

6317

ICTC Female

PP-

--

3.462.05

1.140.58

0.80N

T-

--

20802783

58717234

5735

ICTC ReferredPP

--

-2.92

2.061.15

3.820.83

NT

--

-2911

38808201

103918031

ICTC Direct W

alk-inPP

--

-5.63

3.091.97

1.712.14

NT

--

-2237

32334629

59744021


5 N

T-

9791836

1074717049

2484936069

26520

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (2264)61

1260

6012

DLN (N

A)-

--

--

Block-Level Details

No. HRG

-FSW-

- -

- -

- -

- -

No. HRG

-MSM

- -

- -

- -

- -

-

No. HRG

- IDU-

- -

- -

- -

- -

% Pos;

ICTC-

- -

- -

- -

- -

% Pos;

PPTCT

Gandhina-

gar, 3.8

Kalol, 2.2

Mansa, 1.7

Dahegam,

6.6O

ther, 8.8

- -

- -

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

153)83.66

4.580

04.58

7.19


3




percent positive, N

T = num


omen.

STI/RTI2009

20102011

2012


14224192

60286416


00.39

0.060.27

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

--

--

--

--

-M

SM TIs

--

--

--

--

-IDU TIs

--

--

--

--

-Com

p. TIs-

--

--

11

11

ICTCs-

--

77

837

3941

Blood Banks5

55

55

55

55

STI clinics-

--

11

11

11

ART centres-

--

--

--

--

Link ART centres-

--

-1

11

11

PLHIV Netw

orks-

11

11

11

11

Red Ribbon Clubs-

--

--

--

212

Comm

. care centres-

--

--

--

--

Drop-in-centres-

--

--

--

--

Condom outlets

--

--

--

--

-

VulnerabilitiesM


Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

401093064

1021426831

% of m

ale pop.

5.740.44

1.463.84

% total

migration

1007.64

25.4766.90


Gan-

ganagar, Rajasthan

Mum

bai (Subur-ban),

Maharash-

tra

Thane, M

aharash-tra

--

HRG Size

FSWM

SMIDU


Year: 2008)185

365-

% Total HRG

33.6466.36

-

% Total Pop.

0.010.03

-

Program Target

NA

NA

NA

Program Coverage

--

-

Typology

Home

based-6.64%

;

Brothel based-

77.62%;

Street based-

15.73%

Kothi-59.96%

;

Panthi-N

A;


Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.-

--

% M

arried-

--


Jamnagar Background:

Jamnagar district is located on the southern coast of the Gulf of Kutch in the Saurashtra region of western Gujarat. The district has a population of 21.59 lakh, a sex ratio of 938 females per 1,000 males; female literacy rate of 65.97%, with an overall literacy rate of 74.40% (Census 2011). Focus industry sectors include brass parts, petroleum and petrochemicals, salt, and port related business. Other major industry sectors of the district include engineering and machinery, plastics and oil mills. Among its attractions include a Marine National Park the first in India Khijadiya Bird Sanctuary, and the Dwarka dish temple built in the 16th century. National Highway (NH) 8 Ext. passes through the district.


• Basedon2012HSS-ANCdata,HIVprevalencewaslowamongtheANCattendees.

• According to2012PPTCTdata,HIVpositivitywas lowat0.13%among thePPTCTattendees,witha stable trend in the last threerecordings.


• Accordingto2010HSSdata,HIVprevalencewaslowamongFSWsat0.40%butwasmoderateamongMSMsat5.20%.

• In2012,HIVpositivityamongICTCattendeeswas lowamongmale(1.81%)andfemale(0.99%)clients,aswellasamongreferred(1.22%) and direct walk-in (2.25%) clients. All the ICTC clients had a declining trend, but male and referred clients showed a steep rise in 2011.

• Accordingto2008HRGmappingdata,FSW(2,027;52%ofthetotalHRG)wasthelargestHRGinthedistrictfollowedbyMSM(1,871;48% of the total HRG). The major typology for FSWs was home-based (51.58%). 51.53% of the MSM and 43.23% of FSW respectively are married.


• Accordingtothe2001census,10.17%ofmalepopulationwasmigrants;amongthem9.63%migratedtootherstatesand42.60%migrated to other districts within the state.


• Accordingto2012ICTCdata,HIVtransmissionsfromparenttochildaccountedfor5.17%ofthetotalreportedcases(n=329)inthedistrict.

• AccordingtoDLHS-IIIdata,theHIVandSTI/RTIawarenessrateamongwomenwere50.04%and28.4%,respectively.

• In2012,oneTIsiteforeachofFSWandMSM,andonecompositeTIwasoperationalinthedistrict.


• SustaineffortstocontainandlimitthespreadofHIVinfectionfurther.

• IncreasethenumberofTIsitesinthedistricttoaccommodateandeffectivelyprovideservicestothelargesizeofHRGs.

• Conductsocio-demographicanalysisofHSS-ANCandPPTCTattendeestounderstandriskfactorsforHIVinfection.

• FocusoutreacheffortsalsoforhomebasedFSWs(51.58%ofthetotalFSWsinthedistrict)toreducetheirvulnerabilitytoHIVinfection,and prevent the transmission to clients and regular partners.

• ConsideringhighrateofmigrationtohighHIVprevalencedistricts,strengthenoutreachprogrammethroughawarenesscampaignsaroundsource and transit points such asrailway stations and bus stands.

• StrengthenpositivepreventionandPPTCTprograms.ReinforceoutreacheffortsforHIVtestingandlinkagetonecessarytreatmentandcare services.

Jamnagar District


Jamnagar



1: 65.97%; AN

C Utilization2: 75%

2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

-0.50

-0

0.500

NT

4-

400-

400400

377

PPTCTPP

--

0.400.18

0.170.27

0.120.13

NT

--

551510301

1451111909

908013537

Blood BankPP

--

0.240.30

0.110.14

0.120.09

NT

--

1564017526

2115823643

2279622339

HSS-STDPP

1.601.20

2.400

--

NT

250250

250250

--

HSS-FSWPP

--

-0.40

0.40-

NT

--

-250

249-

HSS-MSM

PP-

--

5.605.20

-N

T-

--

250250

-

HSS-IDUPP

--

--

--

NT

--

--

--

ICTC Male

PP-

--

5.653.47

1.6311.90

1.81N

T-

--

39636710

120426949

12497

ICTC Female

PP-

--

4.612.02

1.060.44

0.99N

T-

--

22124266

83616156

10360

ICTC ReferredPP

--

-5.82

3.371.60

8.891.22

NT

--

-3935

602612664

886518006

ICTC Direct W

alk-inPP

--

-4.33

2.341.06

1.562.25

NT

--

-2240

49507739

42404851


5 N

T-

-5515

1647625487

3231222185

36394

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (1725)47

883

6316

DLN (N

A)-

--

--

Block-Level Details

No. HRG

-FSW-

- -

- -

- -

- -

No. HRG

-MSM

- -

- -

- -

- -

-

No. HRG

- IDU-

- -

- -

- -

- -

% Pos;

ICTC-

- -

- -

- -

- -

% Pos;

PPTCTJam

nagar, 4.96

Khamb-

haliya, 2.25

Dwarka,

2.25Kaliyanpur,

13.74Bhanvad,

12.88

Jamjodh-

pur, 11.9

Lalpur, 4.56

Kalavad, 12.68

Dhrol, 3.92

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

329)83.89

3.954.56

05.17

2.43


3




percent positive, N

T = num


omen.

STI/RTI2009

20102011

2012


3459025065

2282923236


-0.24

0.130.03

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

11

11

11

11

1M

SM TIs

--

--

-1

11

1IDU TIs

--

--

--

--

-Com

p. TIs-

--

--

11

11

ICTCs-

--

710

1112

1818

Blood Banks4

44

55

55

55

STI clinics-

--

22

22

33

ART centres-

--

--

11

11

Link ART centres-

--

--

-1

11

PLHIV Netw

orks-

11

11

11

11

Red Ribbon Clubs-

--

--

2525

44

Comm

. care centres-

--

-1

11

11

Drop-in-centres-

--

11

11

11

Condom outlets

--

--

--

--

-

VulnerabilitiesM


Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

1002489653

4270747888

% of m

ale pop.

10.170.98

4.334.86

% total

migration

1009.63

42.6047.77


Thane, M

aharash-tra

Mum

bai (Suburban)

, Maha-

rashtra

Pune, M

aharash-tra

Mum

bai, M

aharash-tra

Bangalore, Karnataka

HRG Size

FSWM

SMIDU


Year: 2008)2027

18710

% Total HRG

52.0048.00

0

% Total Pop.

0.090.09

0

Program Target

NA

NA

NA

Program Coverage

--

-

Typology

Home

based-51.58%

;

Brothel based-

17.45%;

Street based-

30.97%

Kothi-64.93%

;

Panthi-N

A;


Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.18.41

35.86-

% M

arried51.35

43.23-


JunagadhBackground:

Junagadh district is located on the Kathiawar peninsula in western Gujarat. It is surrounded by Rajkot district (North), Porbandar district (North-West); Amreli district (East). To the South and West is the Arabian Sea. It is the second least-populous district of Gujarat with a population of 27.42 lakh, a sex ratio of 952 females per 1,000 males; female literacy rate of 67.59%, with an overall literacy rate of 74.40% (Census 2011). Agriculture is the backbone of the district economy. 70% of the population is engaged in this primary sector, 22% in secondary sector and 8% in tertiary sector. Junagadh is famous for the Gir Sanctuary, the only abode to Asiatic lions. The mountain range Girnar is a pilgrimage destination for Jainism and Hinduism.Junagadh boasts of some of the best tourist destinations in the State and receives a large influx of tourists every year. National Highway 8D and 8E passes through the district.


• Basedon2012HSS-ANCdata,HIVpositivitywasmoderateat0.50%amongtheANCattendees.Thisrepresentsanincreasecomparedwith 0.25% in the three previous HSS rounds..



• In2012,HIVpositivityamongICTCattendeeswas lowamongmale(1.46%)andfemale(0.72%)clients,aswellasamongreferred(0.88%) and direct walk-in (1.34%) clients. A decreasing trend was observed over a period of five years among all the ICTC clients.

• AccordingtoHRGmappingdata,FSW(230;61.99%ofthetotalHRG)wasthelargestHRGinthedistrictfollowedbyMSM(141;38.01%of the total HRG). 89.16% of the FSWs are married and the major typology for FSWs is home-based (67.47%) Similarly, 77.5% of MSM are married.


• According to the2001 census,11.72%ofmalepopulationwasmigrants; among them4.09migrated toother statesand38.04%migrated to other districts within the state.



• AccordingtoDLHS-IIIdata,theHIVandSTI/RTIawarenessrateamongwomenwas47.1%and28%,respectively.

• In2012,oneTIsiteforeachofFSWandMSMandonecompositeTIwereoperationalinthedistrict.


• ConsideringtheHIVprevalenceamongHSS-ANCattendees,socio-demographicanalysisisrequiredtoascertainriskfactors.

• StrengthenPPTCTprogramcoverageinthedistrict,asparenttochildHIVtransmissionishighinthedistrict.Strengtheninterventionsforenabling early detection among pregnant mothers and spouses, and linkage to necessary HIV prevention, treatment and care services.

• Analysethenumberandprofileofmigrantstoimproveunderstandingofdistrictvulnerabilities,consideringhighrateofmigration.

• FocusinterventionsalsoamonghomebasedFSWconsideringtheirproportionoutofthosemapped(89.16%marriedFSW)andconsideroptions for reaching to their regular partners.

• AnalysevulnerabilityfactorsintransmissionofHIVfromICTCandSTIdata,althoughthereisalowlevelofHIVepidemicinthedistrict.

• AvailabilityofDLNdatawillhelpinbetterunderstandingofdistrictvulnerabilities.

Junagarh District


JunagadhDistrict Population: 27,42,291 (4.54%



; ANC Utilization

2: 74.7%

2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

0.250.50

0.250.25

0.250.50

NT

4400

400400

400398

400

PPTCTPP

-*

*0.30

0.130.12

0.100.10

NT

-*

*4511

1749721406

3751825827

Blood BankPP

0.260.28

0.160.11

0.100.05

0.070.14

NT

85909090

978516726

1811719664

1829818700

HSS-STDPP

-1.20

2.403.20

2.02-

NT

-250

250250

247-

HSS-FSWPP

--

--

--

NT

--

--

--

HSS-MSM

PP-

--

--

-N

T-

--

--

-

HSS-IDUPP

--

--

--

NT

--

--

--

ICTC Male

PP-

--

4.563.06

2.424.58

1.46N

T-

--

73308670

1235828352

17388

ICTC Female

PP-

--

2.601.81

1.050.44

0.72N

T-

--

73429517

1411727435

18292

ICTC ReferredPP

--

-2.26

1.420.89

3.020.88

NT

--

-8419

1004217276

3566220492

ICTC Direct W

alk-inPP

--

-5.36

3.613.19

1.701.34

NT

--

-6253

81459199

2012515188


5 N

T-

137804

1918335684

4788193305

61507

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (2290)53

1285

6314

DLN (N

A)-

--

--

Block-Level Details

No. HRG

- FSW

- -

- -

- -

- -

-

No. HRG

- M

SM-

- -

- -

- -

- -

No. HRG

- IDU

- -

- -

- -

- -

-

% Pos;

ICTC-

- -

- -

- -

- -

% Pos;

PPTCT-

- -

- -

- -

- -

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

385)88.31

0.521.56

0.528.05

1.04


3




percent positive, N

T = num


omen.

