District HIV/AIDS Epidemiological Profiles
developed through Data Triangulation
FACT SHEETS
Gujarat
National AIDS Control Organisation
India’s voice against AIDS
Ministry of Health & Family Welfare, Government of India
6th & 9th Floors, Chandralok Building, 36, Janpath, New Delhi - 110001
www.naco.gov.in
VERSION 1.0
GOI/NACO/SIM/DEP/011214
Published with support of the Centers for Disease Control and Prevention
under Cooperative Agreement No. 3U2GPS001955 implemented by FHI 360
district HIV/AIDS Epidemiological Profiles
developed through Data Triangulation
FACT SHEETS
Gujarat
National AIDS Control Organisation
India’s voice against AIDS
Ministry of Health & Family Welfare, Government of India
6th & 9th Floors, Chandralok Building, 36, Janpath, New Delhi - 110001
www.naco.gov.in
December 2014
Dr. Ashok Kumar, M.D.
F.I.S.C.D & F.I.P.H.A
Dy. Director General
Tele : 91-11-23731956
Fax
: 91-11-23731746
E-mail : [email protected]
FOREWORD
The national response to HIV/AIDS in India over the last decade has yielded encouraging outcomes in terms of
prevention and control of HIV. However, in recent years, while declining HIV trends are evident at the national level
as well as in most of the States, some low prevalence and vulnerable States have shown rising trends, warranting
focused prevention efforts in specific areas.
The National AIDS Control Programme (NACP) is strongly evidence-based and evidence-driven. Based on evidence
from ‘Triangulation of Data’ from multiple sources and giving due weightage to vulnerability, the organizational
structure of NACP has been decentralized to identified districts for priority attention.
The programme has been successful in creating a robust database on HIV/AIDS through the HIV Sentinel Surveillance
system, monthly programme reporting data and various research studies. However, the district level focus of the
programme demands consolidated information that helps better understand HIV/AIDS scenario in each district,
to enable effective targeting of prevention and treatment interventions to the vulnerable population groups and
geographic areas.
Information collected and analysed during the extensive data triangulation exercise conducted during 2009-10
and 2010-11 and updated data from recent years has been the basis for this technical document on District HIV
Epidemiological Profiling. For each district it consists of a brief narrative report on the district background, the HIV/
AIDS epidemic profile of the district based on the updated information compiled from all the available sources, and
key recommendations based on the identified information gaps and areas for programme interventions. I strongly feel
that this document will be highly useful for programme managers at district, State and national levels.
The major outcomes of this exercise were systematic compilation of the available data for a district at one place,
identification of information gaps for effective strategic planning at district level, and development of a framework
for re-prioritisation of districts under the programme. The other key achievements were institutional strengthening,
capacity building of programme staff in data analysis and data use, and involvement and ownership of staff of service
delivery units in the entire process.
We congratulate the efforts made by the National Technical Team, the State AIDS Control Societies, and the State
Coordinating agencies and all the district level personnel involved in the process. The technical & financial support
provided by our partner agencies UNAIDS, USAID, BMGF and PHFI for this exercise is gratefully acknowledged. Special
thanks to the officers from CDC, FHI 360, WHO, UNAIDS & JSI for their efforts in finalizing the individual factsheets.
The efforts of the Officers of Data Analysis & Dissemination Unit at NACO for planning, coordinating & successfully
completing this process and bringing out this valuable document, are appreciated.
(Dr. Ashok Kumar)
iii
Acknowledgement
Under the project ‘District Epidemiological Profiling’ using Data Tringulation, the National AIDS Control Organisation
had undertaken a systematic compilation and analysis of all the available data for 539 districts of the country from
multiple sources, including surveillance data and programme data, to derive meaningful inferences. This document is
an outcome of the Data Triangulation excercise and provides the district-wise HIV epidemic summary and programme
response.
This enormous task would not have been possible without the involvement and ownership of district level programme
managers and staff of service delivery units. The contributions of the District AIDS Prevention and Control Unit teams
(Programme Managers, M&E Officers), ICTC Supervisors, Counselors, Targeted Intervention staff, ART Research
Officers, NRHM District Programme Officers and others who were actively involved in the entire process, are highly
appreciated.
The collaborative effort of the State Coordinating Agencies and the State AIDS Control Societies (SACS) involved
in identifying programme questions, performing quality checks and data validation, preparation of data tables and
compiling data for development of district profile reports, is sincerely acknowledged. The efforts of Deputy Director
(M&E), State Epidemiologists and M&E Officers of SACS who implemented this exercise under the guidance and
leadership of the Project Directors and Additional Project Directors are also appreciated.
The efforts made by the National Technical Team members who developed guidelines and tools for undertaking this
project, and the teams involved in finalizing the database for each district and in preparing the district factsheets, are
highly commendable.
The technical & financial support provided by our partner agencies UNAIDS, USAID, BMGF and PHFI for this exercise
is gratefully acknowledged. Special thanks to the officers from CDC, FHI 360, WHO, UNAIDS & JSI for their sincere
efforts in finalizing the individual district database and factsheets.
Role of Officers of Data Analysis & Dissemination Unit at NACO are deeply appreciated for planning, coordinating &
successfully completing this process and bringing out this valuable document.
iv
Contents
Foreword ............................................................................................................................................. iii
Acknowledgement .............................................................................................................................. iv
Contents ........................................................................................................................................... v
Acronyms ........................................................................................................................................... vi
Glossary ............................................................................................................................................... vii
Introduction .............................................................1
12. Kheda ............................................................32
Methodology ...........................................................2
13. Mahesana ..................................................... 34
Specific Notes on Fact sheets ....................................6
14. Narmada ....................................................... 36
District Map of Gujarat ...........................................9
15. Navsari ..........................................................38
1. Ahmedabad ................................................... 10
16. Panchmahals ................................................. 40
2. Amreli ............................................................12
17. Patan .............................................................42
3. Anand ............................................................14
18. Porbandar ......................................................44
4. Banaskantha ..................................................16
19. Rajkot ............................................................46
5. Bharuch .........................................................18
20. Sabarkantha ...................................................48
6. Bhavanagar ................................................... 20
21. Surat ..............................................................50
7. Dahod ...........................................................22
22. Surendranagar ...............................................52
8. Gandhinagar ................................................. 24
23. The Dangs ......................................................54
9. Jamnagar ...................................................... 26
24. Vadodra .........................................................56
10. Junagadh ...................................................... 28
25. Valsad ............................................................58
11. Kutch .............................................................30
v
Acronyms
AIDS
Acquired Immune Deficiency Syndrome
ANC Antenatal Clinic
ART Anti-Retroviral Therapy
BSS
Behavioral Surveillance Survey
CCC Community Care Centre
CMIS
Computerised Management Information System
DEP district Epidemiological Profile
DIC Drop-in-Centre
DLHS
district Level Health Survey
DLN district Level Network for HIV positive people
FSW Female Sex Workers
HIV Human Immunodeficiency Virus
HRG
High Risk Group
HSS
HIV Sentinel Surveillance
IBBA Integrated Biological and Behavioral Assessment
IBBS
Integrated Biological and Behavioral Survey
ICTC Integrated Counseling and Testing Centre
IDU
Injecting Drug Users
IEC Information Education & Communication
LAC Link ART Centre
MSM Men who have Sex with Men
NACO National AIDS Control Organisation
NACP National AIDS Control Programme
NFHS
National Family Health Survey
PLHIV People Living with HIV
PPTCT Prevention of Parent to Child Transmission
RRC Red Ribbon Club
RTI
Reproductive Tract Infection
SACS
State AIDS Control Society
SCA State Coordinating Agency
STD Sexually Transmitted Disease
STI
Sexually Transmitted Infection
TB Tuberculosis
TI
Targeted Interventions
vi
Glossary
1. ART Centre: Free first line and second line Anti-Retroviral Treatment (ART) is provided to clinically eligible PLHIV
at designated centres across the country. As soon as the persons are detected to be HIV positive at ICTC, they are
referred to the ART centre for pre-ART registration. At the time of registration, all the baseline investigations are
done including CD4 count. If these persons are clinically eligible for treatment, they are started on first line ART.
