Role of Uniformed Personnel in controlling the HIV Epidemic

1. LEADING FROM THE FRONT Role of Uniformed Personnel in controlling the HIV Epidemic UNAIDS INDIA: dwivedir@unaids.org; +91-9810505068

2. Part 1: What is HIV & AIDS Part 2: State of the Epidemic: India and Uniformed Services Part 3: How we can help the fight against HIV/ AIDS Three part presentation UNAIDS INDIA: dwivedir@unaids.org; +91-9810505068

3. HIV - Human Immunodeficiency Virus is the virus that causes AIDS. This virus is passed from one person to another through blood and sexual contact AIDS - Acquired Immuno-Deficiency Syndromeis a condition in which the body’s immune system becomes weak to fight off certain infections There is no cure for HIV/AIDS – Prevention is the Key The infected person can look and lead a healthy life for several years till AIDS sets in What is HIV & AIDS ? UNAIDS INDIA: dwivedir@unaids.org; +91-9810505068

4. HIV is present in an Infected Person’s: Blood; Semen; Vaginal secretions; Breast Milk; Cerebrospinal fluids; HIV is transmitted through: Unprotected sexual contact with an infected person Direct contact with or transfusion of infected blood Sharing infected needles e.g. Injecting Drug Users From a HIV positive mother to her unborn child, during birth, or through breast feeding BUT NOT through: Tears, sweat; toilet seats; food; mosquito bites; shaking hands Presence of Sexually Transmitted Infection enhances the risk of HIV infection Regarding razors, though there is no reported case, there is a very small possibility of transmitting infection, especially if the razor is not cleaned properly. Hence the direction is to carefully disinfect the razor after each use How HIV survives & spreads? UNAIDS INDIA: dwivedir@unaids.org; +91-9810505068

5. Persons having unprotected anal, oral or vaginal sex with multiple partners Partners of injection drug user or treated by quacks People with sexually transmitted diseases Rape victims as accidental exposure to HIV infection is curable if treated with-in 24 hours Couples planning a to have a child as With medication, HIV +ve mother can have HIV –ve child ONLY RELIABLE WAY IS TESTING PROVIDE WIDESPREAD CONFIDENTIAL TESTING OPPORTUNITY. Who MUST get tested ? UNAIDS INDIA: dwivedir@unaids.org; +91-9810505068

6. High probability of injury and blood transfusion Contact with contaminated blood during accidents Frequent interaction with most at risk populations - Sex workers, Injecting drug users (IDU) and Men having sex with men (MSM) High risk taking ability, sexually active age group, long periods of deployment away from home Alcohol use at times enhances vulnerability by clouding judgment and risk behaviour How is police vulnerable to HIV? UNAIDS INDIA: dwivedir@unaids.org; +91-9810505068

7. Routes of HIV transmission 85 out of 100 persons who are HIV+ get infected through unsafe sex in India UNAIDS INDIA: dwivedir@unaids.org; +91-9810505068

8. There are pockets of high prevalence even in low prevalence states From 1 case in 1986 to 25 Lakhs in 2006 Deeper shade of Blue indicates higher prevalence UNAIDS INDIA: dwivedir@unaids.org; +91-9810505068 Source: NACO’s Sentinel Surveillance data: ANC sites (2001, 2003)

9. Percent of infected adults 25 20 15 10 5 0 South Africa Thailand 1990 91 92 93 94 95 96 97 98 99 2000 Year Note: Thailand‘s aggressive HIV control program has hept the infection rate relatively low over the past decade. South Africa did not implement an HIV control program and the rate climbed precipitously. HIV/AIDS in South Africa and ThailandEffect of intervention UNAIDS INDIA: dwivedir@unaids.org; +91-9810505068 Source: UNAIDS

10. The Home Ministry is formulating a methodology for estimating HIV prevalence in Police. Currently, we have data only on known cases. (mostly based on data from testing of blood donated by uniformed personnel). Para Military forces have better records HIV estimates among Police personnel UNAIDS INDIA: dwivedir@unaids.org; +91-9810505068

11. HIV / AIDS and Central Police Forces Contd. UNAIDS INDIA: dwivedir@unaids.org; +91-9810505068

12. HIV prevalence among Central Police Forces UNAIDS INDIA: dwivedir@unaids.org; +91-9810505068

13. In Mumbai, 450 policemen have tested positive for HIV since 1991, prompting the police department to launch AIDS awareness drive http://timesofindia.indiatimes.com/articleshow/411053.cms Mumbai police have decided to make it mandatory for each of the 38,000 constables and officers up to the rank of inspector, to undergo an HIV test every six months. http://timesofindia.indiatimes.com/articleshow/411076.cms After seven cops in Ferozepur (Punjab) tested positive for HIV, policemen are being put through a comprehensive medical examination http://timesofindia.indiatimes.com/articleshow/1166696.cms 6 constables tested positive out of a sample of 500 in Patna i.e. 1.2 % of sample tested Times of India; 26th October, 2006: HIV/AIDS and the Police UNAIDS INDIA: dwivedir@unaids.org; +91-9810505068