STI/RTI2009

20102011

2012


166676720

92028543


-0

0.010.03

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

12

--

-1

11

1M

SM TIs

--

--

11

11

1IDU TIs

--

--

--

--

-Com

p. TIs-

--

-1

11

11

ICTCs-

--

912

1368

7676

Blood Banks4

44

57

77

77

STI clinics-

--

11

11

22

ART centres-

--

--

-1

11

Link ART centres-

--

--

23

44

PLHIV Netw

orks-

--

-1

11

11

Red Ribbon Clubs-

--

--

2525

66

Comm

. care centres-

--

--

-1

11

Drop-in-centres-

--

--

--

--

Condom outlets

--

--

--

--

-

VulnerabilitiesM


Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

1468306009

5585884963

% of m

ale pop.

11.720.48

4.466.78

% total

migration

1004.09

38.0457.86


Mum

bai (Suburban), M

aharash-tra

Thane, M

aharash-tra

Diu, Dam

an & Diu

Mum

bai, M

aharash-tra

Dadra & N

agar Haveli,

Dadra & N

agar Haveli

HRG Size

FSWM

SMIDU


Year: 2008)230

141-

% Total HRG

61.9938.01

-

% Total Pop.

0.010.01

-

Program Target

NA

NA

NA

Program Coverage

--

-

Typology

Home

based-67.47%

;

Brothel based-4.82%

;

Street based-

27.71%

Kothi-30%

;

Panthi-N

A;

Double decker-70%

Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.1.20

27.50-

% M

arried89.16

77.50-


KutchBackground:

Kutch district (also spelled as Kachchh) is the largest district of both Gujarat State and India. The name Kutch was derived from its Geographical Characteristics and particularly resemblance of its earth surface with tortoise. Kutch district is surrounded by the Gulf of Kutch and the Arabian Sea in south and west, while northern and eastern parts are surrounded by the Great and Small Rann (seasonal wetlands) of Kutch. It has a population of 20.90 lakh, with a sex ratio of 907 females per 1,000 males; female literacy rate of 70.73%, with an overall literacy rate of 79.31% (Census 2011). The district is famous for ecologically important Banni grasslands with their seasonal marshy wetlands which form the outer belt of the Rann of Kutch. Kutch is a mineral rich region with very large reserves of Lignite, Bauxite, and Gypsum among other minerals. Transportation as a business has thrived in the district due to the presence of two major ports. National Highway 8A and 15 passes through the district.


• Basedon2012HSS-ANCdata,HIVprevalencewasmoderateat0.75%amongtheANCattendees,withanincreasingtrend.



• In2012,HIVpositivityamongICTCattendeeswas lowamongmale(1.67%)andfemale(1.76%)clients,aswellasamongreferred(1.70%) and direct walk-in (1.69%) clients. positivity levels showed a declining trend among all the ICTC attendees.

• AccordingtoHRGmappingdata,MSM(680;52.15%ofthetotalHRG)wasthelargestHRGinthedistrictfollowedbyFSW(624;47.85%of the total HRG). The major typology for FSWs was home-based (57.31%). 72.07% of MSM and 82.6% of FSW are married.




• Accordingto2012ICTCdata,HIVtransmissionsfromparenttochildandbloodtransfusionaccountedfor5.14%and5.44%ofthetotalreported cases (n=331) in the district.


• In2012,thereweretwocompositeTIsoperationalinthedistrict.


• Conduct socio-demographic analysis ofHSS-ANCandPPTCTattendees to ascertain risk factors, considering the increasing trendofprevalence among HSS-ANC attendees.

• StrengtheninterventionsforpositivepreventionamongspousesandpartnersofHRG,migrantsandgeneralpopulation,andoutreachefforts for early detection, and linkage to necessary treatment and care centers.

• StrengthenPPTCTprogramcoverageinthedistrict,asparenttochildtransmissionsishighinthedistrict(ICTCprogramdata).

• ImprovecounselingatICTCs,sincetherateofunknownHIVtransmissionwashigh.

• Consideringhighrateofmigration,conductspecialawarenesscampaignespeciallyamongpocketsofout-migrantstransitpointsandaround truck halting points and highways in the district.

• StrengthenandimprovequalityofoutreachprogrammeforMSMandFSWs.

Kutch District


KutchDistrict Population: 20,90,313 (3.46%



; ANC Utilization

2: 48.5%

2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

00.50

00

0.500.75

NT

4400

400400

398400

400

PPTCTPP

-*

*0.40

0.220.16

0.170.15

NT

-*

*4881

72997353

134569915

Blood BankPP

0.080.09

0.130.14

0.190.18

0.140.14

NT

35704627

84139811

2150126252

2575424023

HSS-STDPP

--

--

--

NT

--

--

--

HSS-FSWPP

--

--

--

NT

--

--

--

HSS-MSM

PP-

--

--

-N

T-

--

--

-

HSS-IDUPP

--

--

--

NT

--

--

--

ICTC Male

PP-

--

-5.27

3.602.19

1.67N

T-

--

-4956

8675 15463

12581

ICTC Female

PP-

--

-4.29

4.00 2.07

1.76N

T-

--

-2679

3725 7446

6380

ICTC ReferredPP

--

--

3.723.12

1.621.70

NT

--

--

52408104

105548161

ICTC Direct W

alk-inPP

--

--

7.564.84

2.191.69

NT

--

--

23954296

1235510800


5 N

T-

4391

488114934

735313456

28876

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (1804)48

1120

171

DLN (N

A)-

--

--

Block-Level Details

No. HRG

- FSW

- -

- -

- -

- -

-

No. HRG

- M

SM-

- -

- -

- -

- -

No. HRG

- IDU

- -

- -

- -

- -

-

% Pos;

ICTC-

- -

- -

- -

- -

% Pos;

PPTCT-

- -

- -

- -

- -

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

331)74.92

11.785.44

2.425.14

0.30


3




percent positive, N

T = num


omen.

STI/RTI2009

20102011

2012


123899046

110949394


-0.07

0.010.03

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

23

33

2-

--

-M

SM TIs

--

--

--

--

-IDU TIs

--

--

--

--

-Com

p. TIs-

--

--

22

22

ICTCs-

--

78

823

3535

Blood Banks4

43

55

66

66

STI clinics-

--

11

11

11

ART centres-

--

--

-1

11

Link ART centres-

--

-1

1-

23

PLHIV Netw

orks1

11

11

11

11

Red Ribbon Clubs-

--

--

--

88

Comm

. care centres-

--

--

-1

11

Drop-in-centres-

--

11

11

11

Condom outlets

--

--

--

--

-

VulnerabilitiesM


Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

8458620954

1438949243

% of m

ale pop.

10.812.68

1.846.29

% total

migration

10024.77

17.0158.22


Mum

bai (Suburban)

, Maha-

rashtra

Thane, M

aharash-tra

Mum

bai, M

aharash-tra

Nashik,

Maharash-

tra

Pune, M

aharash-tra

HRG Size

FSWM

SMIDU


Year: 2008)624

680-

% Total HRG

47.8552.15

-

% Total Pop.

0.030.03

-

Program Target

NA

NA

NA

Program Coverage

--

-

Typology

Home

based-57.31%

;

Brothel based-

38.94%;

Street based-4.13%

Kothi-77.34%

;

Panthi-N

A;

Double decker-17.2%

Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.25.29

22.75-

% M

arried82.60

72.07-


KhedaBackground:

Kheda, also known as ‘Kaira’ is located 35 km from Ahmedabad, on the bank of river Vatrak. Kheda district borders with Sabarkantha district in the north, Panchmahals district in the east, Vadodara district in the south and Ahmedabad district in the west. The district has a population of 22.98 lakh, 77.24% residing in rural areas, a sex ratio of 937 females per 1,000 males; female literacy rate of 74.67%, with an overall literacy rate of 84.31% (Census 2011). Focus industry sectors are agriculture, mineral-based industries, plastics, engineering and IT sector. Kheda district is also known by the name golden leaf since it is the major producer of tobacco in the state. Famous pilgrimage destinations in the district are Dakortemple, Santram temple, and Mahadev temple. A tourist attraction is Dinosaur and Fossil Park which is a treasure of fossils and fossilized eggs of a 10 meter long dinosaur. National Highway (NH) 8 passes through the district connecting it to cities such as Ahmedabad, Surat and Vadodara.


• Basedon2012HSS-ANCdata,HIVprevalencewasmoderateat0.75%amongtheANCattendees,whileitwas0.25%in2010.



• In2012,HIVpositivityamongICTCattendeeswas lowamongmale(3.90%)andfemale(2.41%)clients,aswellasamongreferred(2.10%) clients and moderate among direct walk-in (8.11%) clients. ICTC male, female and referred clients had a stable trend but observed a steep rise in 2011, whereas direct walk-ins had an increasing trend.

• Accordingto2008-09HRGmappingdata,FSWs(454;)wastheonlyHRGinthedistrict.52.78%ofthemweremarriedandthemajortypology was street-based (58.84%).


• Asper the2001Census,6.94%of themalepopulationweremigrants; among them4.53%migrated toother statesand51.07%migrated to other districts within the state.


• Accordingto2012ICTCdata,HIVtransmissionsfromparenttochildandthroughbloodtransfusionaccountedfor6.99%and9.32%respectively of the total reported cases (n=515) respectively in the district.


• In2012,therewasonecompositeTIinthedistrict.


• ConsideringrisingprevalenceamongHSS-ANCattendees,socio-demographicanalysisneedstobedonetoascertainriskfactors.

• Carryoutdifferentialanalysisofdirectwalk-inclientsatICTCclinics,(asrepresentativeofvulnerablepopulations)toinformdesignandfocusing of various efforts aimed at specific vulnerable groups. Since HIV transmission rate through blood transfusion is high, there is a need to better understand the profile of these positive individuals through in-depth analysis of ICTC data analysis.

• Parenttochildtransmissionratewashigh,thusmoreneedstobedonetounderstandtheprofileoftheseattendeesthroughin-depthanalysis of ICTC data. Strengthen outreach efforts and counselling to enable early HIV detection, positive prevention and / or link to necessary treatment centers.

• IntensifyoutreachactivitieswithHIVpreventionmessagesformigrantsatsourceanddestinationsites.Alsoconductspecialawarenesscampaign especially at tourist’s destinations.

Kheda District


KhedaDistrict Population: 22,98,934 (3.81%



; ANC Utilization

2: 62.2%

2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

--

0.500

0.250.75

NT

4-

-400

322396

400

PPTCTPP

-*

*0.41

0.220.13

0.120.14

NT

-*

*1703

1073717935

2392415674

Blood BankPP

0.160.20

0.340.30

0.250.16

0.260.16

NT

49439793

97879994

1255613026

1403513393

HSS-STDPP

--

--

--

NT

--

--

--

HSS-FSWPP

--

--

--

NT

--

--

--

HSS-MSM

PP-

--

--

-N

T-

--

--

-

HSS-IDUPP

--

--

--

NT

--

--

--

ICTC Male

PP-

--

4.512.94

2.5410.11

3.90N

T-

--

43926192

810211456

9118

ICTC Female

PP-

--

3.812.63

1.461.33

2.41N

T-

--

31234404

69378248

6896

ICTC ReferredPP

--

-2.55

2.201.55

6.682.10

NT

--

-4675

778312365

1581812933

ICTC Direct W

alk-inPP

--

-6.97

4.514.30

5.438.11

NT

--

-2840

28132674

38863081


5 N

T-

203705

921821333

3297443628

31688

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (NA)

--

--

-

DLN (N

A)-

--

--

Block-Level Details

No. HRG

-FSW-

- -

- -

- -

- -

No. HRG

-MSM

- -

- -

- -

- -

-

No. HRG

- IDU-

- -

- -

- -

- -

% Pos;

ICTC-

- -

- -

- -

- -

% Pos;

PPTCTN

adiad, 9.56

Kheda, 5.14

Matar, 2.8

Mahudha,

0

Mehm

da-bad, 0.62

Thasara, 5.1

Balasinor, 0.14

Virpur, 0

Kathla, l 7.5

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

515)75.53

3.699.32

1.366.99

3.11


3




percent positive, N

T = num


omen.

STI/RTI2009

20102011

2012


526939077

1168212061


-0.79

0.900.60

VulnerabilitiesM


Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

730463311

3730832427

% of m

ale pop.

6.940.31

3.543.08

% total

migration

1004.53

51.0744.39


Thane, M

aharash-tra

Mum

bai (Suburban)

, Maha-

rashtra

Pune, M

aharash-tra

Raigarh, M

aharash-tra

-

HRG Size

FSWM

SMIDU


Year: 2008, 2009)454

00

% Total HRG

1000

0

% Total Pop.

