National Sensitisation workshop for Industries on Employer Led Model 29th April 2015 Silver Oak, Habitat World, India Habitat Center, Lodhi Road, New Delhi

1. Introduction to India HIV /AIDS
program and Employer Led
Model

2. Killer Diseases…
Cardiovascular disease (17 m)
Malaria (500 m people fall severely ill)
Diarrhea related diseases (2.2 m)
then why
HIV/AIDS?
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3. Because…
• HIV/AIDS affects the most productive age group of
15-49 years
• HIV infections can be prevented
• It is never possible to get the exact magnitude of the
HIV
• Impact beyond health – socio economic
• Key challenges in HIV prevention:
• There are no immediate and exclusive symptoms
of HIV
• Discussion on sexual issues is a taboo
• High levels of stigma and discrimination
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4. HIV/AIDS Status in India
• 3rd largest no. of People Living with HIV - 21 lakh
• Low adult HIV prevalence : 0.27%
• HIV is concentrated among :
o High Risk Groups (FSW, MSM, TG, IDU)
o Bridge Groups (Migrants & Truckers)
• 2 Key Strategies:
i) Prevention
ii) ii) Care, Support & Treatment
• Programme implemented through State AIDS Control
Societies under the State Govts
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5. Number of PLHIV – Top Ten Countries
61
34
21
16
16
15
15
14
11
11
0 10 20 30 40 50 60 70
South Africa
Nigeria
India
Kenya
Mozambique
Uganda
Tanzania
Zimbabwe
Malawi
Zambia
No. of PLHIV (Lakhs)
Globally, 353 lakh persons estimated to be living with HIV
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6. HIV Concentrated among Key Risk Groups
High risk
groups
(FSW, MSM,
IDU, TG)
Bridge
Population
(Migrant
workers &
Truckers)
General
Population
(Low risk
Men &
Women)
New born
Children
FSW: Female Sex Workers; MSM: Men who have sex with Men; IDU: Injecting Drug Users; TG:
Transgender/ Hijras
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7. Routes of HIV Transmission
Heterosexual,
88.2%
Parent to child,
5.0%Not Specified ,
2.7%
Homosexual,
1.5%
Infected Syringe
and Needles,
1.7%
Blood and Blood
Products, 1.0%
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8. NACP I (1994-
1999)
Initial
interventions
NACP II (1999-
2006)
-
Decentralisation
to states
- Limited
coverage of
services
NACP III (2007-
2012)
Massive scale
up with quality
assurance
mechanisms
>50% reduction
in new
infections
achieved
NACP IV
(2012-17)
Consolidate
gains,
focus on
emerging
vulnerabilities,
Balance with
growing
treatment
needs,
Quality
assurance
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9. Key Achievements in HIV/AIDS Control Programme
• Low adult HIV prevalence : 0.27%
• 3rd largest no. of People Living with HIV - 21 lakh
• Substantial reduction in adult HIV prevalence from
0.41% (2001) to 0.27% (2011)
• 57% reduction in annual new HIV infections among
adults, from 2.74 lakh (2000) to 1.16 lakh (2011)
• 29% reduction in annual AIDS-related deaths from
2.07 lakh (2007) to 1.48 lakh (2011)
• Over 1.5 lakh lives saved due to free testing &
treatment till 2011
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10. Why NACO needs partnership with
other Public & Private sector ?
• Increasing HIV in low prevalence states of North India
due to migrant labor
• Rise in HIV among Injecting Drug Users in some States:
Punjab, Delhi, etc.
• Emerging epidemics to be addressed through effective &
customized region-specific prevention strategies
• Ensure treatment requirements are fully met without
sacrificing the needs of prevention
• Integration with larger health system including private to
ensure sustainability
• Access to social protection schemes for people infected
and affected with HIV/AIDS through mainstreaming of
HIV/AIDS with other ministries
• Alleviating stigma and discrimination
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11. Rationale for ELM

