India

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:

*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: 

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.

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.