0.020

0

Program Target

NA

NA

NA

Program Coverage

--

-

Typology

Home

based-19.37%

;

Brothel based-

21.79%;

Street based-

58.84%

Kothi-81.58%

;

Panthi-N

A;


Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.47.46

29.63-

% M

arried52.78

--

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

--

--

--

--

-M

SM TIs

--

--

--

--

-IDU TIs

--

--

--

--

-Com

p. TIs-

--

--

11

11

ICTCs-

--

68

960

6767

Blood Banks4

44

44

44

44

STI clinics-

--

22

22

33

ART centres-

--

--

-1

1Link ART centres

--

--

11

--

PLHIV Netw

orks-

-1

11

11

11

Red Ribbon Clubs-

--

--

--

-

Comm

. care centres-

--

--

--

--

Drop-in-centres-

--

--

--

--

Condom outlets

--

--

--

--

-


MahesanaBackground:

Mehsana district is located in North Gujarat, about 75 km from Ahmedabad. It borders with Banaskantha district in the north, Patan and Surendranagar districts in west, Gandhinagar and Ahmedabad districts in south and Sabarkantha district in the east. It has a population of 20.27 lakh, 74.65% of population residing in rural areas, with a sex ratio of 925 females per 1,000 males; female literacy rate of 76.12%, with an overall literacy rate of 84.26% (Census 2011). There are more than 70 medium and large scale industries in Mehsana district primarily operating in engineering, chemicals, pharmaceuticals, dairy products, oil and textiles sectors. Asia’s second largest dairy ‘Dudhsagar Milk Cooperative Dairy’ and largest market yard ‘Unjha’ is located in Mehsana. ‘Sun Temple’ at Modhera is an important tourist destination of Mehsana district.


• Basedon2012HSS-ANCdata,HIVprevalencewashighat2.75%among theANCattendees.Mahesanadistrict is knownashighprevalence district with prevalence at 2.75%, and also higher in the past HSS rounds.

• Accordingto2012PPTCTdata,HIVpositivitywaslowat0.13%amongthePPTCTattendees.

• Accordingto2012BloodBankdata,thelevelofHIVpositivitywaslowat0.13%amongtheBloodBankdonors.

• Accordingto2010HSSdata,HIVprevalencewaslowamongMSMsat1.60%.

• In2012,HIVpositivityamongICTCattendeeswas lowamongmale(1.56%)andfemale(0.95%)clients,aswellasamongreferred(1.12%) and direct walk-in (1.45%) clients with an overall declining trend.

• Accordingto2008HRGmappingdata,MSM(1,886;58.23%ofthetotalHRG)wasthelargestHRGinthedistrictfollowedbyFSWs(1,353; 41.77% of the total HRG).




• Accordingto2012ICTCdata,HIVtransmissionsthroughparenttochildtransmissionandunknownroutesaccountedfor4.91%and9.04% respectively of the total HIV reported cases (n=387)-in the district.


• In2012,thereweretwocompositetargetedintervention(TI)sitesinoperationinthedistrict.


• StrengtheneffortstodecreaseandlimitthespreadoftheinfectionfurtherconsideringthelevelofepidemicreportedbyHSSandprogramdata.

• EstablishTIsitesexclusivelyforMSMandFSWs,toprovideHIVpreventiveandreferralservices,consideringtheirlargenumberinthedistrict.

• Conduct socio-demographic analysis of HSS-ANC attendees to ascertain risk factors, considering high prevalence among HSS-ANCattendees. Strengthen efforts for positive prevention focused on couples and also among general population, and linkage to treatment and care services.

• SincethelargestproportionofHRGwasMSM,betterassessmentofthepopulationsizeandprofileofMSMandpartnerpopulationwillhelp in better understanding of district vulnerabilities.Availability of typology data will help to analyze risk factors.

Mahesana District


Mahesana



1: 76.12%; AN

C Utilization2: 59%

2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

1.001.00

01.50

1.002.75

NT

4400

400400

400400

400

PPTCTPP

-*

0.460.33

0.20-

0.120.13

NT

-*

13098263

21807-

3888021780

Blood BankPP

0.160.10

0.090.12

--

-0.13

NT

1016110831

992715766

--

-20785

HSS-STDPP

--

--

--

NT

--

--

--

HSS-FSWPP

--

--

--

NT

--

--

--

HSS-MSM

PP-

--

2.871.60

-N

T-

--

244250

-

HSS-IDUPP

--

--

--

NT

--

--

--

ICTC Male

PP-

--

5.834.47

2.311.52

1.56N

T-

--

61219112

1374820945

16628

ICTC Female

PP-

--

4.883.25

1.571.07

0.95N

T-

--

42436333

1108217585

13642

ICTC ReferredPP

--

-4.74

3.881.78

1.311.12

NT

--

-6608

935814739

2088515542

ICTC Direct W

alk-inPP

--

-6.68

4.112.28

1.331.45

NT

--

-3756

608710091

1764514728


5 N

T-

5711309

1862737252

2483077410

52050

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (NA)

--

--

-

DLN (N

A)-

--

--

Block-Level Details

No. HRG

- FSW

- -

- -

- -

- -

-

No. HRG

- M

SM-

- -

- -

- -

- -

No. HRG

- IDU

- -

- -

- -

- -

-

% Pos;

ICTC-

- -

- -

- -

- -

% Pos;

PPTCT-

- -

- -

- -

- -

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

387)83.72

1.031.29

04.91

9.04


3




percent positive, N

T = num


omen.

STI/RTI2009

20102011

2012


--

92846243


--

-0.65

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

--

--

--

--

-M

SM TIs

--

--

--

--

-IDU TIs

--

--

--

--

-Com

p. TIs-

--

--

22

22

ICTCs-

--

815

3368

7378

Blood Banks4

44

44

44

44

STI clinics-

--

11

11

22

ART centres-

--

-1

11

11

Link ART centres-

--

--

-1

23

PLHIV Netw

orks-

--

--

11

11

Red Ribbon Clubs-

--

--

5555

1938

Comm

. care centres-

--

-1

11

11

Drop-in-centres-

--

-1

11

11

Condom outlets

--

--

--

--

-

VulnerabilitiesM


Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

1175545434

6568846432

% of m

ale pop.

12.320.57

6.894.87

% total

migration

1004.62

55.8839.50


Mum

bai (Suburban)

, Maha-

rashtra

Thane, M

aharash-tra

North

West Delhi, Delhi

Nashik,

Maharash-

tra

Mum

bai, M

aharash-tra

HRG Size

FSWM

SMIDU


Year: 2008)1353

18860

% Total HRG

41.7758.23

0

% Total Pop.

0.070.09

0

Program Target

NA

NA

NA

Program Coverage

--

-

Typology

Home

based-N

A;

Brothel based-

NA;

Street based-

NA

Kothi-N

A;

Panthi-N

A;

Double decker-

NA

Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.-

--

% M

arried-

--


NarmadaBackground:

Narmada district is located at the southern part of Gujarat. The district is bounded by Vadodara district in the north, by Maharashtra state in the east, by Tapi district in the south and by Bharuch district in the west. It is the third least populous district of Gujarat with a population of 5.90 lakh, a sex ratio of 960 females per 1,000 males; female literacy rate of 63.62%, with an overall literacy rate of 73.29% (Census 2011). Located in Nandod taluka, Rajpipla is the district headquarters and the main industrial town of Narmada district. Focus industry sectors include, textiles, food and agriculture and chemicals. A major section of the population is dependent upon agriculture for their livelihood. Some of the main tourist destinations include Shoolpaneshwar Wildlife Sanctuary and Temple and Rajwant Palace, which accounts for a healthy influx of tourists. Major state roads connect the district with key industrial centers in the state.


• Basedon2012HSS-ANCdata,HIVprevalencewasmoderateat0.75%amongtheANCattendees.Thisrepresentsanincreasefromthereported 0.25% in the previous HSS rounds among this population.



• In2012,HIVpositivityamongICTCattendeeswas lowamongmale(1.10%)andfemale(1.30%)clients,aswellasamongreferred(0.67%) and direct walk-ins (2.13%), with a stable trend among all the ICTC clients, but a steep rise in the positivity was observed among male and referred clients in 2011.

• AccordingtoHRGmappingdata,therearesmallnumbersofHRGinthedistrict.FSW(130)accountedfor52%ofthetotalHRGandMSM (120) accounted for 48%.

• In2012,813STI/RTIepisodesweretreatedandthesyphilispositivityrateamongSTIclinicattendeeswas2.49%.

• Asperthe2001Census,8%ofthemalepopulationweremigrants;amongthem1.71%migratedtootherstatesand32.23%migratedto other districts within the state.

• Thetopdestinationforout-of-statemigrationwasNandurbarinMaharashtra.

• Accordingto2012ICTCdata,HIVtransmissionsfromparenttochildandbloodtransfusion,eachaccountedfor15.15%ofthetotalreported cases (n=33) in the district.


• In2012,therewasonecompositeTIsiteinoperationinthedistrict.


• Districtneedscontinuedattentiontodecreaseandlimitthespreadoftheinfectionfurther.

• CarryoutdisaggregatedanalysisofHSS-ANCattendeestoidentifyriskfactorsforHIVepidemicamonggeneralpopulation.Consideringhigh syphilis positivity in the district, strengthen screening activities and management of syphilis.

• ThereisaneedtobetterunderstandtheprofileofHIVpositiveindividualsthroughin-depthanalysisofICTCdataanalysis.

• MoreneedstobedonetounderstandtheprofileoftheICTCattendeesthroughindepthanalysisofICTCdataastheparenttochildHIV transmission rate was high in the district and accordingly strengthen efforts for early detection and linkage to treatment centers, as required, and enable positive prevention among spouses.

• StrengthenIECprogrammeforcreatingHIVandSTIawarenessinthedistrictamonggeneralpopulation,especiallywomen.

Narmada District


Narm

adaDistrict Population: 5,90,379 (0.98%



; ANC Utilization

2: 48.4%

2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

-0

0.250.25

0.250.75

NT

4-

400400

393399

399

PPTCTPP

--

*0.20

0.25*

0.080.04

NT

--

*999

1192*

36092524

Blood BankPP

--

--

--

0.13-

NT

--

--

--

15040-

HSS-STDPP

--

--

--

NT

--

--

--

HSS-FSWPP

--

--

--

NT

--

--

--

HSS-MSM

PP-

--

--

-N

T-

--

--

-

HSS-IDUPP

--

--

--

NT

--

--

--

ICTC Male

PP-

--

2.622.87

1.2613.15

1.10N

T-

--

611698

792844

1630

ICTC Female

PP-

--

2.561.59

1.790.40

1.30N

T-

--

352378

504752

1152

ICTC ReferredPP

--

-1.66

2.772.01

8.860.67

NT

--

-483

578747

11741794

ICTC Direct W

alk-inPP

--

-3.54

2.010.73

2.372.13

NT

--

-480

498549

422988


5 N

T-

-236

19622268

19175205

5306

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (NA)

--

--

-

DLN (N

A)-

--

--

Block-Level Details

No. HRG

-FSW-

- -

- -

- -

- -

No. HRG

-MSM

- -

- -

- -

- -

-

No. HRG

- IDU-

- -

- -

- -

- -

% Pos;

ICTC-

- -

- -

- -

- -

% Pos;

PPTCTN

andod, 3.71

Tilakwada,

0

Dedia-pada, 1.05

Sagbara, 0

Other,

4.41-

- -

-

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

33)66.67

3.0315.15

015.15

0


3




percent positive, N

T = num


omen.

STI/RTI2009

20102011

2012


727953

521813


-1.62

3.412.49

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

--

--

--

--

-M

SM TIs

--

--

--

--

-IDU TIs

--

--

--

--

-Com

p. TIs-

--

--

11

11

ICTCs-

--

12

211

1111

Blood Banks-

--

--

--

--

STI clinics-

--

11

11

11

ART centres-

--

--

--

--

Link ART centres-

--

--

-1

11

PLHIV Netw

orks-

--

--

--

11

Red Ribbon Clubs-

--

--

--

33

Comm

. care centres-

--

--

--

--

Drop-in-centres-

--

--

--

--

Condom O

utlets-

--

--

--

--

VulnerabilitiesM


Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

21116361

680513950

% of m

ale pop.

8.000.14

2.585.29

% total

migration

1001.71

32.2366.06


Nandurbar

,Maharash-

tra-

--

-

HRG Size

FSWM

SMIDU


Year: NA)

130120

NA

% Total HRG

52.0048.00

-

% Total Pop.

0.020.02

-

Program Target

NA

NA

NA

Program Coverage

--

-

Typology

Home

based-N

A;

Brothel based-

NA;

Street based-

NA

Kothi-60.78%

;

Panthi-N

A;


Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.-

52.63-

% M

arried-

--


NavsariBackground:

Navsari district is located in the south eastern part of Gujarat state, in the coastal lowland along Purna River. It has a population of 13.30 lakh, with a sex ratio of 961 females per 1,000 males; female literacy rate of 79.30%, with an overall literacy rate of 84.78% (Census 2011). The district abounds in sugarcane fields, chikoo plantations, and mango trees. Navsari district is the largest producer of chikoo in the State and the largest exporter of the fruit in India. Navsari is known for its floriculture activities and sugar business. The focus sectors of the district are agro and food processing industries, textiles, drugs and pharmaceuticals, mineral related industries, and marine based industries. Famous historical place include Dandi and Vansda National Park. National Highway (NH) 8 and 228 passes through the district.


