Chapter 1: Introduction Current status of HIV in AP and the challenges There are an estimated 0.5 million PLHIV and 150,000 children affected by HIV in Andhra Pradesh. Lack of continuity of care and limited awareness of available HIV services has led to extremely low uptake of PMTCT, HIV testing and counseling, care and ART services among HIV-affected children resulting in high rates of loss-to-follow-up, morbidity and mortality. Genesis/Origin of the Balasahyoga The Balasahyoga programme was seen by the National AIDS Control Organization (NACO) as an operational model that pre-tests the draft national operational guidelines on ‘Protection, care and support for children affected by HIV/AIDS’; developed by the National Task Force Committee for Children and AIDS. The successful implementation of the programme in Andhra Pradesh will ensure replicability and scale-up of the programme in other states of India. The need for comprehensive HIV prevention and care services especially focusing on children and their families is great in Andhra Pradesh. Andhra Pradesh, India’s fifth most populous state1 is one of the country’s six high HIV prevalence states with 19 out of 23 districts having HIV prevalence of 1% or more among women attending government antenatal clinics2. A large differential is also observed within the state, with HIV prevalence being very high in a few districts such as Khammam (3.50%)3, West Godavari (3.25%), and Guntur (3%), indicating increased vulnerability to HIV and AIDS and the need for a scaled-up response. The National AIDS Control Organization (NACO) and State AIDS Control Societies (SACS) funding for HIV prevention and care projects for children is limited to supporting a few targeted interventions with street children and provision of family life education in schools. The response of non-governmental organizations (NGOs), though encouraging, is disproportionately focused on HIV prevention and awareness. A smaller number have begun to provide much-needed care and support services for children infected and affected by HIV and AIDS with FHI supported projects leading the response both at the community and policy levels. World Vision, Catholic Relief Services, Freedom Foundation and India HIV/AIDS Alliance through its mother NGOVasavya Mahila Mandal (VMM) are some of the other organizations that have responded to the care and support needs of children infected and affected by HIV and AIDS, albeit on a small scale. Overall, the response from all the sectors has been localized, and there is a pressing need for greater networking, resource-sharing, planning and scaling-up of initiatives that provide comprehensive HIV care, support and treatment services to children infected and affected by HIV and AIDS. Through the third phase of the National AIDS Control Programme (NACP-III), 1
Andhra Pradesh has a population of 76.2 million - Census 2001 HIV surveillance, 2005; Andhra Pradesh State AIDS Control Society (APSACS) 3 Annual Sentinel Surveillance, Government urban antenatal attendees, APSACS 2005 2