12. Increasing Informalisation of work
• “More than 90% of the
workforce and 50% of the
domestic product are
accounted for by the
informal economy”
• Faster and inclusive growth
needs special attention to
informal economy.
Formal Sector
Formal Jobs,
4.4
Formal Sector
Informal Jobs,
10.9
Informal Sector
Formal Jobs,
0.1Informal Sector
Informal Jobs,
84.6
Percent Distribution of Formal and Informal
Sector Jobs, India (2004-05)
Source: National Statistical Commission, 2012
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13. 13
Challenges
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14. 5/9/2017 NW on EKM 14
Migrant Labor show HIV risk
States with higher vulnerability due to Migration
Source: NACO HIV Sentinel Surveillance 2010-11 – Provisional Findings; Source: Population Council Study -- Reference: Saggurti N, Mahapatra BB, Swain
SN, Jain AK. Male out-migration and sexual risk behavior in India: Is the place of origin critical for HIV prevention programs?. BMC Public Health. 2011. 11:S6;
Higher HIV Prevalence among Pregnant Women with a
Migrant Spouse
Migrants over-represented (80%) among HIV+ men
(Ganjam)
0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.13
0.39
Migrant Non-Migrant
19.7
55.6
52.8
18.7
27.6 25.7
0%
20%
40%
60%
80%
100%
HIV Positive Cases HIV Negative Controls
Non-Migrants Returned Migrants
Active Migrants
Role of Migration
-Low HIV among High risk groups in source states
-Higher HIV in rural than urban
-Higher HIV in spouses of migrants than non-migrants

15. Risky sexual behavior of male workers by the nature of
their occupation
% men reported sex outside
marriage by their occupation
% reported consistent condom use in
sex outside marriage by their
occupation
14
16
12
13
20
30
12
18
23
20
12
21
29
19
0 50 100
Construction workers (N=2426)
Hamalis (N=582)
Daily wage workers (N=1343)
Small Scale Industry laborers
(N=3813)
Stone cutters and others (N=538)
Fishermen (N=891)
Others (N=1626)
Sex with non-spousal unpaid females Sex with sex worker
62
64
50
68
61
56
69
20
24
15
24
19
27
11
0 50 100
Construction workers
Hamalis
Daily wage workers
Small scale industry
workers
Stone cutters and others
Fishermen
Others
Condom use in sex with non-spousal unpaid females
Condom use in sex with sex worker
Source: Population Council, 2008
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16. Goal
To help prospective employers
to implement a comprehensive
program on HIV/AIDS
prevention to care, by
integrating awareness, service
delivery with existing systems,
structures and resources, within
their business and training
agenda.
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17. Objectives
• Increase awareness and access
to HIV/AIDS services for the
informal workers
• To create enabling environment
by reducing stigma and
discrimination against PLHIV
• To encourage and help
prospective employers to
integrate and sustain the HIV
and AIDS Intervention Program
within existing systems and
structures
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18. Strategic Approach
• Evidence based prioritization for
Intervention
• Focus on vulnerable and at risk
workers
• Enhance access to awareness
and services for HIV/AIDS/STI
• No incremental cost :
Integrating in existing structures
and resources for
implementation
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19. Expectations through ELM
• Integration of HIV/AIDS/STI Services in existing health set
ups
– Integrating STI Management within the TATA main hospital, mobile
medical units
– Integrating ICTC/PPTCT Services within the TATA main hospital, mobile
medical units
– Integrating ART and care and treatment services
• Ongoing awareness for vulnerable workers and communities
– Integrating within the health & safety programs
– Training of medical staff, para medical staff at MMU
– Employee volunteers for conducting awareness
• Increasing access to condoms
– Making the supply chain responsible for implementing HIV/AIDS
program for their workers
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20. The Cost and Benefit
20
STI
PPTCT / ICTC
Condom Promotion
HIV/AIDS Awareness to
Workers
HIV-TB
Benefit to
Family
Social benefit
Treatment of OIs
First & Second Line ART
The return on investment in the prevention of HIV far exceeds that of
standard capital investments. Studies have indicated that these returns, in
terms of cost savings through preventing HIV, are as much as 3.5 to 7.5
times the cost of intervention
Per Unit cost at Industry Level
• Comprehensive HIV/AIDS
program – INR 33
• HIV prevention program –
INR 13
• Care and Treatment per
PLHA– INR 6,500
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21. Indirect Benefits
21
•Being responsible corporate citizen : To be good
corporate citizens, extending welfare for contract workers
and communities
•For a positive image among workers : have both
economic and social returns
•Activities can be included as sustainability reporting as
part of Corporate Social Responsibility (Schedule VII of
Company Bill, 2012)
•Contributor to National Program and Millennium
Development Goal (MDG)
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22. Thank You
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