• Basedon2012HSS-ANCdata,HIVprevalencewasmoderateat0.50%,amongtheANCattendees.DuringthepreviousHSSrounds,ANCprevalence was always between 0.5% and 1%.



• In2012,HIVpositivityamongICTCattendeeswas lowamongmale(1.28%)andfemale(1.06%)clients,aswellasamongreferred(1.07%) and direct walk-in (1.43%) clients.

• Accordingto2008HRGmappingdata,FSW(559);wasthelargestHRGinthedistrictrepresenting81.49%followedbyMSM(127)representing 18.51%. The major typology for FSWs was home-based (46.69%).



• Thetoptwodestinationsforout-of-statemigrationwereNawada,Bihar;and,Mumbai(Suburban),Maharashtra.





• Conductsocio-demographicanalysisofHSS-ANCattendeestoascertainriskfactorsforHIVinfection,consideringvaryinglevelsofHIVprevalence reported among HSS-ANC attendees over HSS rounds.

• Conductin-depthanalysisofICTCdatatounderstandtheprofileoftheseattendeesastheparenttochildHIVtransmissionrateishigh.Strengthen efforts for positive prevention focusing on sero-discordant couples.

• ConsideringhighrateofmigrationtohighHIVprevalentdistricts,strengthenoutreachprogramsthroughawarenesscampaignsaroundsource and transit points such as railway stations and bus stands.

• SincethelargestHRGwasFSW,betterassessmentofthepopulationsizeandtheprofileofclientpopulation,includingmigrantsandtruckers, will help in better understanding of district vulnerabilities Focus efforts on hard to reach sub groups such as home-based FSW.

Navsari District


Navsari



1: 79.30%; AN


2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

-1.00

0.750.50

0.750.50

NT

4-

400400

397399

400

PPTCTPP

-*

0.800.60

0.180.09

0.080.09

NT

-*

9961543

1034512190

1144913262

Blood BankPP

0.480.68

0.690.54

0.320.28

0.240.10

NT

87729366

1097113033

1320513718

840918937

HSS-STDPP

-4.00

2.001.20

9.24-

NT

-250

250250

249-

HSS-FSWPP

--

--

--

NT

--

--

--

HSS-MSM

PP-

--

--

-N

T-

--

--

-

HSS-IDUPP

--

--

--

NT

--

--

--

ICTC Male

PP-

--

3.702.02

1.686.90

1.28N

T-

--

43466787

87009280

10261

ICTC Female

PP-

--

3.331.95

1.370.35

1.06N

T-

--

27935175

76588250

9288

ICTC ReferredPP

--

-3.18

1.801.32

5.191.07

NT

--

-5092

825510809

1135714147

ICTC Direct W

alk-inPP

--

-4.49

2.401.95

1.301.43

NT

--

-2047

37075549

61735402


5 N

T-

639996

868222307

2854828979

32811

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (1402)51

973

5921

DLN (N

A)-

--

--

Block-Level Details

No. HRG

-FSW-

- -

- -

- -

- -

No. HRG

-MSM

- -

- -

- -

- -

-

No. HRG

- IDU-

- -

- -

- -

- -

% Pos;

ICTC-

- -

- -

- -

- -

% Pos;

PPTCTG

andevi, 3.89

Chikhli, 3.9

Vansda, 1.6

Jalalpor 5.68

Navsari, 3.87

- -

- -

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

229)90.83

0.870.87

05.24

2.18


3




percent positive, N

T = num


omen.

STI/RTI2009

20102011

2012


79213955

9313074


-0.49

1.260.34

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

--

--

--

--

-M

SM TIs

--

--

--

--

-IDU TIs

--

--

--

--

-Com

p. TIs-

--

--

11

11

ICTCs-

--

512

1721

2828

Blood Banks2

22

22

32

33

STI clinics-

--

11

11

33

ART centres-

--

--

-1

11

Link ART centres-

--

--

11

11

PLHIV Netw

orks-

--

--

11

11

Red Ribbon Clubs-

--

--

--

99

Comm

. care centres-

--

--

--

--

Drop-in-centres-

--

-1

11

11

Condom O

utlets-

--

--

--

--

VulnerabilitiesM


Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

470793463

973633880

% of m

ale pop.

7.490.55

1.555.39

% total

migration

1007.36

20.6871.96


Naw

ada, Bihar

Mum

bai (Subur-ban),

Maharash-

tra

Thane, M

aharash-tra

Mum

bai, M

aharash-tra

Dadra & N

agar Haveli,

Dadra & N

agar Haveli

HRG Size

FSWM

SMIDU


Year: 2008)559

1270

% Total HRG

81.4918.51

0

% Total Pop.

0.040.01

0

Program Target

NA

NA

NA

Program Coverage

--

-

Typology

Home

based-46.69%

;

Brothel based-

13.06%;

Street based-

40.25%

Kothi-37.78%

;

Panthi-N

A;


Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.-

--

% M

arried-

--


PanchmahalsBackground:

Panchmahal, also PanchMahals, is a district in the eastern end of Gujarat State. Panch-mahal means “five tehsils/talukas” (5 sub-divisions), and refers to the five sub-divisions namely: Godhra, Dahod, Halol, Kalol and Jhalod that were transferred by the Maharaja Sindia of Gwalior to the British. The district has a population of 23.88 lakh, a sex ratio of 945 females per 1,000 males; female literacy rate of 59.95%, with an overall literacy rate of 72.32% (Census 2011). Panchmahals is rich in minerals and agricultural produce. Major occupations in the district are dairy farming and agriculture. Main crops cultivated are wheat, maize and pulses. Tourist attractions in the district include Champaner-Pavagadh Archeological Park (listed as World Heritage Site by UNESCO), temple of Mata Kalika in Pavagarh, the Jain pilgrimage center at Pavoli, fairs of ChaitiAtham and Math Kotal, Kadana Dam, etc. which attract a large number of tourists every year. National Highway (NH) 59, NH-8 and State Highway 4 pass through the district.


• Basedon2012HSS-ANCdata,HIVprevalencewaslow(0.25%)amongtheANCattendees.ThisisconsistentwiththepreviousHSSrounds.

• Accordingto2012PPTCTdata,HIVpositivitywasmoderateat0.60%amongthePPTCTattendees,withastabletrendtill2011,butasudden rise was observed in 2012.


• In2012,HIVpositivityamongICTCattendeeswas lowamongmale(1.47%)andfemale(1.39%)clients,aswellasamongreferred(1.36%) and direct walk-in (1.80%) clients, with a stable trend among all the ICTC clients, but an increase in the positivity was observed among male and referred clients in 2011.

• According to2008HRGmappingdata,MSM(234)was the largestproportionofHRG in thedistrict representing55.45%followedby FSW (188) representing 44.55% of the total HRG. 71.62% of the FSWs were married and the major typology was street-based (95.83%).


• Thetoptwodestinationsforout-of-statemigrationwerePuneandMumbai(Suburban),Maharashtra.

• Accordingto2012ICTCdata,HIVtransmissionsfromparenttochildaccountedfor9.43%ofthetotalHIVreportedcases(n=159)inthe district.




• AlthoughthereislowleveloftheHIVepidemicinthedistrict,continueeffortstocontainandlimitthespreadofHIVinfection.AnalyseICTC and STI data to ascertain vulnerability factors contributing to HIV transmission.

• ConductdisaggregatedanalysisofPPTCTdatatoassessriskfactorsinthedistrict.

• Withparenttochildtransmissionhighinthedistrict,itisnecessarytostrengthenPPTCTprogramcoverageinthedistrict.Strengthenefforts for enabling early detection, and positive prevention among couples.

• SinceMSMarethelargestproportionofHRGmapped,abetterassessmentofthepopulationsizeandprofileofMSMandtheirpartnerpopulation will enhance understanding of district vulnerabilities and accordingly inform the response. Availability of typology based data will help in analyzing risk factors.

Panchmahal District


PanchMahals

District Population: 23,88,267(3.96% of G


1: 59.95%; AN


2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

-0

0-

00.25

NT

4-

400400

-332

4.00

PPTCTPP

-*

0.210.03

0.190.05

0.170.60

NT

-*

9431116

47597514

122626882

Blood BankPP

0.110.08

0.270.08

0.040.20

0.240.30

NT

26172462

40825039

69188652

141548927

HSS-STDPP

1.200.40

4.90-

--

NT

250250

204-

--

HSS-FSWPP

--

--

--

NT

--

--

--

HSS-MSM

PP-

--

--

-N

T-

--

--

-

HSS-IDUPP

--

--

--

NT

--

--

--

ICTC Male

PP-

--

2.481.83

1.326.16

1.47N

T-

--

35455094

71089392

6666

ICTC Female

PP-

--

2.072.01

1.560.67

1.39N

T-

--

21232882

36585803

4387

ICTC ReferredPP

--

-1.95

1.601.46

4.791.36

NT

--

-4246

72698101

109509169

ICTC Direct W

alk-inPP

--

-3.45

4.951.24

2.191.80

NT

--

-1422

7072665

42451884


5 N

T-

610943

678412735

1828027457

17935

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (1000)32

1145

349

DLN (N

A)-

--

--

Block-Level Details

No. HRG

- FSW

- -

- -

- -

- -

-

No. HRG

- M

SM-

- -

- -

- -

- -

No. HRG

- IDU

- -

- -

- -

- -

-

% Pos;

ICTC-

- -

- -

- -

- -

% Pos;

PPTCT-

- -

- -

- -

- -

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

159)86.16

1.260

09.43

3.14


3




percent positive, N

T = num


omen.

STI/RTI2009

20102011

2012


124443681

63816686


-1.13

1.060.33

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

--

--

--

--

-M

SM TIs

--

--

--

--

-IDU TIs

--

--

--

--

-Com

p. TIs-

--

--

11

11

ICTCs-

--

57

834

4448

Blood Banks3

33

33

33

33

STI clinics-

--

11

11

22

ART centres-

--

--

-1

11

Link ART centres-

--

--

1-

--

PLHIV Netw

orks-

--

--

11

11

Red Ribbon Clubs-

--

--

--

--

Comm

. care centres-

--

--

--

--

Drop-in-centres-

--

--

--

--

Condom outlets

--

--

--

--

-

VulnerabilitiesM


Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

--

--

% of m

ale pop.

--

--

% total

migration

0-

--


Pune, M

aharash-tra

Mum

bai (Subur-ban),

Maharash-

tra

Thane, M

aharash-tra

Daman,

Daman &

Diu

Dadra & N

agar Haveli,

Dadra & N

agar Haveli

HRG Size

FSWM

SMIDU


Year: 2008)188

2340

% Total HRG

44.5555.45

0

% Total Pop.

0.010.01

0

Program Target

NA

NA

NA

Program Coverage

--

-

Typology

Home

based-2.5%

;

Brothel based-1.67%

;

Street based-

95.83%

Kothi-N

A;

Panthi-N

A;

Double decker-

NA

Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.77.60

--

% M

arried71.62

--


PatanBackground:

Patan district is located in northern Gujarat and bounded by Banas kantha district in the north and northeast, Mehsana district in the east and southeast, Surendranagar district in the south and Kutch district and the Kutch nu Nanu Ran (Little Rann of Kutch) in the west. It has a population of 13.42 lakh, with a sex ratio of 935 females per 1,000 males; female literacy rate of 62.01%, with an overall literacy rate of 73.47% (Census 2011). The economy of Patan is mainly agrarian but food processing, agriculture, and textiles are the major vocational and industrial activities in Patan. There are many Hindu temples and Jain Temple (nearly 150 temples) in the district. Patan has a few good tourist spots, to attract people interested in heritage and history. National Highway 14, 15 and State Highway 7, 8 and 10 run through the district connecting it with major cities of the state and the rest of India.


• Basedon2012HSS-ANCdata,HIVpositivitywasmoderateat0.50%,amongtheANCattendees,representinganincreasingtrendoverthe last three data recordings.



• Accordingto2010HSSdata,theHIVprevalencewasmoderateamongMSMsat4.15%.


• Accordingto2009HRGmappingdata,FSW(295)representthelargestproportionofHRGinthedistrictwith79.95%.Therewere74MSM mapped.



• Thetoptwodestinationsforout-of-statemigrationwereMumbai(Suburban)inMaharashtraandRanchiinJharkhand.



• In2012,therewereatwocompositeTIsitesoperationalinthedistrict.


• SustaineffortstocontainandlimitthespreadofHIVinfectionwhilenotingtheavailableepidemiologicandprogramdata.

• ConsideringHIVprevalenceamongHSS-ANCattendees,socio-demographicanalysisneedstobedonetoascertainriskfactorsforHIV.

• GiventhehighproportionofreportedparenttochildHIVtransmissionatICTC,moreneedstobedonetounderstandtheprofileoftheseattendees through in-depth analysis of ICTC data and accordingly strengthen efforts for early detection and positive prevention among couples.

• FocusontheoutreacheffortsforstreetbasedFSW(67.18%ofthetotalFSWinthedistrict)tokeepHIVprevalenceamongthematlowlevel.

• AvailabilityofDLNdatawillhelpinbetterunderstandingofdistrictvulnerabilities.