Otherwise, PLHIV are followed up every six months for CD4 count. The number of PLHIV on ART mentioned in the
document refers to those on first line ART at NACO-supported ART centres. Another 30,000 PLHIV are estimated
to be receiving ART in the private sector.
2. Blood Safety: Under the Blood Safety programme, Blood Banks across the country are supported by NACO and
voluntary blood donation is strongly promoted to ensure that every blood unit collected is screened and is free
from HIV and other infections.
3. Community Care Centres (CCC): CCC have been set up in the non-government sector with the objective of
providing PLHIV with psychosocial support, counseling for drug adherence and nutrition, treatment of opportunistic
infections, home-based care, referral and outreach services for follow up, besides tracing patients lost to follow up
and those missing anti-retroviral drugs as per schedule.
4. Condom Promotion: The condom promotion strategy under NACP focuses on two aspects: ensuring availability
of and creating demand for condoms. There are two channels of condom supply by the Government, namely
free and socially marketed. Under the programme, free condoms are distributed to High Risk Groups through TI
projects and service delivery outlets such as ICTCs, STI clinics, etc. Under the Targeted Condom Social Marketing
Programme, condoms are provided at subsidized rates for HRG as well as general population through traditional
and non-traditional condom outlets, rural outlets, and outlets at TIs and truck halt points.
5. Core Composite TI: Targeted Interventions providing HIV prevention services to more than one High Risk
Group.
6. Counseling and Testing Services: Integrated Counseling and Testing Centre (ICTC) is a place where a person
is counseled and tested for HIV on his/her own volition (Client-Initiated) or as advised by a health service provider
(Provider-Initiated) in a supportive and confidential environment. These centres are the entry points for reinforcing
HIV prevention messages and linking HIV positive people to HIV care, support and treatment services. There are
several contexts for providing HIV testing services - voluntary counseling and testing, prevention of parent to child
transmission, screening of TB patients and diagnostic testing of symptomatic patients.
7. Drop-in-Centre (DIC): DIC is a platform to provide PLHIV psycho-social support, linkages with services counseling
on drug adherence, nutrition, livelihood and legal issues. They have been set up in the high prevalent districts and
are managed primarily by PLHIV networks.
8. High Risk Groups (HRG): Populations with high risk behaviour for contracting HIV, include Female Sex Workers
(FSW), Men who have Sex with Men (MSM) and Injecting Drug Users (IDU). The other risk groups identified
as Bridge Population (between the General population and HRG) include the Single Male Migrants and Long
Distance Truckers.
vii
9. Link ART Centres: In order to facilitate the delivery of ART services nearer to the homes of beneficiaries, the
Link ART Centres (LAC), located mainly at ICTC in the district/Sub-district level hospitals, were set up and linked
to nodal ART centres within accessible distance.
10. PLHIV Networks: Networks of HIV positive persons have been formed at the national, state and district levels.
Such networks act as platforms for People Living with HIV/AIDS (PLHIV) to share their concerns, and seek support
and legal aid. They address stigma and discrimination-related cases among their members and also provide social
support for those isolated by their family and community. The networks are encouraged to advocate and promote
the utilisation of HIV related services.
11. Prevention of Parent to Child Transmission (PPTCT): Mother to child transmission of HIV may take place
during pregnancy, during childbirth or through breast feeding. To prevent this, under the PPTCT programme every
pregnant woman visiting antenatal clinics or visiting hospital at the time of delivery is tested for HIV infection.
A pregnant woman found positive for HIV infection is closely followed up to ensure institutional delivery. At the
time of delivery, the pregnant woman and the new-born baby are given a single dose of Nevirapine to prevent
mother to child transmission of HIV.
12. Red Ribbon Clubs: Red Ribbon Clubs (RRC) formed in colleges provide a forum for students to come together
to share information on HIV/AIDS and safe behaviours, to discuss related issues and also motivate them to
participate in voluntary blood donation.
13. STI/RTI Services: Sexually Transmitted Infections/Reproductive Tract Infections increase the risk of HIV transmission
significantly. STI/RTI services are aimed at preventing HIV transmission and promoting sexual and reproductive
health under the National AIDS Control Programme and the Reproductive and Child Health programme of the
National Rural Health Mission (NRHM).
14. Targeted Intervention: Targeted Interventions (TI) are peer-led preventive interventions focused on HRG and
bridge populations, implemented by Non-Government Organisations and Community-based Organisations in a
defined geographic area. They provide prevention services such as behavioural change communication, condom
distribution, STI/RTI services, needle and syringe exchange, Opioid substitution therapy, referrals and linkages to
health facilities providing HIV/AIDS services, community mobilisation and creating enabling environment.
viii
Introduction
The National AIDS Control Programme under National AIDS Control Organisation has a strong focus on district level
planning, implementation and monitoring of interventions for prevention and control of HIV/AIDS. This approach
requires consolidated information for each district to understand the HIV epidemic scenario and to identify programme
areas for priority attention.
During the past few years, greater information related to HIV has become available for a substantial number of
districts in the country in the form of monthly programme reports, mapping and size estimations of risk groups, data
from HIV Sentinel Surveillance, behavioural surveys research studies, and etc.
In view of this context, the Department of AIDS Control had undertaken a project titled “Epidemiological Profiling
of HIV/ AIDS Situation at district and Sub-district Level using Data Triangulation”/“district Epidemiological Profiling
(DEP)” in 25 states (539 districts) in two phases during 2009-10 and 2010-11.
The exercise of district Epidemiological Profiling involved two broad components – Descriptive Analysis and Data
Triangulation. The former part is guided by thematic areas and describes the ‘what, who, when & where’ of the HIV
epidemic, while the latter ‘Triangulation’ part explains the ‘how and why’ of it by synthesizing data from multiple
sources into a meaningful framework. The available epidemiological data, behavioural/ vulnerability data and
programme data for the district level were compiled and analysed to get a comprehensive picture of the HIV/AIDS
epidemic scenario, in order to guide programme decisions appropriately in each district.
The important outcomes of the district Epidemiological Profiling exercise included the generation of reports describing
the HIV profile and programme response in each district, identification of information gaps for planning strategic
information activities, capacity building of district level personnel in data management, institutional strengthening
and fostering linkages between programme units and academic institutions for addressing strategic information
needs in the programme.
This technical document consists of the epidemiological profile summary along with the available updated information
for each district of the State. Each district summary highlights the key epidemiological features of the district and key
recommendations based on these findings. The document would be useful to programme managers, academicians
and researchers as a quick reference for the HIV/AIDS situation in a district.
District HIV/AIDS Epidemiological Profiles : Gujarat | 1
Methodology
Framework of district Epidemiological Profiling (DEP): DEP has two broad components Descriptive Analysis
and Data Triangulation.
