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India
>> Regional Overview >> India Overview ACTIVITY DATA SHEET
PROGRAM: India
TITLE AND NUMBER: Reduced Transmission and Mitigated Impact of Infectious Diseases, Especially STD/HIV/AIDS, in India, 386-007
STATUS: Continuing
PLANNED FY 2001 OBLIGATION AND FUNDING SOURCE: $16,600,000 CSD
PROPOSED FY 2002 OBLIGATION AND FUNDING SOURCE: $18,100,000 CSD
INITIAL OBLIGATION: FY 1995 ESTIMATED COMPLETION DATE: FY 2006Summary: This objective responds to the global issue of improving health under USAID's Strategic Plan. More than 3.5 million Indians are infected with HIV. Although HIV prevalence is less than one percent nationwide, India is second only to South Africa in terms of numbers infected. Over 420,000 Indians die annually from tuberculosis; nearly two million new cases are reported annually. India is one of the world's last reservoirs of polio.
USAID began to tackle this issue in 1992 by developing the AIDS Prevention and Control (APAC) activity in the Indian state of Tamil Nadu, one of India's three recognized HIV epicenters. The ten-year APAC activity targeted transmission in high-risk groups by: 1) using proven strategies for behavior change; 2) increasing access to, and utilization of, high quality condoms; and 3) expanding access to, and utilization of, quality treatment for sexually transmitted diseases (STDs). In FY 1999, USAID expanded its program to include the state of Maharashtra, where antenatal HIV prevalence approaches 2%. USAID's seven year, $41.5 million AVERT activity will fund comprehensive prevention and care programs throughout the state of Maharashtra, particularly in Mumbai, Pune, Thane and Sangli, where a large number of HIV infections have been reported. The activity will strengthen the capacity of the state government and NGOs to respond to the epidemic. It will particularly address issues affecting women and children. USAID funds six programs for children affected by AIDS.
Other USAID activities will encompass tuberculosis (TB) treatment, anti-microbial resistance, eradication of polio and other vaccine preventable diseases, and improved surveillance of infectious diseases. In 1999, USAID supported the development of a model Directly Observed Therapy Short Course (DOTS) treatment center in Tamil Nadu in collaboration with WHO and under the supervision of the Tuberculosis Research Center. The program will institutionalize DOTS in pilot areas and eventually throughout the state. Medical officers from Tamil Nadu and other states are being trained, bacterial isolates are being tested for resistance, and implementation lessons on therapy, compliance, and patient follow-up are being learned. The lessons learned will improve the efficiency of DOTS therapy in Tamil Nadu and throughout the rest of India. PACT/CRH will continue to strengthen the private sector to improve access to and use of quality health products and services.
Key Results: This objective expects to reduce transmission of HIV/AIDS and related infectious diseases in India, especially Tamil Nadu, by: (1) increasing the number of individuals belonging to specified high-risk groups who report increased condom use in most recent sexual encounters with a non-regular partner; (2) increasing the number of individuals with STD seeking care from qualified medical practitioners in Tamil Nadu; and (3) increasing the number of APAC grants for AIDS prevention in Tamil Nadu.
Performance and Prospects: The FY 2001 planned CSD obligations of $18,600,000 include: $9,000,000 for HIV/AIDS control and prevention activities; $1,000,000 to help children affected by HIV/AIDS; $4,100,000 for the polio eradication program; and $4,500,000 for tuberculosis treatment and surveillance.
The results indicators have shown significant achievements in promoting behavior change and reduced transmission of HIV/AIDS in Tamil Nadu. Performance on all indicators for reducing transmission of HIV/AIDS and related infectious diseases has exceeded targets. APAC activities continue to demonstrate high levels of condom use among prostitutes and their clients. Prostitutes' condom use increased by 3.1% from 1999 to 2000 (88.1% to 91.2%); 70.1% of truckers report condom use during their last non-regular sexual encounter, up from 66.9% in FY 1999. Condom use among sexually transmitted infection patients fluctuates around 15%-16%. More work is required to increase use for this risk group.
The startup of AVERT activity has been slower than desired. A Governing Board has been formed and recruitment for key staff is underway. A Project Management Unit (PMU) is in position to be registered. Once it is established (April-May 2001), specific proposals/plans will be in place to expedite activities that will reach the anticipated beneficiaries of the project. USAID is working with the National AIDS Control Organization (NACO) and the Maharashtra state government to accelerate NGO and state activities and workplans for the next 18 months. Unfortunately, it is unlikely there will be on the ground activities until 2002. USAID is funding six different NGO activities, which support street children affected by AIDS. The number of such grants will be expanded in FY 2001. As part of the Prime Minister's Business Coalition Initiative, USAID is partnering with several industrial houses to address AIDS in the workplace. USAID is one of the lead donors in the area of HIV/AIDS, particularly for targeted interventions. It is a member of the donor coordination committee set up by the government.