Patan District


PatanDistrict Population: 13,42,746 (2.22%



; ANC Utilization

2: 53.4%

2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

-0.50

0.250

0.250.50

NT

4-

400400

400398

799

PPTCTPP

--

0.630.17

0.320.31

0.300.24

NT

--

23834632

102789211

1317011300

Blood BankPP

0.190.08

0.040.06

--

-0.19

NT

31503629

55637718

--

-13543

HSS-STDPP

--

--

--

NT

--

--

--

HSS-FSWPP

--

--

--

NT

--

--

--

HSS-MSM

PP-

--

-4.15

-N

T-

--

-241

-

HSS-IDUPP

--

--

--

NT

--

--

--

ICTC Male

PP-

--

5.194.64

3.497.99

2.26N

T-

--

42403923

61309990

8447

ICTC Female

PP-

--

3.092.35

1.850.53

1.33N

T-

--

35893613

55277936

7725

ICTC ReferredPP

--

-3.05

3.162.34

5.291.79

NT

--

-4922

53748817

1346610991

ICTC Direct W

alk-inPP

--

-6.23

4.493.87

2.851.87

NT

--

-2907

21622840

44605181


5 N

T-

-2383

1246117814

2086831096

27472

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (1290)49

664

5721

DLN (N

A)-

--

--

Block-Level Details

No. HRG

-FSW-

- -

- -

- -

- -

No. HRG

-MSM

- -

- -

- -

- -

-

No. HRG

- IDU-

- -

- -

- -

- -

% Pos;

ICTC-

- -

- -

- -

- -

% Pos;

PPTCTPatan, 3.94

Chansma,

1.69Harij, 1.99

Radhan-pur, 0

Sami,

0Siddhpur,

2.62Santalpur,

0.25M

ehsana, 0

Bk, 3.11

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

295)87.80

3.730.34

0.346.10

1.69


3




percent positive, N

T = num


omen.

STI/RTI2009

20102011

2012


127759360

1138210766


-2.29

0.181.65

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

--

--

--

--

-M

SM TIs

--

--

--

--

-IDU TIs

--

--

--

--

-Com

p. TIs-

--

--

22

22

ICTCs-

--

67

816

2737

Blood Banks2

23

33

43

44

STI clinics-

--

22

23

33

ART centres-

--

--

-1

11

Link ART centres-

--

--

1-

11

PLHIV Netw

orks-

--

-1

11

11

Red Ribbon Clubs-

--

--

2525

926

Comm

. care centres-

--

--

--

--

Drop-in-centres-

--

--

--

--

Condom O

utlets-

--

--

--

--

VulnerabilitiesM


Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

434096550

1697619883

% of m

ale pop.

7.101.07

2.783.25

% total

migration

10015.09

39.1145.80


Mum

bai (Suburban) ,M

aharash-tra

Ranchi, Jharkhand

Mum

bai, M

aharash-tra

Thane, M

aharash-tra

South Delhi, Delhi

HRG Size

FSWM

SMIDU


Year: 2009)295

74-

% Total HRG

79.9520.05

-

% Total Pop.

0.020.01

-

Program Target

NA

NA

NA

Program Coverage

--

-

Typology

Home

based-17.52%

;

Brothel based-

15.31%;

Street based-

67.18%

Kothi-52.94%

;

Panthi-N

A;


Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.6.43

47.06-

% M

arried95.34

57.35-


PorbandarBackground:

Porbandar forms a part of the erstwhile Kathiawar peninsula located in the western part of Gujarat. This district is surrounded by Jamnagar district to the north, Junagadh district to the south and the Arabian Sea to the west. It is the second least-populous district of Gujarat with a population of 5.86 lakh, a sex ratio of 947 females per 1,000 males; female literacy rate of 68.32%, with an overall literacy rate of 76.63% (Census 2011). Porbandar is the birth place of Father of the Nation Mahatama Gandhi. Focus industry sectors areport and ship building, cement industry and mineral-based industries. Fishing industry is a prominent activity in Porbandar including sea food processing. The district is very famous for KirtiMandir (the birth place of Mahatma Gandhi), Bharat Mandir, Nehru Planetarium and Vijay Vilas. National highway 8 B and 8E (Ext.) passes through the district, connecting Porbandar with Rajkot and Jamnagar.


• Basedon2012HSS-ANCdata,HIVprevalencewasmoderateat0.50%amongtheANCattendees,withafluctuatingtrend.


• Accordingto2012BloodBankdata,HIVpositivitywaslowamongtheBloodBankdonors,withadecreasingtrend.

• In2012,HIVpositivityamongICTCattendeeswas lowamongmale(0.85%)andfemale(0.60%)clients,aswellasamongreferred(0.48%) and direct walk-in (2.31%) clients a stable trend among all the ICTC clients, but an abrupt upsurge in the positivity was observed among male and referred clients in 2011.

• Accordingto2008-09HRGmappingdata,Thereare214FSWrepresentingthetotalHRGpopulationinthedistrict.Themajortypologyfor FSWs was home-based (69.63%).




• Accordingto2012ICTCdata,HIVtransmissionthroughbloodtransfusionaccountedfor6.02%ofthetotalreportedcases(n=93)inthedistrict.




• SustainfocusoncontainingandlimitingtheHIVepidemic,whilenotingtheavailableevidencesfromepidemiologicandprogramdata.

• Conductsocio-demographicanalysisofHSS-ANCattendeestounderstandriskfactorsforHIVepidemicamonggeneralpopulation,andaccordingly strengthen interventions.

• FocusoutreacheffortsamonghomebasedFSWs(69.63%ofthetotalFSWsinthedistrict)tokeepHIVtransmissionamongthemandtheir clients at low level.

• SincereportedHIVtransmissionthroughbloodtransfusionisrelativelyhigh,thereisaneedtobetterunderstandtheprofileofthesepositive individuals through in-depth analysis of ICTC and ART data.

• AvailabilityofDLNdatahelpinbetterunderstandingofdistrictvulnerabilities.

Porbandar District


PorbandarDistrict Population: 5,86,062 (0.97%



; ANC Utilization

2: 71.3%

2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

-0

-0.50

00.50

NT

4-

400-

400399

400

PPTCTPP

-*

0.210.19

0.080.11

00.06

NT

-*

9462574

51816423

35778161

Blood BankPP

0.290.20

0.160.21

0.040.03

0.110

NT

27423915

57626592

67557676

809395756

HSS-STDPP

--

--

--

NT

--

--

--

HSS-FSWPP

--

--

--

NT

--

--

--

HSS-MSM

PP-

--

--

-N

T-

--

--

-

HSS-IDUPP

--

--

--

NT

--

--

--

ICTC Male

PP-

--

2.681.74

1.2014.29

0.85N

T-

--

27663498

49153947

6237

ICTC Female

PP-

--

2.000.87

0.990.18

0.60N

T-

--

15522172

33203290

5169

ICTC ReferredPP

--

-2.00

1.470.99

10.250.48

NT

--

-2452

34805744

54169805

ICTC Direct W

alk-inPP

--

-3.00

1.321.41

0.822.31

NT

--

-1866

21902491

18211601


5 N

T-

175946

689210851

1465810814

19567

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (546)61

486

6713

DLN (N

A)-

--

--

Block-Level Details

No. HRG

-FSW-

- -

- -

- -

- -

No. HRG

-MSM

- -

- -

- -

- -

-

No. HRG

- IDU-

- -

- -

- -

- -

% Pos;

ICTC-

- -

- -

- -

- -

% Pos;

PPTCTPorbandar,

0Ranavav,

0Kutiyana,

0-

- -

- -

-

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

83)87.95

3.616.02

02.41

0


3




percent positive, N

T = num


omen.

STI/RTI2009

20102011

2012


127759360

1138210766


-2.29

0.181.65

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

--

--

--

--

-M

SM TIs

--

--

--

--

-IDU TIs

--

--

--

--

-Com

p. TIs-

--

-1

11

11

ICTCs-

--

45

56

1414

Blood Banks2

23

33

33

33

STI clinics-

--

11

11

11

ART centres-

--

--

-1

11

Link ART centres-

--

--

--

--

PLHIV Netw

orks-

--

--

--

11

Red Ribbon Clubs-

--

--

--

22

Comm

. care centres-

--

--

--

--

Drop-in-centres-

--

--

--

--

Condom O

utlets-

--

--

--

--

VulnerabilitiesM


Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

434096550

1697619883

% of m

ale pop.

7.101.07

2.783.25

% total

migration

10015.09

39.1145.80


Mum

bai (Suburban) ,M

aharash-tra

Ranchi, Jharkhand

Mum

bai, M

aharash-tra

Thane, M

aharash-tra

South Delhi, Delhi

HRG Size

FSWM

SMIDU


Year: 2009)295

74-

% Total HRG

79.9520.05

-

% Total Pop.

0.020.01

-

Program Target

NA

NA

NA

Program Coverage

--

-

Typology

Home

based-17.52%

;

Brothel based-

15.31%;

Street based-

67.18%

Kothi-52.94%

;

Panthi-N

A;


Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.6.43

47.06-

% M

arried95.34

57.35-


RajkotBackground:

Rajkot is located in the south-west region of Gujarat. The district headquarter is Rajkot city: the largest city in Saurashtra and fourth largest in Gujarat state. This district is surrounded by Kutch district in north, Surendranagar and Bhavnagar districts in the east, Amreli and Junagadh districts in south and Jamnagar district in the west.The district has a population of 37.99 lakh, a sex ratio of 924 females per 1,000 males; female literacy rate of 75.26%, with an overall literacy rate of 82.20% (Census 2011). Rajkot is one of the biggest centers for engineering industry. Special Economic Zone (SEZ) for engineering sector is proposed in the district, which will further boost the growth of engineering sector as well as increase the industrial output and exports of the district. The occupational pattern in Rajkot is primarily based on manufacturing and service sector. Rajkot is well connected to other cities through National Highways (NH) & State Highways (SH).


• Basedon2012HSS-ANCdata,HIVprevalencewasmoderateat0.75%,amongtheANCattendees.HIVprevalencewas1%in2011.

• Accordingto2012PPTCTdata,HIVpositivitywaslowat0.16%amongthePPTCTattendees,withadecreasingtrend.

• Accordingto2012BloodBankdata,HIVpositivitywaslowat0.09%amongtheBloodBankdonors,withadecreasingtrend.

• Accordingto2010HSSdata,HIVpositivitywaslowamongFSWsandMSMsat0.40%and2.85%respectively,withadecreasingtrendover the years.

• In2012,HIVpositivityamongICTCattendeeswas lowamongmale(2.53%)andfemale(1.38%)clients,aswellasamongreferred(1.99%) and direct walk-in (1.94%) clients, with a decreasing trend among all the ICTC clients.

• Accordingto2008HRGmappingdata,FSW(2,487)represent51.07%ofHRGinthedistrictandMSM(2,383)representtheremaining48.93% . The major typologies for FSWs were home-based (37.43%) and street based (34.66%).



• Thetoptwodestinationsforout-of-statemigrationwereMumbai(Suburban)andThaneinMaharashtra.


• In2012,thereweresevenTIsites(2TIsiteseachforFSWandMSMand3compositesite)inoperationinthedistrictforover4,800HRGsin the district.


• Continueattentiononthedistricttodecreaseandlimitthespreadoftheinfectionfurther.

• Considering theHIVprevalence level, conduct socio-demographic analysis ofHSS-ANCattendees to ascertain risk factors to informresponse.

• PresenceoflargesizeofHRGsshouldbeconsideredforstrengtheningHIVpreventiveandreferralservicesinthedistrict.Focuspositiveprevention also among spouses of HRG and strengthen interventions reaching out to potential clients including migrants .

• Assess the population size and profile of FSWs client population, including migrants and truckers, to better understand the districtvulnerabilities. Also, focus outreach efforts also among home based FSW (37.43% of the total FSWs in the district) to keep HIV prevalence among them at low level.

• Analyse the population size and profile of migrants to improve understanding of district vulnerabilities, considering high rate ofmigration.

Rajkot District


RajkotDistrict Population: 37,99,770 (6.29%



; ANC Utilization

2: 82.2%

2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

00.75

0.500.50

1.000.75

NT

4400

400400

400400

400

PPTCTPP

1.581.45

1.080.85

0.230.19

0.180.16

NT

12001240

23104838

2260723232

3278729088

Blood BankPP

0.320.20

0.220.23

0.160.12

0.060.09

NT

4821545886

4496356413

6544577231

2091083034

HSS-STDPP

--

--

--

NT

--

--

--

HSS-FSWPP

4.402.80

2.802.00

0.40-

NT

250250

250250

250-

HSS-MSM

PP12.40

14.0015.60

6.402.85

-N

T250

250250

250246

-

HSS-IDUPP

--

--

--

NT

--

--

--

ICTC Male

PP-

--

16.817.56

4.285.86

2.53N

T-

--

679510780

1603328605

22553

ICTC Female

PP-

--

11.113.91

1.940.70

1.38N

T-

--

42409632

1395325796

21657

ICTC ReferredPP

--

-9.75

4.383.40

4.471.99

NT

--

-6018

1259618367

3119322670

ICTC Direct W

alk-inPP

--

-20.45

8.192.86

2.001.94

NT

--

-5017

781611619

2320821540


5 N

T1200

12402310

1587343019

5321887188

73298

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (9477)29

1086

7011

DLN (N

A)-

--

--

Block-Level Details

No. HRG

-FSW-

- -

- -

- -

- -

No. HRG

-MSM

- -

- -

- -

- -

-

No. HRG

- IDU-

- -

- -

- -

- -

% Pos;

ICTC-

- -

- -

- -

- -

% Pos;

PPTCTDoraji, 53.33

Gondal,

43.86

Jamkan-

dorana, 25

Jasdan, 34

Jetpur, 36.59

Kota-dasangani,

26

Lodhika, 14.29

Maliya

Miyana,

66.67

Morbi,

43.04

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

869)90.45

3.221.15

0.353.34

1.50


3




percent positive, N

T = num


omen.