Table 1: Components of district Epidemiological Profiling
Components
of district
Proling
What it Does?
Guiding
Elements
Action To Do
Output
Descriptive
Analysis
Describes
(What? Who? When?
Where?)
Themes
Analyse Data &
Describe the Themes
Descriptive Section of
district Report
Triangulation
Explains
(How? Why?)
Questions
Triangulate Data &
Answer the Questions
Synthesis Section of
district Report
Descriptive analysis of different datasets is organized into the following four thematic areas (Fig.1):
1. Current state of HIV epidemic (levels, trends, differentials and burden of HIV; profle of PLHIV)
2. Drivers of the epidemic (size and profle of risk groups; vulnerabilities STI, risk behaviour, Migration, contextual
factors/regional vulnerabilities)
3. Programme response and gaps
4. Information gaps
Programme
Response &
Gaps
Drivers of
Epidemic
Current
State of
Epidemic
district
Profile
Information
Gaps
Fig. 1: Thematic Areas of district Profiling
Epidemiological Framework of HIV/AIDS Scenario in the district
Data Triangulation may be of information on same data element from different data sources or of information on
different data elements. Triangulation may be done in the time plane or geographical plane. Triangulation synthesizes
the data on the following three elements to explain the inferences arrived at in the descriptive analysis and provides
answers to the programmatic questions.
1. Information on HIV and STIs in different population groups (epidemiological data)
2. Information on vulnerabilities (mapping and behavioural data on Risk Groups, district vulnerabilities)
3. Information on programme response (programme data)
2 | District HIV/AIDS Epidemiological Profiles : Gujarat
Concept of Data Triangulation: Data Triangulation is an Analytical Approach that synthesizes data from
multiple sources to improve the understanding of a public health issue and guide programmatic decision-making to
address the issue (Fig. 2). By putting different bits of information from different sources into a meaningful framework,
it explains and improves the understanding of HIV/AIDS scenario in the district. By providing answers to vital
programme questions, it helps in taking effective decisions for planning and implementation of HIV prevention and
control efforts. It helps to understand the gap between need and programme response and also helps to identify the
information gaps that hinder effective planning.
HIV & STIs
in Different
Groups
TRIANGULATION
Size &
Vulnerability
of Risk
Groups
Programme
Response
Fig. 2: Conceptual Framework of Data Triangulation
Synthesis of Epidemiological, Behavioural and Programme Data
The basic principle of Data Triangulation is “to analyse and interpret a dataset in the light of information emerging
from other datasets, so that the synthesis offers a better understanding of the issues than what will be inferred from a
single dataset.” Triangulation involves compilation, examination, comparison and collective interpretation
of data from multiple independent data sources, followed by reasonable explanation of facts pertaining to the issue
under consideration (Fig. 3). The explanation is aimed towards developing a comprehensive picture of the issue,
building an epidemiological framework that depicts the possible interplay among various factors and answering some
pre-specified questions.
Fig. 3: Schematic representation of processes involved in Data Triangulation
District HIV/AIDS Epidemiological Profiles : Gujarat | 3
Other key features of the process of Data Triangulation are as follow:
1. It gives importance to every bit of information
2. It helps overcome limitations and biases inherent in each dataset
3. It adds value to each dataset and improves their utility
4. It gives high importance to quality analysis of data and undertakes thorough quality checks and validation
5. Indicates the level of reliability in any inference or conclusion
Table 2: Data Sources used for district Epidemiological Profiling
Thematic areas for HIV Epidemiological
Profling
Major Sources
HIV Levels, Trends and Differentials
HIV Sentinel Surveillance (HSS); Integrated Biological &
Behaviroual Assessment (IBBA); ICTC data; PPTCT data; Blood
bank data; NFHS-III; Any other HIV prevalence studies
STI Levels, Trends and Differentials
Behaviroual Surveys (IBBA); STI Clinic data; Targeted
Intervention (TI) data; NFHS-I,II & III; DLHS-I ,II & III;
Other Behavioral studies
HIV estimations
HIV burden in the district
Size Estimates of General Population and
Other Risk Groups
Census Population Projections; Mapping of HRG; TI data
Profile, Turn-over & Migration of key risk
groups
HSS ;IBBA; BSS; Mapping of HRG ;ICTC data; STI Clinic data;
TI data; Other Studies on High Risk Groups; DLHS
Size & Patterns of Migration among
General Population
Census data; Mapping of Migrants; Population Council studies;
Other studies on migrants
Risk Behaviours and Prevention Practices
among key risk groups and general population
BSS; IBBA; DLHS; TI data; Mapping of HRG; Other published/
unpublished data
Profile of PLHIV
HSS; IBBA; ICTC data; PPTCT data; ART data; Positive person
networks; Blood Bank Data; NFHS-III; Any other HIV prevalence
studies
District Vulnerabilities
Local Knowledge; Open sources such as Wikipedia; district
Websites; State Government Websites; etc.
Programme Response
Programme reporting through CMIS
4 | District HIV/AIDS Epidemiological Profiles : Gujarat
Process of district Epidemiological Profiling: The process starts with identifying a broad set of important,
actionable and appropriate questions that the programme wants to find answers to, in a given region, and revisits
and refines the questions at every step of the process. The process of DEP has the following steps:
1. Understanding thematic areas and questions for district Profiling and Triangulation
2. Review of data sources and assessment of data availability in the district
3. Decision on themes to be described and questions to be answered for the district
4. Compilation of secondary data
5. Quality check for completeness, correctness and consistency
6. Data validation, adjustments and filling data gaps
7. Preparation of data tables with clean data for analysis
8. Data analysis, interpretation and inferences; describe thematic areas
9. Data Triangulation (hypotheses building; answer triangulation questions)
10. Preparation of district and State reports
11. Discussions and consultation with SACS, local experts, district level programme managers and service delivery
functionaries on draft reports
12. Presentation and discussion of draft reports with the National Technical Team
13. Finalisation of district Epidemiological Profile reports
Important Outcomes of district Epidemiological Profiling include:
1. Cleaning and validation of programme data (since 2004)
2. Systematic compilation of all data related to HIV for each district at one place for routine use
3. district reports describing the profile of HIV epidemic and programme response in each district
4. Development of framework for re-prioritisation of districts under the programme
5. Prioritisation extended upto Sub-district/Block level with high priority blocks identified
6. Identification of information gaps at district and state level for planning strategic Information activities
7. Capacity building of district level programme managers and staff of service delivery units in handling and analyzing
data, enabling them to understand the importance of the data they generate and the need for ensuring its quality,
and appreciate the use of data for programme review, decision-making and effecting improvements.
8. Enhanced understanding among the programme managers of HIV epidemic and response in the state and
different districts
9. Better use of data in developing district and State Annual Action Plans
10. Institutional strengthening (building state level resource pools) and fostering linkages between programme units
and academic institutions for addressing Strategic Information needs in the programme
District HIV/AIDS Epidemiological Profiles : Gujarat | 5
Specific Notes on Fact sheets
1. Each district fact sheet has two parts: a narrative part consisting of background along with a map, HIV epidemic
profile and key recommendations, and a tabular part consisting HIV levels and trends, PLHIV profile, block-level
details, vulnerabilities and programme response. While the narrative part gives an overview of the district HIV/
AIDS profile, the table provides detailed information about the HIV/AIDS scenario in the district.