Polio eradication is progressing in India, but eliminating the virus from urban slums and hard-to-reach populations will be an arduous and expensive task. Polio cases have declined from 1,126 in 1999 to 263 in 2000, with the bulk of cases in Uttar Pradesh and Bihar. It is estimated that 98.5% of Indian children under-five years were immunized in 2000. Through a grant, USAID initiated support for an intensified effort in urban slums. Maximizing the impact of NGOs in polio eradication is a recognized priority.
USAID will continue to work with the World Health Organization (WHO) to institutionalize DOTS therapy for TB control and with PACT-CRH to enhance the application of safe and affordable new technologies. Data from the DOTS project indicate that 70% of cases are detected in the project area and, of those cases, 75% are treated successfully, a doubling of treatment success over the last 18 months. Over 100,000 people have been tested for TB as part of a systematic community survey in Tamil Nadu. With USAID and World Bank support, more than 50% of Tamil Nadu has been covered by DOTS, although the effectiveness of coverage needs to be improved. A TB resistance survey has been completed. Data indicates about 2% of TB patients present some form of resistance. The multidrug-resistance tuberculosis survey will continue. More than 1,400 health providers have completed in depth training at the Tuberculosis Research Center during the life span of the project.
USAID is exploring options to expand HIV/AIDS activities to Pondicherry and Goa (two states that border the current HIV/AIDS programs in Tamil Nadu and Maharashtra), and, as appropriate, to use program resources to fight urban infectious diseases.
Possible Adjustments to Plans: During FY 2001, USAID will review this activity and prepare a new strategy in FY 2002.
Other Donor Programs: The World Bank is the major donor to the national level AIDS control program. UNAIDS as well as other UN agencies work at the national level. The United Kingdom has initiated an HIV intervention with truck drivers to promote behavior modification and STD treatment, and to promote behavior change programs in the states of Andhra Pradesh, West Bengal, Kerala, Gujarat, and Orissa. Other donors who have or will initiate state-specific HIV prevention programs are Australia (Manipur, Meghalaya, Mizoram and Delhi), and Canada (Rajasthan and Karnataka). All donor programs are carefully coordinated under the leadership of the National Agency for AIDS Control (NACO).
Principal Contractors, Grantees, or Agencies: 1) Polio: WHO, United Nations Children's Fund (UNICEF), Rotary International, Center for Disease Control (CDC); 2) Tuberculosis: WHO and CDC; 3) Surveillance: WHO and CDC; 4) HIV/AIDS and other infectious diseases: International Clinical Epidemiology Network, NACO, Voluntary Health Services, Family Health International, PATH and ICICI Limited.
FY 2002 Performance Table
India: 386-007
Performance Measures:
Indicator FY97 (Actual) FY98 (Actual) FY99 (Actual) FY00 (Actual) FY00 (Plan) FY01 (Plan) FY02 (Plan) Indicator 1: Percentage of individuals belonging to specified high-risk groups who report condom use in most recent sexual encounters with a non-regular partner. 47 53 57 59 57 62 65 Indicator 2: Percentage of population with symptomatic Sexually Transmitted Diseases (STD) seeking care from qualified medical practitioners in Tamil Nadu. 67 77 71 65 72 75 77 Indicator Information:
Indicator Level (S) or (IR) Unit of Measure Source Indicator Description Indicator 1: IR Percentage Behavioral Sentinel Surveillance (BSS) Study Figures are simple arithmetic averages for commercial sex workers, STD clinic attenders, truck drivers and helpers. Groups such as male and female factory workers, and male and female students are not included since BSS data indicates they are not "high risk groups". Indicator 2: IR Percentage Behavioral Sentinel Surveillance (BSS) Study Figures are simple arithmetic averages for male factory workers, truck drivers and helpers (Male students not included in 1998, 1999 BSS). Qualified medical practitioners are allopathic (western medicine) doctors. U.S. Financing
(In thousands of dollars)
Obligations Expenditures Unliquidated Through September 30, 1999 5,920 DA 5,259 DA 661 DA 33,569 CSD 13,737 CSD 19,832 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Fiscal Year 2000 0 DA 661 DA 15,000 CSD 12,421 CSD 0 ESF 0 ESF 0 SEED 0 SEED 0 FSA 0 FSA 0 DFA 0 DFA Through September 30, 2000 5,920 DA 5,920 DA 0 DA 48,569 CSD 26,158 CSD 22,411 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Prior Year Unobligated Funds 0 DA 0 CSD 0 ESF 0 SEED 0 FSA 0 DFA Planned Fiscal Year 2001 NOA 0 DA 16,600 CSD 0 ESF 0 SEED 0 FSA 0 DFA Total Planned Fiscal Year 2001 0 DA 16,600 CSD 0 ESF 0 SEED 0 FSA 0 DFA Future Obligations Est. Total Cost Proposed Fiscal Year 2002 NOA 0 DA 0 DA 5,920 DA 18,100 CSD 48,280 CSD 131,549 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA
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Last Updated on: May 29, 2002 |