STI/RTI2009

20102011

2012


9209723921

3264130318


-1.26

0.640.55

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

11

11

12

22

2M

SM TIs

11

11

12

22

2IDU TIs

--

--

--

--

-Com

p. TIs-

--

-2

33

33

ICTCs-

--

1021

4445

4645

Blood Banks6

65

611

1111

1111

STI clinics-

--

33

33

33

ART centres-

--

11

11

11

Link ART centres-

--

--

-2

46

PLHIV Netw

orks-

11

11

11

11

Red Ribbon Clubs-

--

--

4040

1010

Comm

. care centres-

--

-2

22

11

Drop-in-centres-

11

11

11

11

Condom O

utlets-

--

--

--

--

VulnerabilitiesM


Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

1499108285

4975491871

% of m

ale pop.

9.160.51

3.045.62

% total

migration

1005.53

33.1961.28


Mum

bai (Suburban) ,M

aharash-tra

Thane, M

aharash-tra

Pune, M

aharash-tra

Mum

bai, M

aharash-tra

Jaipur, Rajasthan

HRG Size

FSWM

SMIDU


Year: 2008)2487

2383-

% Total HRG

51.0748.93

-

% Total Pop.

0.070.06

-

Program Target

NA

NA

NA

Program Coverage

--

-

Typology

Home

based-37.43%

;

Brothel based-

27.91%;

Street based-

34.66%

Kothi-53.76%

;

Panthi-N

A;


Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.-

--

% M

arried-

--


SabarkanthaBackground:

Sabarkantha district derives its name from the river Sabarmati that separates Sabarkantha from the neighbouring districts. The district is bounded by the Rajasthan State to the north, Banaskantha and Mehsana districts to the west, Gandhinagar, Kheda, and Panchmahal districts to the south. It has a population of 24.27 lakh, 85.04% of which reside in rural areas, with a sex ratio of 950 females per 1,000 males; female literacy rate of 65.29%, with an overall literacy rate of 76.60% (Census 2011). The economy of the district is heavily dependent on Agriculture and Dairy Farming. Food processing and textiles are the other emerging sectors which have opened up new opportunities for investment. Major tourist destinations are Idar, Shamlaji temple, Polo Forests, Vijaynagar. NH 8 passes through the district connecting it with major cities of the State and also with the rest of India.


• Basedon2010HSS-ANCdata,HIVprevalencewashighat1.50%amongtheANCattendees.Sabarkantha isahighHIVprevalencedistrict with prevalence at 1% of higher in the last HSS round also (1.25% in 2008).

• Accordingto2012PPTCTdata,HIVpositivitywaslowat0.23%amongthePPTCTattendees,withadecreasingtrend.

• Accordingto2012BloodBankdata,HIVpositivitywaslowat0.08%amongtheBloodBankdonors,withaflattrend.


• Accordingto2008HRGmappingdata,FSW(829;64.56%ofthetotalHRG)wasthelargestHRGinthedistrictfollowedbyMSM(455;35.44% of the total HRG). The major typology for FSWs was street-based (49.58%).





• In2012,twocompositeTIsiteswereoperationalinthedistrict.


• IncreasethenumberofTIsitesinthedistricttoprovideHIVpreventiveandreferralservicestoaccommodatethesizeablenumberofHRGs.

• Conductsocio-demographicanalysisofHSS-ANCattendeestoascertainriskfactors,consideringhighHIVprevalenceamongHSS-ANCattendees.

• NotingthelevelofHIVtransmissionviaparenttochildofallreportedcases,thereisaneedtobetterunderstandtheprofileanddynamicsof clinic attendees and their spouses also through analysis of ICTC data. Accordingly strengthen HIV prevention efforts among married women and encourage early detection and linkage to necessary treatment services.

• AnalysevulnerabilityfactorsintransmissionofHIVfromICTCandSTIdata,consideringtheHIVepidemicinthedistrict.

• StrengthenIECforgeneralpopulationwithHIVawarenessandHIVpreventionmessages,includingsexualriskreduction.

Sabarkantha District


SabarkanthaDistrict Population: 24.27,346 (4.02%



; ANC Utilization

2: 49.7%

2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

0.250.75

0.251.25

1.50-

NT

4400

400400

399400

-

PPTCTPP

-0.85

0.550.34

0.250.28

0.230.23

NT

-1170

33017700

1329215859

1761113618

Blood BankPP

0.220.43

0.100.10

0.070.16

0.090.08

NT

50944636

94198954

1716420381

9378817829

HSS-STDPP

--

--

--

NT

--

--

--

HSS-FSWPP

--

--

--

NT

--

--

--

HSS-MSM

PP-

--

--

-N

T-

--

--

-

HSS-IDUPP

--

--

--

NT

--

--

--

ICTC Male

PP*

*8.60

3.903.31

2.407.72

2.64N

T*

*4009

131888219

962210672

9102

ICTC Female

PP*

*-

3.592.58

1.890.90

1.97N

T*

*-

61777355

907910986

8590

ICTC ReferredPP

--

-3.22

2.631.59

4.451.54

NT

--

-9739

1163513635

1513512501

ICTC Direct W

alk-inPP

--

-5.72

3.963.67

3.824.16

NT

--

-3744

39395066

65235191


5 N

T214

17157310

2706528866

3456039269

31310

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (NA)

--

--

-

DLN (N

A)-

--

--

Block-Level Details

No. HRG

- FSW

- -

- -

- -

- -

-

No. HRG

- M

SM-

- -

- -

- -

- -

No. HRG

- IDU

- -

- -

- -

- -

-

% Pos;

ICTC-

- -

- -

- -

- -

% Pos;

PPTCT-

- -

- -

- -

- -

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

409)82.15

1.964.40

0.497.58

3.42


3




percent positive, N

T = num


omen.

STI/RTI2009

20102011

2012


27856508

79225217


-0.14

0.820.64

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

--

--

--

--

-M

SM TIs

--

--

--

--

-IDU TIs

--

--

--

--

-Com

p. TIs-

--

--

22

22

ICTCs-

--

1112

1236

4645

Blood Banks2

22

35

55

55

STI clinics-

--

11

11

22

ART centres-

--

--

-1

11

Link ART centres-

--

-1

21

12

PLHIV Netw

orks-

--

-1

11

11

Red Ribbon Clubs-

--

--

--

2526

Comm

. care centres-

--

--

--

--

Drop-in-centres-

--

--

--

--

Condom outlets

--

--

--

--

-

VulnerabilitiesM


Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

--

--

% of m

ale pop.

--

--

% total

migration

0-

--


Thane, M

aharash-tra

Mum

bai (Subur-ban),

Maharash-

tra

Dungarpur, Rajasthan

Udaipur, Rajasthan

Mum

bai, M

aharash-tra

HRG Size

FSWM

SMIDU


Year: 2008)829

455-

% Total HRG

64.5635.44

-

% Total Pop.

0.030.02

-

Program Target

NA

NA

NA

Program Coverage

--

-

Typology

Home

based-17.61%

;

Brothel based-

32.81%;

Street based-

49.58%

Kothi-82.85%

;

Panthi-N

A;


Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.-

--

% M

arried-

--


SuratBackground:

Surat district is surrounded by Bharuch and Narmada districts to the north, Navsari district to the southand east Tapi district. To the west is the Gulf of Khambat. Surat is the second most populous district of Gujarat with a population of 60.79 lakh, 79.68% of the population reside in urban areas, a sex ratio of 788 females per 1,000 males; female literacy rate of 81.02%, with an overall literacy rate of 86.65% (Census 2011). Focus industry sectors include textiles and apparels, gems and jewelry, chemicals and petrochemicals, ports, IT enabled services and bio technology. Emergence of a petro chemical complex, gems and jewelry park and the centrally promoted Surat SEZ are expected to further fuel the industrial and economic growth of the city. Famous tourist places are The Surat Castle, Mughalsarai, Andrews Library, Sardar Vallabhai Patel Museum and Marjan Shami Roza. Surat is well connected to various locations through national and state highways.


• Basedon2012HSS-ANCdata,HIVprevalencewashighat1%amongtheANCattendees.SuratisknownasahighHIVprevalencedistrictwith 1% or more prevalence reported over HSS rounds (1.26% HIV prevalence among ANC in 2010).



• Accordingto2010HSSdata,HIVprevalencewaslowamongFSWs(0.80%),MSM(1.20%)andIDUs(1.60%).


• AccordingtoHRGmappingdata,MSM(9,816;56.44%ofthetotalHRG)wasthelargestHRGinthedistrictfollowedbyFSW(5,775;33.21% of the total HRG) and IDU (1,800;10.35% of the total HRG). 55.09% of the mapped MSM and 67.67% of the mapped FSW were reported married. The major typology for FSWs was home-based (61.93%).

• In2012,1,43,237STI/RTIepisodesweretreatedandthesyphilispositivityrateamongSTIclinicattendeeswas0.13%.

• Accordingto2012ICTCdata,HIVtransmissionfromparenttochildaccountedfor4.85%ofthetotalreportedcases(n=1731).


• Thetoptwodestinationsforout-of-statemigrationwereGanjam,Odisha;andNandurbar,Maharashtra.



• ContinueattentiontodecreaseandlimitthespreadofHIVinfectionfurther,notingtheHSSANCHIVprevalence,HRGpopulationsizeestimate, migration levels, and other vulnerability factors.

• Conductsocio-demographicanalysisofHSS-ANCattendeestounderstandriskfactorsforhighHIVepidemicamonggeneralpopulation.

• SincethelargestHRGareMSM,betterassessmentofthesizeandprofileofMSMandpartnerpopulationwillhelpinbetterunderstandingof district vulnerabilities.

• FocusonIDU-FSWsexualnetworksandaddressthedualriskthatisposedduetotherateofinfectionamongIDUsandthelargenumberof FSWs in a district with multiple industries.

• Consideringhighrateofmigration,strengthenoutreachprogrammethroughawarenesscampaignsaroundsourceandtransitpointssuchas railway stations and bus stands.

Surat District


SuratDistrict Population: 60,79,231 (10.07%



; ANC Utilization

2: 78.4%

2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

1.251.25

1.500.76

1.261.00

NT

4400

400400

394398

400

PPTCTPP

--

2.530.66

0.380.27

0.210.27

NT

--

864724437

4800147928

5040136235

Blood BankPP

--

0.230.17

0.170.12

0.090.07

NT

--

7993087583

8330488889

9378889976

HSS-STDPP

--

--

--

NT

--

--

--

HSS-FSWPP

13.208.00

7.204.40

0.80-

NT

250250

250250

250-

HSS-MSM

PP15.60

12.807.60

101.20

-N

T250

250250

250250

-

HSS-IDUPP

--

--

1.60-

NT

--

--

250-

ICTC Male

PP-

--

14.194.99

2.591.95

2.93N

T-

--

1324531049

5240669332

38342

ICTC Female

PP-

--

14.664.98

2.131.81

2.12N

T-

--

701317819

3222942745

28647

ICTC ReferredPP

--

-10.62

4.332.79

2.452.31

NT

--

-7885

2496143483

5553740971

ICTC Direct W

alk-inPP

--

-16.74

5.672.01

1.353.01

NT

--

-12373

2390741152

5654026018


5 N

T-

-8647

4469596869

132563162478

103224

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (20049)33

1063

5713

DLN (N

A)-

--

--

Block-Level Details

No. HRG

-FSW-

- -

- -

- -

- -

No. HRG

-MSM

- -

- -

- -

- -

-

No. HRG

- IDU-

- -

- -

- -

- -

% Pos;

ICTCO

lpad, 4.43

Palsana, 2.52

Kamrej,

0.81Bardoli,

5.3Vyara, 3.29

Mandvi, 2.63

Valod, 0

Mahuva, 2.92

Mangrol, 3.35

% Pos;

PPTCT-

- -

- -

- -

- -

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

1731)89.95

2.311.62

0.234.85

1.04


3




percent positive, N

T = num


omen.

STI/RTI2009

20102011

2012


484477190388

163724143237


-0.30

0.120.13

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

11

11

35

55

5M

SM TIs

11

11

15

55

5IDU TIs

--

--

11

11

1Com

p. TIs-

--

--

44

44

ICTCs-

--

842

5083

9193

Blood Banks8

88

88

98

77

STI clinics-

--

33

34

44

ART centres-

-1

12

23

33

Link ART centres-

--

--

-1

11

PLHIV Netw

orks1

12

22

22

22

Red Ribbon Clubs-

--

--

5050

1818

Comm

. care centres-

--

-2

22

22

Drop-in-centres-

33

33

33

33

Condom O

utlets-

--

--

--

--

VulnerabilitiesM


Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

16254723574

29839109134

% of m

ale pop.