2. ‘Background’ gives a brief overview of the district with respect to its geographic location, key demographic
information like total population with male-female distribution, literacy status – based on 2011 Census. The
section also describes the district characteristics or contextual factors that makes it vulnerable to spread of HIV.
3. ‘Epidemic profile’ describes the thematic areas mentioned above (under the data sources) for each district based
on available information.
4. From DLHS-III, percentages of ever married women aged 15-49 years who have heard of HIV/AIDS and RTI/STI
have been taken as awareness indicators among women for HIV and RTI/STI respectively.
5. ‘Key recommendations’ is the final section of the factsheet where ‘Triangulation’ of data is attempted to highlight
the key programme priorities for the district based on the HIV epidemic profile and programme gaps. Any future
potential for spread of infection, if indicated by any information or results, is highlighted and appropriate action
to address the situation is suggested. On the basis of this analysis, recommendations for improving existing
programme, and the need for initiation of new programmes, etc. are highlighted. The recommendation section
also highlights information gaps, if any.
6. Data on ANC utilization mentioned in the table refer to the proportion of women who received at least three or
more antenatal checkups (Data source: DLHS-III).
7. HIV positivity rates among HSS-ANC, PPTCT and Blood Bank attendees are used to represent levels and trends
of HIV Infection among general population. Level is interpreted as high (HIV positivity ≥1%), moderate (HIV
positivity between 0.5-1%) or low (HIV positivity ≤ 0.5%). HIV trend is interpreted as rising, stable or declining.
8. HIV positivity rates among HSS-HRG, HSS-STD and ICTC general clients disaggregated by sex and nature of client
(direct walk-in and referred) are used to represent levels and trends of HIV Infection among high risk groups
and vulnerable population. Level is interpreted as high (HIV positivity ≥ 10%), moderate (HIV positivity between
5-10%) or low (HIV positivity ≤ 5%). HIV trend is interpreted as rising, stable or declining.
9. Positivity at HSS, PPTCT, Blood bank and ICTC sites is presented only for those years where the sample size is valid
i.e. HSS-ANC: ≥ 300 tested, HSS-HRG/STD: ≥ 187 tested, ICTC (male + female/direct walk-in + referred): ≥ 600
tested, PPTCT and BB: ≥ 900 tested.
10. HIV positivity among PPTCT and ICTC attendees at sub-district level wherever data is available is presented under
block level details.
11. Size, demographic and risk profile of PLHIV in a district is inferred from three data sources: ICTC data, ART
Registration data and data from the PLHIV Network in the district.
6 | District HIV/AIDS Epidemiological Profiles : Gujarat
12. Information on major vulnerabilities that are influencing the epidemic/high risk behaviour i.e drivers of the
epidemic is included under the “vulnerabilities” section. It includes:
a. Size and Profile of HRG
b. STIs – levels and trends
c. Migration patterns
d. District Vulnerabilities/ Contextual Factors
13. Information on size and profile (demographic or sub-typology) of HRG is available from mapping data. Size of
HRG as a proportion of the districts population has been stated wherever available, for comparison purposes.
The Taluks/Blocks with high concentration of different HRGs have been given under block level details, wherever
available. Targeted Intervention (TI) targets and coverage of HRG population are also mentioned, wherever
available under “HRG size”.
14. Based on CMIS-STI data, number of episodes of STI/RTI managed using syndromic approach and VDRL/RPR test
results for syphilis in the district are given under “STI/RTI”.
15. Wherever possible, an attempt has been made to describe the male out-migration patterns in the district based
on Census 2001 data. The table also includes the proportion of male migrants going to other states (inter-state)
along with top five destination districts.
16. The section on programme response describes the number of facilities offering HIV services under NACP and
services provided in the district till 2012. This covers both prevention interventions and care, support and treatment
interventions.
17. The number of TIs mentioned in the document includes only NACO-supported TIs. Migrant TIs include source,
transit and destination TIs.
18. All maps used in this document have been prepared from the Survey of India.
19. The district wise factsheets include updated information till 2012. Therefore, the districts newly created after
2012 have not been shown as separate districts. The districts with insufficient data are also not included in
this report.
District HIV/AIDS Epidemiological Profiles : Gujarat | 7
8 | District HIV/AIDS Epidemiological Profiles : Gujarat
District Map of Gujarat
District HIV/AIDS Epidemiological Profiles : Gujarat | 9
Ahmedabad
Background:
Ahmedabad district comprises the city of Ahmedabad, Ahmedabad District
the 7th largest city of India located in the central part of
the state of Gujarat. It is the most populous district of
Gujarat and the eighth most populous district in India with
a population of 72.08 lakh, a sex ratio of 903 females
per 1,000 males; female literacy rate of 80.29%, with an
overall literacy rate of 86.65% (Census 2011). Ahmedabad
is an industrial hub for textiles and is popularly known
as the ‘Manchester of India’. Ahmedabad is developing
excellent urban infrastructure for services economy which
is largely an urban phenomenon. Ahmedabad is the center
of Gujarati cultural activities and diverse traditions of
different ethnic and religious communities. The district is
home to one of the famous World Heritage Site, the Adalaj Vav (Stepwell), and other tourist spots. National Highway 8 passes through the
district connecting it to major industrial centers.
HIV Epidemic Profile:
• Based on 2012 HSS-ANC data, HIV prevalence was low at 0.25% among the ANC attendees, representing a fluctuating trend.
• According to 2012 PPTCT data, HIV positivity was low at 0.20% among the PPTCT attendees, with a stable trend.
• According to 2012 Blood Bank data, HIV positivity was low at 0.12% among the Blood Bank donors, with a stable trend.
• According to 2010 HSS-FSW data, HIV prevalence was low at 3.21% among the FSWs. According to 2010 HSS-MSM data, HIV prevalence
was low at 3.02% among the MSM.
• In 2012, HIV positivity among ICTC attendees was low among male (2.95%) and female (2.09%) clients, as well as among referred
(2.05%) and direct walk-in (3.33%) clients. A decreasing trend was observed over a period of five years among all the ICTC clients
• According to HRG mapping data, MSM (6,526) represent 51.58% of the total HRG population in the ) in the district followed by FSW
(5,667) representing 44.79% , while IDU (460) represent the remaining 3.64%. 96% of the mapped MSM are married.
• In 2012, 87,760 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.39%.
• As per the 2001 Census, 6.21% of the male population were migrants; among them 15.56% migrated to other states and 41.59%
migrated to other districts within the state.
• The top two destinations for out-of state migration were Thane and Mumbai (Suburban), Maharashtra.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 67.1% and 37.4%, respectively.
• In 2012, nine targeted intervention (TI) sites were operational in the district.
Key Recommendations:
• Given the number of mapped HRGs and HIV prevalence among vulnerable groups, increase the number of TI sites in the district. Conduct
socio-demographic analysis and necessary outreach for HIV prevention delivery to spouses or partners of HRG also, and support their
linkage to services.
• Conduct socio-demographic analysis of HSS-ANC data to ascertain risk factors, considering fluctuating prevalence among HSS-ANC
attendees.
• district needs to continue attention to decrease and limit the spread of HIVinfection further among both general and HRG population.
• Considering high rate of migration to high HIV prevalent districts, strengthen outreach programme through awareness campaigns around
source and transit points like railway stations and bus stands.
• Analyze the population size and profile of FSW’s clients, including migrants and truckers, to better understand district vulnerabilities.
• Availability of ART or DLN data would help in better understanding of district vulnerabilities.