14. Knowledge and attitudes about HIV: Police Assessment with 51 respondents SI/ HC/ C in the North East. February 2006 UNAIDS INDIA: dwivedir@unaids.org; +91-9810505068

15. HIV Prevalence in some militaries Angola 40-60% Cote d’Ivoire 10-20% Rep of Congo 40-60% Eritrea 10% Nigeria 10-20% Tanzania 15-30% (Source: DIA/AFMIC, 1999) The situation can be very grim UNAIDS INDIA: dwivedir@unaids.org; +91-9810505068

16. Because police can support prevention initiatives as part of their regular work and automatically get sensitized for their own protection Because police can be leaders in HIV/AIDS response and demonstrate that they care for social concerns. Because police may themselves face situations of vulnerability Why police should be concerned with HIV/AIDS? UNAIDS INDIA: dwivedir@unaids.org; +91-9810505068

17. Police are role models for the communities Police have an automatic audience because of their position as protectors of law Their daily work brings them in contact with some of the key populations (KPs) most vulnerable to HIV/AIDS Sex workers Men who have sex with men Injecting drug users NGO outreach workers need their protection to reach and engage with vulnerable populations Police can make a difference because…

18. Government of India has set-up National Task Force for Prevention of HIV/AIDS in Central Police Forces in December 2005. NACO has set-up a Technical Advisory Group on uniformed services to integrate the response to the epidemic by the different formation of Army, Para Military and the Police. Indian Army has an extensive HIV prevention and care programme through the AIDS Control Organization located in AFMC Pune Different para-military forces (Assam Rifles, CRPF, BSF) have extensive HIV prevention and care programmes. State Armed Police, though as vulnerable as Para Military force have ad hoc sporadic activities Civil Police are the least attended to in most states, except for notable exceptions like Gujarat and Karnataka. Current Programmes UNAIDS INDIA: dwivedir@unaids.org; +91-9810505068

19. Establish epidemiological database for HIV estimation Integrate efforts of all uniformed services Plan on basis of universal access for covering the entire force in a time frame Utilize command structure of force for accelerated programming and message transmission through the regular meetings Integrate session on HIV in all training programmes Regular assessment on knowledge on HIV Integrate messages on HIV as a part of general health information. Integrate testing and treatment with facilities for general population Proposed Approaches UNAIDS INDIA: dwivedir@unaids.org; +91-9810505068

20. Be accessible to NGOs working on AIDS: understand the nature of their work and identify ways to help each other in working efficiently Where possible meet with Key Populations and people living with HIV/AIDS to understand their problems Protect peer educators working for vulnerability reduction of high risk groups (e.g. peers distributing condoms) Respect Human Rights of PLHA and high risk groups Emphasis on sections relating to rehabilitation of IDUs and Sex Workers etc. Objectives of new approach UNAIDS INDIA: dwivedir@unaids.org; +91-9810505068

21. Structural changes To provide for sustained access to HIV prevention information: • Integrating basic Health and programming messages in Personal Health Record/ Treatment Card, as part of each police persons “Kit” defined in Uniform Rules. (Integrating HIV information integrated with other public health problems removes resistance from sharing with families, besides not stigmatizing the disease) • Toll free help lines for seeking specialized information and counseling For institutionalized long term coordination with NGOs: • Designation of focal points at the state and district level for NGO coordination – (changing the TOR of the officer in-charge of welfare / human rights at the state level, and Gazetted Officer in-charge police line in the district) UNAIDS INDIA: dwivedir@unaids.org; +91-9810505068

22. Tools and instruments • HIV and Uniformed Services Tool Kit- with graded content, depending on interest of user • Ready to use presentations, handouts for different levels (State, District and Police Station) • Health and HIV in syllabus of recruitment exams and in-service training • WEB enabled knowledge base on HIV and Uniformed services for efficient knowledge management and dissemination • Optical Mark Recognition based system to regularly track behaviour surveillance UNAIDS INDIA: dwivedir@unaids.org; +91-9810505068

23. To you and your life : Police are more vulnerable because of high blood contact, deployment away from home and high risk taking behaviour Your family To the country Some countries have 20-30 percent of their security personnel infected with HIV. They can-not protect themselves, their people, or their country HIV is a Security threat UNAIDS INDIA: dwivedir@unaids.org; +91-9810505068

24. Police have led society from the front in all major social crisis. The fight against HIV is a matter of effective leadership, and resolve at all levels to protect society, our people and most of all health of the personnel and fitness andmorale of the force It is a resolve to uphold personal, social, economic and national security of the country and its citizens Leadership and resolve UNAIDS INDIA: dwivedir@unaids.org; +91-9810505068

25. For any queries, request for materials etc. please get in touch. Email: dwivedir@unaids.org Mobile: +91 9810505068