India

HIV/AIDS in Jhabua and Alirajpur, Madhya Pradesh

December 31, 2009

Dr. Fabian Toegel

HIV/AIDS in Jhabua and Alirajpur, Madhya Pradesh

The HIV/AIDS program was started 4 years ago and is now providing HIV/AIDS awareness, prevention, counseling, testing, and treatment services to hundreds of community members per month. We have the most integrated public private partnership (PPP) HIV/AIDS services set-up in the state with a PPP Integrated Testing and Counseling Center, PPP Link Antiretroviral Treatment Center, and a ‘DOTS’ treatment center for tuberculosis (often occurring in HIV+ patients). Our care and support program assists 217 HIV positive individuals with medical, psychosocial, and livelihood generation services. We specifically tailor our program to the needs of the tribal communities which we work with, addressing the needs of vulnerable populations such as children, migrants, truckers, and female sex workers.

Together with the United Nations Population Fund we are embarking on a comprehensive HIV/AIDS awareness, prevention and treatment program for female sex workers in our districts. We work closely with our partner on the ground, Jeevan Jyoti Health Service Society, and with the state and national government HIV/AIDS bodies, MPSACS and NACO, as well as other NGOs doing work in our communities and across the country.

Key Indicators:

HIV/AIDS Testing 2006 – 2009 4900
HIV+ patients registered at ART center 188
Deaths 25
Currently on ART 44
Currently receiving ART from JJH link-ART center 21
MP state prevalence 2006 Sentinel Surveillance 11
Avg STIs cases reported at 7  hospitals in Jhabua/Alirajpur per month 500-900
Female Sex Workers 251
Men Having Sex with Men 290
High Risk Youth* 1893
Drivers** 794
“Blue film shops” 300

 

*youth who have various sexual partners, including FSW. Many of these youth are employed as drivers within the district.

**Drivers who cross state boundaries

***Blue films or pornographic film shops are a new feature in Jhabua and either sell, rent, or screen these DVDs. Many of the customers of these shops also partake in high risk behavior.

The 2006 HIV Sentinel Surveillance data shows that the prevalence of HIV in Madhya Pradesh has remained relatively stable (0.17 in 2002 to 0.11 in 2006).1 Though state-wide data suggest stability in HIV prevalence, cases of HIV in the Jhabua area seem to be on the rise. At the project’s inception approximately two year ago, Jeevan Jyoti Health Services Society was facilitating care for 54 patients infected with HIV. This number continues to rise, with an average of 6 to 7 new cases being identified each month (Figure 1). A total of 175 patients have been registered as HIV positive in Jhabua and Alirajpur. This increase in HIV cases highlights the critical need for appropriate HIV/AIDS-related programs in Jhabua and Alirajpur.

 

Figure 1 Total number of HIV-positive individuals identified by Jeevan Jyoti Health Services Society from the project’s inception in June 2007 until July, 2009

Taking into account the high rate of case detection in Jhabua, there is concern that there could be many more patients given the risk factors associated with Jhabua and Alirajpur’s populations.

High levels of migration to high prevalence areas

An average of 64% of Jhabua and Alirajpur’s population migrates seasonally to neighboring states Gujarat, Maharashtra, or Rajasthan or to Indore. In the 175 HIV positive cases we’ve identified so far, 40% have migrated for work. The figure below demonstrates the high amount of HIV cases in the districts surrounding Jhabua and Alirajpur. Damod, Gujarat where most migrants travel is a category A district according to recent surveillance. Below Alirajpur, Nandurbar, Maharashtra is a Category A district as well. Neighboring Banswara district is only a category B district according to 2006 data, but there are currently 302 HIV+ people registered in this center. Migrants for Jhabua and Alirapur frequently travel to high prevalence districts where they partake in high risk behaviors. 

The figure on the next page demonstrates there is a high correlation between blocks with high migration rates and high numbers of PLHA. Yet, the maps also demonstrate that some districts that have high rates of migration also have low rates of PLHA. This does not mean that there is actually a low prevalence of HIV, but that we have not been able to penetrate these areas yet because of staffing limitation.