10 | District HIV/AIDS Epidemiological Profiles : Gujarat
Ahmedabad
2005
0
400
4.80
250
-
-
2006
0
400
18.00
250
-
11747
84168
103728
135508
149514
127155
District Population: 72,08,200 (11.94% of Gujarat Population); Female Literacy1: 80.29%; ANC Utilization2: 67.3%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
0
0.25
0.50
0.25
HSS-ANC
400
400
400
400
0.43
0.31
0.37
0.24
0.19
0.20
PPTCT
11747
34752
47068
58861
65785
56042
0.22
0.18
0.24
0.21
0.15
0.12
Blood Bank
301759 239776 157718 163782 175822 183157
22.00
HSS-STD
250
6.43
3.21
HSS-FSW
249
249
4.17
3.02
HSS-MSM
216
232
HSS-IDU
6.38
5.04
2.84
2.75
2.95
ICTC Male
31447
27603
44717
54626
42648
5.86
4.97
1.86
2.18
2.09
ICTC Female
17969
14482
31930
29103
28465
5.42
3.89
2.55
2.36
2.05
ICTC Referred
14168
22094
36803
40568
40078
6.50
6.26
2.32
2.72
3.33
35248
19991
39844
43161
31035
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
-
% Married
-
% Widowed
or Divorced
11
NT
% Ill., Prim. Edu.
-
62
ICTC Direct
Walk-in
Total tested at
ICTCs 5
% 15-24 yrs
60
PLHIV Profile, 2012
% On ART
9
Unknown
Kadi Kalol Mehsana
2.13
15.79
-
Parent to
Child
-
1.56
-
-
1.73
24
Homo-sexual
3.34
Dholka Viramgam
4.44
0
3.83
ART (20068)
Hetero-sexual
1.94
-
Bavla
7.5
-
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
87.59
-
Sanand
3.23
Block-Level Details
Taluka2
Dascroi
0
-
DLN (NA)
% of Total
(N=1854)
No. HRG-FSW
No. HRG-MSM
No. HRG- IDU
Taluka 1
Ahmedabad
3.64
% Pos;
ICTC
% Pos;
PPTCT
% Total HRG
Size Est., (Mapping,
Year: NA)
0.08
44.79
5667
FSW
NA
0.09
51.58
6526
MSM
-
NA
0.01
3.64
460
IDU
6.21
190708
15.56
0.97
29683
41.59
2.58
79311
Male Migration, 2001 Census
InterIntraState
state
42.85
2.66
81714
Intradistrict
Overall
100
2009
2
2
1
1
44
24
5
1
2
30
3
3
-
2010
2
3
1
1
75
22
6
2
2
30
3
3
-
2011
3
5
1
1
78
23
7
2
2
140
1
3
-
2012
3
5
1
93
24
8
2
1
2
148
1
3
-
Thane, Mumbai
Pune,
Mumbai, Sirohi,
Maharash- (Suburban)
Maharash- Rajasthan
, Maha- Maharashtra
tra
tra
rashtra
Top 5 districts for inter-state out-migration
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
% Total Pop.
NA
-
HRG Size
Program Target
-
Street
based56.45%
2012
-
Home
basedKothiDaily
16.13%; 79.71%; InjectorsNA;
Brothel PanthibasedNA;
Non daily
27.42%;
Double InjectorsNA
decker20.29%
Program Coverage
Typology
% <25 yrs.
% Married
2011
Programme Response
2006
2007
2008
1
1
2
1
1
3
1
16
27
18
22
22
5
5
1
1
1
2
2
2
1
2
2
3
3
-
16.94
8.00
96.00
STI/RTI
2010
2005
1
1
15
1
2
-
2009
-
-
87760
0.39
2004
1
1
15
-
85307
1.10
No. episodes treated
% Syphilis positivity
-
53022
1.10
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
Comm. care centres
Drop-in-centres
Condom outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); ­4 PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 11
Amreli
Background:
Amreli is located in the western part of Gujarat, near
the Gulf of Khambhat: an inlet of the Arabian Sea
along India’s western coast. Amreli city is the district
headquarters of Amreli. It has a population of 15.13 lakh
that is largely rural (74.51%), a sex ratio of 964 females
per 1,000 males; female literacy rate of 66.97%, with
an overall literacy rate of 74.49% (Census 2011). The
economy of Amreli depends upon agriculture. The district
is a non-industrial area. Amreli is home to many wild
life sanctuaries including the Gir Lion Sanctuary, the only
abode to Asiatic Lions in the world, and Paniya and Mityala
wildlife sanctuaries which are tourist attractions. National
Highway 8E passes through the district connecting it to
Junagadh and Bhavnagar district.
Amreli District
HIV Epidemic Profile: • Based on 2012 HSS-ANC data, HIV prevalence was low at 0.25% among the ANC attendees, with a fluctuating trend.
• According to 2012 PPTCT data, HIV positivity was low at 0.12% among the PPTCT attendees, with a stable trend.
• According to 2012 Blood Bank data, HIV positivity was low at 0.04% among the Blood Bank donors, with a stable trend.
• In 2012, HIV positivity among ICTC attendees was relatively low among male (2.39%) and female (0.88%) clients, as well as among
referred (1.80%) and direct walk-in (1.29%) clients. ICTC male clients experienced a fluctuating trend, female and direct walk-ins had a
declining trend, whereas referred clients observed a stable trend with a rise in 2011.
• According to HRG mapping data, FSW (210; 53.98% of the total HRG) was the largest HRG in the district followed by MSM (179; 46.02%
of the total HRG).
• In 2012, 5,565 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.50%.
• According to the 2001 census, out of the overall population, 16.35% of males were migrants; among them 3% migrated to other states
and 70.36% migrated to other districts within the state.
• The top two destinations for out-of-state migration were Mumbai (Suburban) and Thane, Maharashtra.
• According to 2012 ICTC data, HIV transmissions through from parent to child accounted for 5.16% of the total HIV transmissions in the
district.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 47.2% and 27.6%, respectively.
• There were two composite TIs in the district in 2012.
Key Recommendations:
• Conduct socio-demographic analysis of HSS-ANC data to ascertain risk factors of HIV transmission and those affecting health service
retention.
• Continue attention to decrease and limit the spread of the HIV infection, further even though HIV prevalence among ANC attendees has
been reported at low levels.
• Conduct in-depth analysis of ICTC data to understand the profile of attendees, as the parent to child transmission rate was high. Establish
mechanisms for increasing HIV testing among pregnant women.
• Considering that FSW represent the largest proportion of HRG in the district, conducting an assessment of the size and profile of the FSW
clients’ population including migrants and truckers will help in improving the understanding of district vulnerabilities.
• Availability of HRG typology data would help in analyzing risk factors.
12 | District HIV/AIDS Epidemiological Profiles : Gujarat
Amreli
2006
0
398
0.48
3973
-
14178
13295
27084
20377
District Population: 15,13,614 (2.51%of Gujarat Population); Female Literacy1: 66.97%; ANC Utilization2: 63.8%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
1.00
0.52
1.01
0.25
HSS-ANC
400
382
398
400
0.80
0.20
0.14
0.13
0.07
0.12
PPTCT
996
4586
8034
6357
14616
10610
0.91
0.21
0.08
0.16
0.06
0.04
Blood Bank
3629
5765
6326
6806
7165
7155
HSS-STD
HSS-FSW
HSS-MSM
HSS-IDU
5.81
2.71
2.38
6.81
2.39
ICTC Male
1892
3325
3867
6521
4565
3.47
1.99
1.34
0.66
0.88
ICTC Female
1295
2819
3071
5947
5202
2.71
1.57
1.66
5.22
1.80
ICTC Referred
1991
3624
4284
7259
5664
8.44
3.53
2.34
2.00
1.29
1196
2520
2654
5209
4103
2005
0.59
3195
-
7773
% Married
-
% Widowed
or Divorced
15
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
996
% Ill., Prim. Edu.