5.970.87

1.104.01

% total

migration

10014.50

18.3667.14


Ganjam

, O

disha

Nandurbar,

Maharash-

tra

Thane, M

aharash-tra

Mum

bai (Suburban), M

aharash-tra

Dhule, M

aharash-tra

HRG Size

FSWM

SMIDU


Year: NA

57759816

1800

% Total HRG

33.2156.44

10.35

% Total Pop.

0.090.16

0.03

Program Target

NA

NA

NA

Program Coverage

--

-

Typology

Home

based-61.93%

;

Brothel based-

36.56%;

Street based-1.51%

Kothi-32.92%

;

Panthi-N

A;


Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.28.63

11.93-

% M

arried67.67

55.09-


SurendranagarBackground:

Surendranagar district is located in the central region ofGujarat, in the Saurashtra peninsula. The district has a population of 17.55 lakh, a sex ratio of 929 females per 1,000 males; female literacy rate of 62.20%, with an overall literacy rate of 73.19% (Census 2011). Surendranagar is one of the largest producers of “Shankar” Cotton in the world and, is also the home to the first cotton trading exchange in India. Surendranagar is a base for industrial sectors such as textiles, chemicals, ceramics and food processing industries. Some of the major tourist destinations in the district are Tarnetar Mela, Chotila Hills and Ranak devi Temple. Surendranagar’s dry air is believed to be the best place in Gujarat to cure tuberculosis patients, since the colonial times. National Highway 8A passes through the district connecting it to Ahmedabad and Kutch.


• Basedon2012HSS-ANCdata,HIVprevalencewasmoderateat0.50%amongtheANCattendees.Itwasreportedat0.25%inboththe2010 and 2007 HSS rounds.



• Accordingto2010HSS-FSWdata,HIVprevalencewaslowamongFSWs.

• In2012,HIVprevalenceamongICTCattendeeswaslowamongmale(1.46%)andfemale(0.54%)clients,aswellasamongreferred(1.18%) and direct walk-in clients (0.79%).

• Accordingto2008HRGmappingdata,FSW(1,793;51.82%ofthetotalHRG)wasthelargestHRGinthedistrictfollowedbyMSM(1,667; 48.18% of the total HRG). 80.41% and 45.49% of the mapped MSM and FSW were married. The major typology for FSWs was home-based (94.69%).




• Accordingto2012ICTCdata,HIVtransmissionsfromparenttochild,throughunknownroutesatandthroughhomosexualrouteswasat 8.70%, 6.52% 5.80%, respectively, out of the total reported cases in the district.


• In2012,therewereonlytwocompositeTIsitesinoperation,fortheover3,000estimatedHRGsinthedistrict.


• InitiateatleasttwoTIsiteseachforFSWandMSMinthedistrictimmediately,asthereisasizableHRGpopulationinthedistrict.

• ConsideringtheHIVprevalenceamongHSS-ANCattendees,socio-demographicanalysisisneededtoascertainriskfactors.

• ImprovethequalityofcounselingatICTCs,sincetherateofunknownHIVtransmissionishigh.Reinforcepositivepreventionmessages.

• Conductin-depthanalysisofICTCdatatounderstandtheprofileoftheseattendees,asthetransmissionfromparenttochild(8.70%ofall reported cases) and through MSM (5.80% of all reported cases) is notable.

• Vulnerability factors forHIV transmissionneeds tobeanalysed from ICTCandSTI data.This accordingly can informHIVpreventioninterventions

Surendranagar District


SurendranagarDistrict Population: 17,55,873 (2.91%



; ANC Utilization

2: 39%

2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

-1.75

0.25-

0.250.50

NT

4-

400400

-397

400

PPTCTPP

**

*0.10

0.180.06

0.100.11

NT

**

*7033

1242212472

1933619560

Blood BankPP

*0.18

*0.25

0.180.17

0.040.12

NT

*1126

*1187

85628470

54899669

HSS-STDPP

03.27

--

--

NT

250214

--

--

HSS-FSWPP

--

--

0-

NT

--

--

249-

HSS-MSM

PP-

--

--

-N

T-

--

--

-

HSS-IDUPP

--

--

--

NT

--

--

--

ICTC Male

PP-

--

4.753.13

1.743.57

1.46N

T-

--

43827659

1043226441

13856

ICTC Female

PP-

--

2.851.69

0.910.24

0.54N

T-

--

32336504

974021294

13730

ICTC ReferredPP

--

-3.63

2.171.37

3.681.18

NT

--

-4741

888112712

2364214814

ICTC Direct W

alk-inPP

--

-4.45

2.971.29

0.510.79

NT

--

-2874

52827460

2409312772


5 N

T833

400470

1464826585

3264467071

47146

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (1554)57

1179

6213

DLN (N

A)-

--

--

Block-Level Details

No. HRG

-FSW-

- -

- -

- -

- -

No. HRG

-MSM

- -

- -

- -

- -

-

No. HRG

- IDU-

- -

- -

- -

- -

% Pos;

ICTC-

- -

- -

- -

- -

% Pos;

PPTCTLim

bdi, 5.4

Sayla, 4.76

Wadhw

an, 2.2

Chotila, 3.4

Dhan-gadhra,

2.9

Halvad, 3.2

Patdi, 0.64

Other, 5.7

Total, 4.6

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

276)75.72

5.802.54

0.728.70

6.52


3




percent positive, N

T = num


omen.

STI/RTI2009

20102011

2012


213587731

70277739


-1.82

1.520.53

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

--

--

--

--

-M

SM TIs

--

--

--

--

-IDU TIs

--

--

--

--

-Com

p. TIs-

--

--

22

22

ICTCs-

--

1114

1530

3647

Blood Banks2

22

45

55

55

STI clinics-

--

22

22

33

ART centres-

--

--

11

11

Link ART centres-

--

--

-1

22

PLHIV Netw

orks-

--

-1

11

11

Red Ribbon Clubs-

--

--

--

88

Comm

. care centres-

--

--

11

--

Drop-in-centres-

--

-1

11

11

Condom O

utlets-

--

--

--

--

VulnerabilitiesM


Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

664012879

3098032542

% of m

ale pop.

8.430.37

3.934.13

% total

migration

1004.34

46.6649.01


Thane, M

aharash-tra

Mum

bai (Subur-ban),

Maharash-

tra

Ahmadna-

gar, M

aharash-tra

Nashik,

Maharash-

tra

Pune, M

aharash-tra

HRG Size

FSWM

SMIDU


Year: 2008)1793

1667N

A

% Total HRG

51.8248.18

-

% Total Pop.

0.100.09

-

Program Target

NA

NA

NA

Program Coverage

--

-

Typology

Home

based-94.69%

;

Brothel based-5.31%

;

Street based-

NA

Kothi-59.23%

;

Panthi-N

A;


Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.14.69

47.27-

% M

arried80.41

45.49-


The DangsBackground:

Dangs is a tribal district located in southern Gujarat. The district shares its border with the State of Maharashtra and is covered with high hills and dense forests. It is the least populous district of Gujarat with a population of 2.26 lakh, with a sex ratio of 1007 females per 1,000 males; female literacy rate of 68.75%, with an overall literacy rate of 76.80% (Census 2011). As per the Planning Commission, Dangs is the most backward district in India. In Dangs, 50% of population is working. Majority of population is dependent on agriculture for their livelihood. Animal husbandry and bamboo cutting are the other economic activities in the region. Dangs district is gradually emerging into an agro processing and tourism hub. The reserved forests in Dangs are amongst the richest forests in the State. Saputara is an important tourist destination in the district. Rich wildlife, gardens, ropeway, sunrise point and echo point are some of the main tourist attractions in Dangs. Dangs is well connected with Maharashtra state by roads.


• Basedon2010HSS-ANCdata,HIVprevalencewaslowat0.28%amongtheANCattendeescomparedto0.27%and0%ANCHIVprevalence in 2010 and 2008 respectively .

• Accordingto2010PPTCTdata,HIVpositivitywaslowamongthePPTCTattendees.

• In2012,HIVpositivity among ICTCattendeeswas lowamongmale (0.89%)and female (0.67%) clients, andalsoamong referred(0.95%) and direct walk-in (0.47%) clients, with a stable trend among all the ICTC clients, but an abrupt increase in the positivity was observed among male and referred clients in 2011.

• In2012,1,362STI/RTIepisodesweretreated.


• Thetoptwodestinationsforout-of-statemigrationwereNandurbarandNashik,Maharashtra.


• In2012,therewasnoinformationaboutthepresenceofafunctionalTIinthedistrict.


• ContinuationofHIVpreventioneffortstocontainandreducetheHIVepidemic.

• Conductsocio-demographicanalysisofHSS-ANCattendeestoascertainriskfactors,consideringtheHIVprevalenceandHIVpositivityrate among ANC attendees.

• ConductdisaggregatedanalysisofPPTCTdatatoassessriskfactorsinthedistrict.

• Consideringhighrateofmigration,strengthenoutreachprogrammethroughawarenesscampaignsaroundsourceandtransitpointssuchas railway stations and bus stands. Conduct special awareness campaign especially among general population, pockets of out-migrants transit points and around truck halting points and highways in the district.

• AvailabilityofARTorDLNdatawillhelpinbetterunderstandingofdistrictvulnerabilities.

The Dangs District


The Dangs



1: 68.75%; AN


2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

--

00.27

0.28-

NT

4-

-400

376361

-

PPTCTPP

-*

*0

0-

0-

NT

-*

*1133

1198-

1111-

Blood BankPP

*-

**

--

--

NT

*-

**

--

--

HSS-STDPP

--

--

--

NT

--

--

--

HSS-FSWPP

--

--

--

NT

--

--

--

HSS-MSM

PP-

--

--

-N

T-

--

--

-

HSS-IDUPP

--

--

--

NT

--

--

--

ICTC Male

PP-

--

1.060.66

0.8211.46

0.89N

T-

--

658455

972803

1119

ICTC Female

PP-

--

1.401.09

1.250

0.67N

T-

--

571460

878528

893

ICTC ReferredPP

--

-2.12

1.521.39

9.540.95

NT

--

-660

5261151

9221375

ICTC Direct W

alk-inPP

--

-0.18

00.43

0.980.47

NT

--

-569

389699

409637


5 N

T-

52519

23622113

18502442

3446

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (NA)

--

--

-

DLN (N

A)-

--

--

Block-Level Details

No. HRG

- FSW

- -

- -

- -

- -

-

No. HRG

- M

SM-

- -

- -

- -

- -

No. HRG

- IDU

- -

- -

- -

- -

-

% Pos;

ICTC-

- -

- -

- -

- -

% Pos;

PPTCT-

- -

- -

- -

- -

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

16)100

00

00

0


3




percent positive, N

T = num


omen.

STI/RTI2009

20102011

2012


97183792

21791362


1.972.56

2.57-

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

--

--

--

--

-M

SM TIs

--

--

--

--

-IDU TIs

--

--

--

--

-Com

p. TIs-

--

--

--

--

ICTCs-

--

11

14

44

Blood Banks1

11

11

11

11

STI clinics-

--

11

11

11

ART centres-

--

--

--

--

Link ART centres-

--

--

--

-1

PLHIV Netw

orks-

--

--

--

--

Red Ribbon Clubs-

--

--

--

13

Comm

. care centres-

--

--

--

--

Drop-in-centres-

--

--

--

--

Condom outlets

--

--

--

--

-

VulnerabilitiesM


Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

12506496

63175693

% of m

ale pop.

13.300.53

6.726.06

% total

migration

1003.97

50.5145.52


Nandurbar,

Maharash-

tra

Nashik,

Maharash-

tra-

--

HRG Size

FSWM

SMIDU


Year: 2008)57

00

% Total HRG

1000

0

% Total Pop.

0.030

0

Program Target

NA

NA

NA

Program Coverage

--

-

Typology

Home

based-N

A;

Brothel based-

NA;

Street based-

NA

Kothi-N

A;

Panthi-N

A;

Double decker-

NA

Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.-

--

% M

arried-

--


VadodraBackground:

Vadodara, one of India’s most cosmopolitan cities, is located to the south east of Ahmedabad, on the banks of river Vishwamitri. The district is bounded by Panch mahal and Dahod districts to the north, Anand and Kheda districts to the west, Bharuch and Narmada districts to the south, and the state of Madhya Pradesh to the east. The district has a population of 41.57 lakh, a sex ratio of 934 females per 1,000 males; female literacy rate of 74.40%, with an overall literacy rate of 81.21% (Census 2011). The district is referred to as the “Sanskar Nagari” (City of Culture) due to its rich cultural traditions. The industrial clusters include chemicals and fertilizers, pharmaceuticals, biotechnology, cotton textiles, machine tools, glass, engineering, tobacco, fisheries and dairy. It has major tourist attractions including The Baroda Museum and Art Gallery, Sursagar Lake, The Tribal Museum, etc. National Highway (NH) 8 and State Highway 6 pass through the district.


• Basedon2012HSS-ANCdata,HIVprevalencewasmoderateat0.50%amongtheANCattendees,withafluctuatingtrend.