 

Large high risk populations

Jhabua and Alirajpur also have high numbers of high risk populations such as female sex workers, MSM, truckers, and youth who report visiting FSW and having multiple sexual relations. In a recent survey of 60 villages, Jeevan Jyoti staff found the following: 

S.NO VILLAGE NAME F.SW. M.S.M YOUNG (HIGH RISK) DRIVERS CD SHOP
(BP)
1 MEGHNAGAR 3 9 26 72 10
2 RANAPUR 16 12 40 39 11
3 NANPUR 4 2 21 4 4
4 UMRAALI 3 1 9 6 5
5 BAMANIYA 5 5 17 11 5
6 JHAKNAWADA 3 3 23 4 6
7 BALEDI 2 0 11 2 2
8 JHABUA 27 62 196 81 21
9 CHAKTALA 6 2 13 8 3
10 SORWA 3 1 22 2 3
11 AAMKHUT 1 2 34 4 4
12 JHIRAN 2 0 7 1 2
13 DHOLIYAWAD 0 0 19 2 1
14 RAIPURIYA 5 6 46 14 9
15 KAKANWANI 7 2 23 5 7
16 KANWADA 3 0 11 3 3
17 KULWATA 0 1 9 2 2
18 ALIRAJPUR 19 27 136 39 17
19 BHABRA 9 9 69 13 6
20 PETLAWAD 12 13 82 56 13
21 RAMBHAPUR 2 4 10 7 5
22 MOHANKOT 0 2 27 5 1
23 KUNDANPUR 1 1 24 6 3
24 RAJLA 2 0 19 2 2
25 BADAGUDA 0 3 21 1 1
26 MEDWA 1 2 11 1 2
27 BAKHATGAD 1 3 17 3 2
28 AAMBUA 4 3 37 21 5
29 ANDHARWAD 0 0 24 1 1
30 PITOL 5 5 29 19 6
31 KARDU 2 3 19 4 2
32 THANDLA 8 19 123 72 17
33 TAARKHEDI 2 7 17 9 3
34 BARVET 3 2 36 5 2
35 CHANDPUR 2 1 16 19 3
36 BARJHAR 1 0 15 7 1
37 BORI 5 4 42 17 3
38 UMARKOT 2 2 14 1 1
39 MACHLIYA 0 0 7 1 0
40 KARWAD 6 5 47 9 9
41 BORAYTA 3 1 19 2 4
42 KALYANPURA 2 5 52 6 6
43 KHATTALI 3 3 16 2 2
44 MADRANI 1 2 11 1 4
45 DHEKAL 0 0 7 0 2
46 FULMAAL 2 0 9 3 1
47 SOUNDWA 7 4 37 9 5
48 JOBAT 11 13 109 27 15
49 PARA 5 7 21 13 8
50 HARINAGAR 2 2 13 4 3
51 SAARANGI 3 7 48 9 4
52 SAMOI 2 1 13 0 1
53 CHENPURA 1 0 23 1 1
54 KATTHIWADA 2 3 21 9 4
55 WALPUR 2 2 19 7 3
56 UDAIGAD 7 5 33 16 5
57 BHAGOR 1 1 9 5 2
58 BEKALDA 0 0 7 1 1
59 MAANDLI 3 2 18 2 1
60 KAALIDEVI 5 3 30 11 7
61 KHEDI 0 0 9 0 1
62 ETC 13 7 0 44 17
total   251 290 1893 794 300

 

High levels of STIs

In addition to knowing that many people in Jhabua and Alirajpur participate in high risk behavior, we also know that there are many reported cases each month for STIs at the 7 major hospitals in Jhabua. The table below lists the estimates of the number of STI cases seen per month by the doctors at the 7 hospitals.

 

Serial no Place Doctor Name Per month/round 
1 Government Hospital Jhabua Dr. Gadariya 90-120
2 Government Hospital Alirajpur Dr. Madam Gavli 60-90
3 Petlawad PHC Dr. Urmila Soeal 70-80
4 Thandal PHC Dr. Chaturvedi 70-80
5 Mission Hospital Jobat Dr. Swarna lata Wilsion 100-120
6 Mission Hospital Thandla Dr. Vinaya 90-100
7 Jeevan Jyoti Hospital Meghnagar Dr. Minaxi Morya 70-90

 

Low level of knowledge about HIV and STI prevention

All of these risk factors are compounded by the low level of awareness about HIV in the districts. Only 35 percent of women and 59 percent of men in rural Madhya Pradesh have ever heard of AIDS. Furthermore, in rural areas, far less is known about the protective benefits of condom use. Fewer than half as many women in rural areas versus urban areas (26 percent versus 63 percent) understand that consistent condom use can reduce HIV transmission. The statistics for men show slightly better, though still inadequate, rates of understanding regarding HIV transmission, thus emphasizing the vulnerability of this population to HIV (Figure 1).2

 

The percentage of married adults aged 14 to 49 who have heard of AIDS in 1998-1999 compared to 2005-2006 (NFHS-3). National Family Health Survey-3 (NFHS-3). Deonar, Mumbai, International Institute for Population Sciences, 2005-2006.

 

 


 

1HIV Sentinel Surveillance (HSS) Technical Report: India, HIV Estimates – 2006. National AIDS Control Organisation (NACO), 2006.

2National Family Health Survey-3 (NFHS-3). Deonar, Mumbai, International Institute for Population Sciences, 2005- 2006.

 
Country Page: India Initiative Page: HIV/AIDS Prevention & Care Program