-
66
-
% 15-24 yrs
84
-
% On ART
8
NT
-
66
ICTC Direct
Walk-in
Total tested at
ICTCs 5
ART (1058)
PLHIV Profile, 2012
DLN (NA)
-
-
-
-
-
-
-
-
-
-
Unknown
-
-
-
Parent to
Child
Homo-sexual
-
-
-
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
Hetero-sexual
2.58
-
-
-
2.58
88.39
-
-
-
5.16
% of Total
(N=155)
-
-
Amreli,
6.3
-
Babra,
20
-
Bagasara,
29.4
-
Dhari,
21.7
-
Lathi,
20.7
-
Liliya,
14.3
-
Rajula,
16.7
-
Sk,
34.8
-
Jafrabad,
33.3
Block-Level Details
% Pos;
ICTC
-
0
No. HRG-FSW
-
-
1.29
No. HRG- IDU
No. HRG-MSM
% Pos;
PPTCT
% Total Pop.
% Total HRG
Size Est., (Mapping,
Year: NA)
NA
0.01
53.98
210
FSW
-
NA
0.01
46.02
179
MSM
-
NA
-
-
-
IDU
114700
0.49
3444
70.36
11.51
80699
Male Migration, 2001 Census
InterIntraState
state
26.64
4.36
30557
Intradistrict
Overall
16.35
3.00
2011
2
44
1
1
1
1
5
1
-
-
100
2010
2
18
1
1
1
1
-
2012
2
44
1
1
1
1
5
1
-
Top 5 districts for inter-state out-migration
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
Program Target
-
HRG Size
Program Coverage
2012
2009
2
8
1
1
2
-
Mumbai
Diu,
Mumbai,
(Suburban) Thane, Daman
& Maharash, Maha- Maharashtra
Diu
tra
rashtra
2011
5565
0.50
Non daily
InjectorsNA
Daily
InjectorsNA;
KothiNA;
PanthiNA;
Home
basedNA;
Typology
Brothel
basedNA;
STI/RTI
2010
5379
0.80
Double
deckerNA
5137
0.65
Street
basedNA
2009
2005
1
-
-
1998
-
-
-
2004
1
-
% <25 yrs.
% Married
No. episodes treated
% Syphilis positivity
-
Programme Response
2006
2007
2008
2
6
8
1
1
1
1
1
1
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
Comm. care centres
Drop-in-centres
Condom outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); 4 ­PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 13
Anand
Background:
Anand district, popularly known as Charotar, is located Anand District
near the Gulf of Cambay in the southern part of Gujarat. It
is bounded by Kheda district to the north, Vadodara district
to the east, Ahmedabad district to the west, and the Gulf
of Khambhat to the south. The district has a population
of 20.9 lakh witha sex ratio of 921 females per 1,000
males, female literacy rate of 77.76%, with an overall
literacy rate of 85.79% (Census 2011). Focus industry
sectors are: food and agriculture, engineering and autoparts, chemicals, port and ship building, minerals, and
cement. The largest dairy cooperative of India is situated
in the district. Famous Tourist places of the district include:
Amul Dairy Cooperative Museum, Flo -Art, Khambhat and
Anklavadi. National Highway (NH) 8 passes through the district connecting Anand to Vadodara and Kheda district.
HIV Epidemic Profile: • Based on 2012 HSS-ANC data, HIV prevalence was low among the ANC attendees, with a declining trend in the last three recordings.
• According to 2012 PPTCT data, HIV positivity was low at 0.12% among the PPTCT attendees, with a stable trend.
• According to 2012 Blood Bank data, the level of HIV positivity was low at 0.10% among the Blood Bank donors, with a stable trend.
• In 2012, HIV prevalence among ICTC attendees was low among male (1.84%) and female (1.44%) clients, and also among referred
(1.47%) and direct walk-in (2.23%) clients. Male, female and referred clients represented a stable trend, though male and referred clients
had observed a steep rise in the positivity in 2011. Direct walk-in clients had a declining trend.
• According to HRG size mapping data, MSM (4,889; 59.97% of the total HRG) was the largest HRG in the district followed by FSW (3,264;
40.03% of the total HRG).
• In 2012, 6,490 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.26%.
• According to the 2001 census, out of the overall population, 5.31% of males were migrants; among them 4.10% migrated to other states
and 22.91% migrated to other districts within the state.
• The top two destinations for out-of-state migration were Thane and Mumbai (Suburban), Maharashtra.
• According to 2012 ICTC data, HIV transmissions from parent to child accounted for 8.03% of the total reported HIV transmissions in the
district.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 48.8% and 21.3%, respectively.
• In 2012, there were only two composite targeted intervention (TI) sites in operation in the district, while there were over 8,000 mapped
HRGs in the district.
Key Recommendations:
• Considering the large number of HRGs mapped in the district, strengthen TIs for MSM and FSWs in the district to provide HIV preventive
and referral services. Considering the large proportion of married HRG, secure HIV prevention services also for spouses or partners of
HRG’s, and support linkage to HIV treatment and care services, as needed.
• Given the high level of parent to child transmission of HIV, more needs to be done to understand the profile of the attendees through
in-depth analysis of ICTC data. Measures to increase voluntary HIV testing of pregnant women and early detection are also needed.
• Though data reflects a low level epidemic, the district needs to continue attention to avert and limit the spread of the infection further as
vulnerability and risk factors exist.
• Strengthen outreach activities with HIV prevention messages for migrants at source and destination sites and among general population,
especially women.
14 | District HIV/AIDS Epidemiological Profiles : Gujarat
Anand
28232
District Population: 20,90,276 (3.46%of Gujarat Population); Female Literacy1: 77.76%; ANC Utilization2: 68.5%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
0.25
0.25
0
0
HSS-ANC
400
399
400
400
*
0.30
0.31
0.19
0.11
0.12
PPTCT
*
1578
9547
11415
10521
13285
0.11
0.16
0.12
0.11
0.13
0.10
Blood Bank
9259
15058
23365
27685
27074
25821
HSS-STD
HSS-FSW
HSS-MSM
HSS-IDU
3.87
3.20
2.22
12.69
1.84
ICTC Male
6149
6995
9400
5924
8476
2.34
1.85
1.32
0.63
1.44
ICTC Female
4785
5576
6994
4605
6471
2.65
2.07
1.28
9.22
1.47
ICTC Referred
9013
10452
12967
7686
11136
5.78
5.24
3.94
2.53
2.23
1921
2119
3427
2843
3811
2006
0.25
400
*
*
0.15
8928
21050
% Widowed
or Divorced
-
27809
% Married
-
22118
-
2005
*
*
0.27
7505
-
12512
% Ill., Prim. Edu.