• Accordingto2010HSSdata,HIVprevalencewaslowamongFSWs(3.61%)andMSM(2.01%),withanoveralldecliningtrend.

• In2012,HIVpositivityamongICTCattendeeswas lowamongmale(2.82%)andfemale(2.19%)clients,aswellasamongreferred(2.47%) and direct walk-in (2.91%) clients, with a fluctuating trend among male and referred client, but a declining trend among female and direct walk-in clients.

• Accordingto2008HRGsizemappingdata,MSM(5,894;65.21%ofthetotalHRG;54.04%married)wasthelargestHRGinthedistrictfollowed by FSW (2,770; 30.65% of the total HRG; married) and IDU (374; 4.14% of the total HRG). 54.04% and 84.04% of the mapped MSM and FSW respectively, were married. The major typology for FSWs was home-based (34.13%).





• In2012,sevenTIsites(4MSMTI,2FSWTIand1compositeTI)wereinoperation,whiletherewereover8,500estimatednumberofHRGin the district.


• Continueeffortstodecreaseandlimitthespreadoftheinfectionfurther,consideringthenumberofHIVpositivecases,HRGsizeestimate,and other vulnerability factors.

• IncreasethenumberofTIsitesinthedistrictconsideringthelargenumberofmappedHRGs.

• Conduct socio-demographic analysis of HSS-ANC attendees to understand risk factors associated with HIV transmission among thegeneral population. Strengthen HIV prevention efforts among married women.

• FocusonIDU-FSWsexualnetworksandaddressthedualriskthatisposedduetoinfectionamongIDUsandalargenumberofFSWs.Strengthen and improve quality of outreach programme for IDUs and FSWs.

• SincethelargestHRGareMSM,abetterassessmentofthesizeandprofileofMSMandpartnerpopulation,willhelpinbetterunderstandingof district vulnerabilities.

Vadodara District


VadodraDistrict Population: 41,57,568 (6.89%



; ANC Utilization

2: 50.2%

2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

0.250.25

0.500

00.50

NT

4400

400400

399400

400

PPTCTPP

**

0.740.40

0.280.22

0.120.16

NT

**

17604712

2565626775

4352335611

Blood BankPP

0.200.15

0.090.11

0.160.16

0.130.11

NT

2032625366

2767535627

6547870915

3124680823

HSS-STDPP

2.403.35

--

--

NT

250239

--

--

HSS-FSWPP

6.808.40

9.607.20

3.61-

NT

250250

250250

249-

HSS-MSM

PP4.00

6.802.00

3.352.01

-N

T250

250250

239249

-

HSS-IDUPP

--

--

--

NT

--

--

--

ICTC Male

PP-

--

8.655.47

3.378.60

2.82N

T-

--

542314400

1846323455

19895

ICTC Female

PP-

--

8.885.10

2.950.63

2.19N

T-

--

29968276

1250520564

13364

ICTC ReferredPP

--

-7.29

4.633.08

5.882.47

NT

--

-5569

1683825629

3112525391

ICTC Direct W

alk-inPP

--

-11.54

7.373.78

2.452.91

NT

--

-2850

58385339

128947868


5 N

T318

4701760

1313148332

5774387542

68870

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (6063)36

1172

6113

DLN (N

A)-

--

--

Block-Level Details

No. HRG

- FSW

- -

- -

- -

- -

-

No. HRG

- M

SM-

- -

- -

- -

- -

No. HRG

- IDU

- -

- -

- -

- -

-

% Pos;

ICTC-

- -

- -

- -

- -

% Pos;

PPTCT-

- -

- -

- -

- -

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

855)88.07

1.751.99

0.584.44

3.16


3




percent positive, N

T = num


omen.

STI/RTI2009

20102011

2012


3757518713

2421522826


-1.37

0.620.52

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

11

11

12

22

2M

SM TIs

11

11

14

44

4IDU TIs

--

--

--

--

-Com

p. TIs-

--

--

11

11

ICTCs-

--

818

2662

89119

Blood Banks5

57

78

98

99

STI clinics-

--

22

22

33

ART centres-

--

--

11

11

Link ART centres-

--

--

--

--

PLHIV Netw

orks1

11

11

11

11

Red Ribbon Clubs-

--

--

5050

--

Comm

. care centres-

--

-1

11

--

Drop-in-centres-

11

11

11

11

Condom outlets

--

--

--

--

-

VulnerabilitiesM


Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

13002211557

3691781548

% of m

ale pop.

6.850.61

1.954.30

% total

migration

1008.89

28.3962.72


Thane, M

aharash-tra

Mum

bai (Subur-ban),

Maha-

rashtra

Pune, M

aharash-tra

Raigarh, M

aharash-tra

Jhabua, M

adhya Pradesh

HRG Size

FSWM

SMIDU


Year: 2008)2770

5894374

% Total HRG

30.6565.21

4.14

% Total Pop.

0.070.14

0.01

Program Target

NA

NA

NA

Program Coverage

--

-

Typology

Home

based-34.13%

;

Brothel based-

33.13%;

Street based-

32.74%

Kothi-66.67%

;

Panthi-N

A;


Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.18.65

46.67-

% M

arried84.04

54.04-


ValsadBackground:

Valsad district is located at the southern most tip of Gujarat, near the Gulf of Khambhat. It is bound by Navsari district to the north, Nashik district of Maharashtra state to the east, and Union Territory of Dadra and Nagar Haveli and Thane district of Maharashtra to the south. The district has a population of 17.03 lakh, a sex ratio of 926 females per 1,000 males; female literacy rate of 74.96%, with an overall literacy rate of 80.94% (Census 2011). Focus industry sectors include chemicals, textiles, horticulture industry and paper industry. Tourism is a major economic activity observed in the district. Udawada City is an important tourist destination in Valsad district for the Parsi pilgrims due to the presence of the Fire Temple which is a World Heritage Site, Daman and Lady Wilson Museum. National Highway (NH) 8 passes through the district.


• Basedon2012HSS-ANC,HIVprevalencewaslowat0.25%amongtheANCattendees.



• In2012,HIVpositivityamongICTCattendeeswas lowamongmale(2.18%)andfemale(1.55%)clients,aswellasamongreferred(2.12%) and direct walk-in (1.41%) clients, with overall decreasing trend among all the ICTC attendees.

• Accordingto2008HRGmappingdata,MSM(492;53.83%ofthetotalHRG)wasthelargestHRGinthedistrictfollowedbyFSW(422;46.17% of the total HRG). The major typology for FSWs was street-based (100%). 63.35% and 80.56% of mapped FSW and MSM respectively were married.

• In2012,7,995STI/RTIepisodesweretreated.


• Thetoptwodestinationsforout-of-statemigrationwereThane,MaharashtraandDaman,Daman&Diu.

• Accordingto2012ICTCdata,HIVtransmissionsfromparenttochildandthroughunknownroutesaccountedfor7.40%and8.68%ofthe total reported cases (n=311) respectively in the district.

• AccordingtoDLHS-IIIdata,theHIVandSTI/RTIawarenessrateamongwomenwere50.5%and22.7%,respectively.

• In2012,twocompositeTIsiteswereoperational,andaround900individualsidentifiedasHRGsinthedistrict.


• Continueattention to limit the spreadofHIV infection in thedistrict, noting thenumberofHIVpositive cases,HRGsizeandothervulnerability factors.

• ImprovecounselingatICTCs,sincetherateofunknownHIVtransmissionreportedoutofallcasesishigh.Strengtheneffortsforpositiveprevention.

• Consideringthereportedparenttochildtransmissioncases(7.40%ofallreportedcases)itisnecessarytostrengthenPPTCTprogramcoverage in the district, and reinforce HIV prevention messages to married women.

• Consideringthehighrateofmigration(tohighHIVprevalentdistricts),strengthenoutreachprogrammethroughawarenesscampaignsaround source and transit points such as railway stations, bus stands, around truck halting points and highways and also at the tourist spots in the district.

• AvailabilityofDLNdatawouldhelpinbetterunderstandingofdistrictvulnerabilities.

Valsad District


ValsadDistrict Population: 17,03,068 (2.82%



; ANC Utilization

2: 47%

2005

20062007

20082009

20102011

2012

HSS-ANC

PP4

-0

0.500.76

00.25

NT

4-

400400

397399

399

PPTCTPP

-*

0.540.31

0.330.16

0.220.25

NT

-*

11096522

88089589

817710010

Blood BankPP

1.100.45

0.280.21

0.120.12

00.12

NT

1925520017

2226821654

2803330388

3126821624

HSS-STDPP

--

--

--

NT

--

--

--

HSS-FSWPP

--

--

--

NT

--

--

--

HSS-MSM

PP-

--

--

-N

T-

--

--

-

HSS-IDUPP

--

--

--

NT

--

--

--

ICTC Male

PP-

--

5.773.33

1.965.73

2.18N

T-

--

36044325

86579657

8956

ICTC Female

PP-

--

5.952.66

1.510.81

1.55N

T-

--

21342854

62756445

7505

ICTC ReferredPP

--

-5.22

2.911.78

5.252.12

NT

--

-4369

51828000

934811124

ICTC Direct W

alk-inPP

--

-7.82

3.461.77

1.691.41

NT

--

-1369

19976932

67545337


5 N

T-

4381109

1226015987

2452124279

26471

PLHIV Profile, 2012

% O

n ART%

15-24 yrs%

Ill., Prim. Edu.

% M

arried%

Widow

ed or Divorced

ART (1454)54

1621

205

DLN (N

A)-

--

--

Block-Level Details

No. HRG

-FSW-

- -

- -

- -

- -

No. HRG

-MSM

- -

- -

- -

- -

-

No. HRG

- IDU-

- -

- -

- -

- -

% Pos;

ICTCValsad, 7.41

Pardi, 9.04

Umargam

, 4.69

Dharam-

pur, 3.42

Kaparada, 4.16

Other,

5.26-

- -

% Pos;

PPTCT-

- -

- -

- -

- -

Route of HIV Transm

ission, ICTC 2012

Hetero-sexualHom

o-sexualBlood

TransfusionN

eedle/ Syringe

Parent to Child

Unknown

% of Total

(N=

311)79.74

2.571.61

07.40

8.68


3




percent positive, N

T = num


omen.

STI/RTI2009

20102011

2012


1120014712

200657995


-0.05

0.070

Programm

e ResponseN

o.2004

20052006

20072008

20092010

20112012

FSW TIs

--

--

--

--

-M

SM TIs

--

--

--

--

-IDU TIs

--

--

--

--

-Com

p. TIs-

--

--

22

22

ICTCs-

--

57

721

2121

Blood Banks4

45

55

65

55

STI clinics-

--

11

11

11

ART centres-

--

--

--

11

Link ART centres-

--

--

11

11

PLHIV Netw

orks-

--

-1

11

11

Red Ribbon Clubs-

--

--

--

99

Comm

. care centres-

--

--

--

--

Drop-in-centres-

--

--

--

--

Condom O

utlets-

--

--

--

--

VulnerabilitiesM


Overall

Inter-State

Intra-state

Intra-district

No. out-

migration

6259411164

1337638054

% of m

ale pop.

8.521.52

1.825.18

% total

migration

10017.84

21.3760.79


Thane, M

aharash-tra

Daman,

Daman &

Diu

Dadra & N

agar Haveli,

Dadra & N

agar Haveli

Mum

bai, M

aharash-tra

Mum

bai (Suburban), M

aharash-tra

HRG Size

FSWM

SMIDU


Year: 2008)422

492-

% Total HRG

46.1753.83

-

% Total Pop.

0.020.03

-

Program Target

NA

NA

NA

Program Coverage

--

-

Typology

Home

based-0%

;

Brothel based-0%

;

Street based-100%

Kothi-84.3%

;

Panthi-N

A;

Double decker-15.7%

Daily Injectors-

NA;

Non daily

Injectors-N

A

% <

25 yrs.10.42

29.85-

% M

arried80.56

63.35-




The National AIDS Control Programme has a strong focus on district level planning, implementation and monitoring of interventions for prevention and control of HIV. The Programme is generating a rich evidence base on HIV/AIDS through a robust and expanded HIV Sentinel Surveillance system, monthly reporting from programme units, mapping and size estimations, behavioural surveys as well as several studies, research projects and evaluations.

In this context of increased availability of data and the requirement of decentralized planning at the district level, a project titled “Epidemiological Profiling of HIV/AIDS Situation at district and Sub-district Level using Data Triangulation” was undertaken by the National AIDS Control Organisation in 25 states (539 districts). The objective of this exercise was to develop district HIV/ AIDS epidemic profiles, by consolidating all the available information for a district at one place and drawing meaningful inferences using Data Triangulation approaches.

This technical document is an outcome of the data triangulation process and consists of a snapshot on the district background, and on the HIV epidemic profile of each district based on the available updated information, thereby giving an overview of the HIV epidemic scenario in each of the districts of the State.

This document would be useful for the HIV programme managers and policy makers at all levels to help in decision making, as well as for researchers and academicians as a quick reference guide to the HIV/AIDS situation in the districts.

District HIV/AIDS Epidemiological Profiles

Documents

Transcript of District HIV/AIDS Epidemiological Profiles