-
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
747
% 15-24 yrs
-
500
% On ART
-
678
-
NT
-
ICTC Direct
Walk-in
Total tested at
ICTCs 5
ART (NA)
PLHIV Profile, 2012
DLN (NA)
-
-
-
-
-
-
-
-
-
-
-
-
Unknown
Homo-sexual
-
-
-
Parent to
Child
Hetero-sexual
1.20
-
-
-
-
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
85.54
-
-
-
-
2.81
% of Total
(N=249)
-
-
-
8.03
No. HRGFSW
-
-
-
Block-Level Details
0
No. HRGMSM
-
-
2.41
No. HRGIDU
-
-
-
-
-
-
-
-
-
-
% Pos;
ICTC
-
-
-
% Pos;
PPTCT
% Total HRG
Size Est., (Mapping,
Year: NA)
0.16
40.03
3264
FSW
NA
0.23
59.97
4889
MSM
-
NA
-
-
-
IDU
51597
0.22
2118
22.91
1.22
11823
Male Migration, 2001 Census
InterIntraState
state
72.98
3.87
37656
Intradistrict
Overall
5.31
4.10
2011
2
19
6
3
1
1
86
-
-
100
2010
2
15
6
2
1
1
35
-
Thane, Mumbai
Mumbai,
Jaipur,
Maharash- (Suburban)
, Maha- Rajasthan Maharashtra
tra
rashtra
2009
2
8
6
2
1
1
35
-
2012
2
21
6
3
1
1
86
-
Top 5 districts for inter-state out-migration
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
% Total Pop.
NA
-
HRG Size
Program Target
-
Street
based14.73%
2012
-
Home
basedKothiDaily
36.18%; 48.76%; InjectorsNA;
Brothel PanthibasedNA;
Non daily
49.1%;
Double InjectorsNA
decker51.24%
Program Coverage
Typology
% <25 yrs.
% Married
2011
Programme Response
2006
2007
2008
1
2
7
8
5
5
6
2
2
1
1
1
1
-
22.22
32.08
76.23
59.12
STI/RTI
2010
2005
1
4
-
2009
74852
-
-
6490
0.26
2004
1
4
-
5826
0.21
No. episodes treated
% Syphilis positivity
-
16819
0.55
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
Comm. care centres
Drop-in-centres
Condom outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); ­4 PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 15
Banaskantha
Background:
Banaskantha district’s administrative headquarters is Banaskantha District
Palanpur which is also its largest city. The district is located
in the Northeast of Gujarat and is presumably named
after the West Banas River which runs through the valley
between Mount Abu and Aravalli Range, entering into the
plains of Gujarat in this region and flowing towards the
Rann of Kutch. It has a population of 31.16 lakh that is
largely rural (86.73%), with a sex ratio of 936 females
per 1,000 males; female literacy rate of 52.58%,
with an overall literacy rate of 66.39% (Census 2011).
The economy of the district is based on agro and food
processing, tourism, textile and mineral based industries
(ceramics). The district is famous for two pilgrim sites: the
Ambaji temple and the Balaram temple which draw many tourists. National highway 14 and 15 and many other state highways pass through
the district connecting it to other states and districts.
HIV Epidemic Profile:
• Based on 2010 HSS-ANC, HIV prevalence was low at 0.25% among the ANC attendees.
• According to 2012 PPTCT data, HIV positivity was low at 0.17% among the PPTCT attendees, with a stable trend.
• According to 2012 Blood Bank data, HIV positivity was low at 0.11% among the Blood Bank donors, with a stable trend.
• According to 2010 HSS-FSW data, HIV prevalence was low among FSWs at 1.21%, but due to lack of previous year’s data, a trend could
not be determined.
• In 2012, HIV positivity among ICTC attendees was low among male (1.48%) and female (1.26%) clients as well as among referred
(0.79%) and direct walk-in (2.21%) clients, with an overall declining trend.
• According to HRG size mapping data, MSM (785; 60.02% of the total HRG) was the largest HRG in the district followed by FSW (523;
39.98% of the total HRG).
• In 2012, 6,778 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 1.18%.
• The top two destinations for out-of-state migration were Mumbai (Suburban), Maharashtra and Sirohi, Rajasthan.
• According to 2012 ICTC data, HIV transmissions from parent to child accounted for 10.32% of the total reported transmissions in the
district.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 27.4% and 14.2%, respectively.
• In 2012, there were two composite targeted intervention (TI) sites in operation in the district, while there were around 1,300 mapped
HRGs in the district.
Key Recommendations:
• Establish TI sites exclusively for MSM and FSWs to provide HIV preventive and referral services, considering their significant presence in the
district. Considering the high proportion of married HRG in the district (62.45% for FSW and 83.38% for MSM) HIV prevention services
for spouses or partners of HRGs’ are also needed in addition to HIV treatment and care services.
• Though HIV positivity among ICTC attendees is at low levels, the district needs to continue focus on decreasing and limiting the spread
of HIV infection further.
• Conduct in-depth analysis of ICTC data to understand the profile of ICTC attendees given the high parent to child transmission rate (2012
ICTC data).
• Conduct outreach campaign on HIV and STI awareness and sexual risk reduction messages especially among women.
• Better assessment of the size and profile of migrants will further improve understanding of district vulnerabilities.
16 | District HIV/AIDS Epidemiological Profiles : Gujarat
Banaskantha
2006
1.00
400
*
*
0.09
5547
2.00
250
-
32442
47823
81844
58523
District Population: 31,16,045 (5.16% of Gujarat Population); Female Literacy1: 52.58%; ANC Utilization2: 28.7%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
0
0
0.25
HSS-ANC
400
399
400
*
*
0.29
0.16
0.18
0.17
PPTCT
*
*
14626
21943
42274
24136
0.14
0.05
0.13
0.11
0.09
0.11
Blood Bank
8527
8430
23926
27981
30763
32195
0.95
1.60
HSS-STD
210
250
1.21
HSS-FSW
248
HSS-MSM
HSS-IDU
4.46
2.73
1.98
1.53
1.48
ICTC Male
7204
10787
15614
23460
18844
4.70
2.75
2.06
1.30
1.26
ICTC Female
4362
7029
10266
16110
15543
3.09
1.90
1.51
1.07
0.79
ICTC Referred
8128
12022
15853
21282
20116
8.00
4.45
2.79
1.86
2.21
3438
5794
10027
18288
14271
2005
0.17
6042
0.40
250
-
12052
% Married
-
% Widowed
or Divorced
10
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
336
% Ill., Prim. Edu.
-
37
56
% 15-24 yrs
45
-
% On ART
10
NT
-
53
ICTC Direct
Walk-in
Total tested at
ICTCs 5
ART (2230)
PLHIV Profile, 2012
DLN (NA)
-
-
-
-
-
-
-
-
-
-
-
-
-
Unknown
Homo-sexual
-
-
-
-
Parent to
Child
Hetero-sexual
1.26
-
-
-
-
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
88.00
-
-
-
-
0
% of Total
(N=475)
-
-
-
10.32
No. HRG-FSW
-
-
-
Deodar, Dhanera, Kankrej, Palanpur,
0.99
2.16
2.03
7.25
Block-Level Details
Deesa,
6.84
0
No. HRG-MSM
-
-
0.42
No. HRG- IDU
-
Danta,
2.69
Tharad,
2.45
-
Amirgadh, Bhabhar,
1.09
0.97
% Pos;
ICTC
% Pos;
PPTCT
% Total Pop.
% Total HRG
Size Est., (Mapping,
Year: NA)
NA
0.02
39.98
523
FSW
4.45
NA
0.03
60.02
785
MSM
N.A
NA
-
-
-
IDU
-
-
-
-
-
-
Intradistrict
-
-
-
Male Migration, 2001 Census
InterIntraState
state
-
-
Overall
-
2009
2
28
10
2
1
1
40
-
2010
2
70
9
2
1
1
1
40
-
2011
2
111
9
3
1
2
1
17
1
-
2012
2
112
10
3
1
3
1
17
1
-
Mumbai
Thane,
Mumbai,
(Suburban) Sirohi,
Jalor,
, Maha- Rajasthan MaharashRajasthan Maharashtra
tra
rashtra
Top 5 districts for inter-state out-migration
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
Program Target
2.97
HRG Size
Program Coverage
Non daily
InjectorsNA
Daily
InjectorsNA;
Kothi30%;
PanthiNA;
Double
decker70%
2012
Street
based19.37%
Brothel
based35.97%;
Home
based44.66%;
Typology
% <25 yrs.
% Married
2011
Programme Response
2006
2007
2008
7
16
4
8
9
2
2
1
1
-
14.62
20.63
62.45
83.38
STI/RTI
2010
2005
4
-
2009
21660
-
-
6778
1.18
2004
4
-
6359
1.30
No. episodes treated
% Syphilis positivity
-
6733
1.45
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
Comm. care centres
Drop-in-centres
Condom outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); ­4 PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 17
Bharuch
Background:
Bharuch is located in the southern part of Gujarat, near the Bahruch District
Gulf of Khambhat an inlet of the Arabian Sea along the
west coast of India. The district has a population of 15.50
lakh, with a sex ratio of 924 females per 1,000 males;
female literacy rate of 76.79%, with an overall literacy
rate of 83.03% (Census 2011). Bharuch is a formidable
industrial base in sectors as diversified as chemicals
and petrochemicals, textiles, drugs and pharmaceuticals,
and ports and ship building. There are a large number
of industrial estates in the district’s Special Economic
Zones (SEZ). Centrally located with in the industrial belt.
Dahejport is an ideal location in Asia to serve north, west
and central India and international destinations such as
the Middle East, Africa, Europe and North America. National Highway 8 passes through the district, connecting it with Ahmedabad and
Mumbai.
HIV Epidemic Profile:
• Based on 2012 HSS-ANC data, HIV prevalence was moderate at 0.75% among the ANC attendees, with an increasing trend over the last
four data recordings.
• According to 2012 PPTCT data, the level of HIV positivity was low at 0.15% among the PPTCT attendees, with a stable trend.
• According to 2012 Blood Bank data, the level of HIV positivity was low at 0.20% among the Blood Bank donors, with a stable trend.
• In 2012, HIV prevalence among ICTC attendees was low among male (3.23%) and female (1.92%) clients, as well as among referred
(1.03%) and direct walk-in (3.82%) clients. While male and referred clients had a fluctuating trend, female and direct walk-ins had a
declining trend.
• According to HRG size mapping data FSWs (272; 74.11% of the total HRG) was the largest HRG in the district. The major typology for
FSWs was street-based (68.41%).
• In 2012, 6,530 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 1.49%.
• According to the 2001 census, out of the overall population, 9.98% of males were migrants; among them 4.49% migrated to other states
and 33.94% migrated to other districts within the state.
• The top two destinations for out-of-state migration were Mumbai (Suburban) and Thane in Maharashtra.
• According to 2012 ICTC data, HIV transmissions from parent to child accounted was 9.18% and through blood transfusion accounted for
7.65% of the total transmissions in the district.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 46.6% and 20.8%, respectively.
• In 2012, only one composite TI was operational in the district.
Key Recommendations:
• Considering rising HIV prevalence among HSS-ANC attendees, the district needs to continue attention to decrease and limit the spread of
the infection further.
• Given the high rate of parent to child transmission of HIV in the district, it is necessary to strengthen the PPTCT program coverage in the
district including early HIV detection.
• Conduct in-depth analysis of ICTC data to better understand the profile of HIV positive individuals. This is also in the context of the HIV
transmission rate through blood transfusion (ICTC data 2012) .
• Considering the level of male migration, strengthen outreach programmes through HIV awareness campaigns around source and transit
points such as railway stations and bus stands. Conduct special awareness campaign especially among pockets of out-migrants transit
points and around truck halting points and highways in the district.
18 | District HIV/AIDS Epidemiological Profiles : Gujarat
Bharuch
2006
0.75
400
*
*
-
8896
10189
19492
14932
District Population: 15,50,822 (2.57% of Gujarat Population); Female Literacy1: 76.79%; ANC Utilization2: 64.6%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
0
0
0.25
0.75
HSS-ANC
400
400
398
399
0.37
0.36
0.14
0.14
0.17
0.15
PPTCT
1079
1651
5729
5106
10004
7454
0.23
0.17
0.15
0.20
0.17
0.20
Blood Bank
11974
13599
13404
15992
16945
16685
HSS-STD
HSS-FSW
HSS-MSM
HSS-IDU
5.68
4.92
2.68
5.30
3.23
ICTC Male
1356
1972
2871
5451
3995
4.57
5.10
2.44
1.71
1.92
ICTC Female
875
1195
2212
4037
3483
2.32
3.11
1.70
4.39
1.03
ICTC Referred
1164
1963
2002
3985
3209
8.43
8.06
3.15
3.33
3.82
1067
1204
3081
5503
4269
2005
-
3882
% Married
-
% Widowed
or Divorced
8
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
1079
% Ill., Prim. Edu.
-
29
327
% 15-24 yrs
35
-
% On ART
9
NT
-
56
ICTC Direct
Walk-in
Total tested at
ICTCs 5
ART (946)
PLHIV Profile, 2012
DLN (NA)
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Unknown
Homo-sexual
-
-
-
-
Parent to
Child
Hetero-sexual
4.08
-
-
-
-
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
72.45
-
-
-
-
2.55
% of Total
(N=196)
-
-
-
9.18
No. HRG-FSW
-
-
-
Vagra,
20
Jambusar,
21.05
Valiya,
18.18
Hansot,
57.14
Zagdia,
30
-
Block-Level Details
Amod,
14.51
4.08
No. HRG-MSM
-
-
7.65
No. HRG- IDU
-
Anklesh- Bharuch,
wer, 7.83 3.97
% Pos;
ICTC
% Pos;
PPTCT
% Total HRG
Size Est., (Mapping,
Year: NA)
0.02
74.11
272
FSW
NA
0.01
25.89
95
MSM
-
NA
-
-
NA
IDU
9.98
71225
4.49
0.45
3195
33.94
3.39
24176
Male Migration, 2001 Census
InterIntraState
state
61.57
6.15
43854
Intradistrict
Overall
100
2009
1
6
2
1
1
-
2010
1
6
2
1
1
-
2011
1
22
2
1
1
9
-
2012
1
27
2
1
1
9
-
Dadra &
Mumbai
Nagar
(Suburban), Thane, Nandurbar Mumbai, Haveli,
Maharash- Maharash- ,Maharash- Maharash- Dadra &
tra
tra
tra
tra
Nagar
Haveli
Top 5 districts for inter-state out-migration
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
% Total Pop.
NA
-
HRG Size
Program Target
-
Street
based68.41%
2012
-
Home
KothibasedDaily
14.73%; 70.95%; InjectorsNA;
Brothel PanthiNA;
baseddaily
16.86%; Double Non
InjectorsdeckerNA
29.05%
Program Coverage
Typology
% <25 yrs.
% Married
2011
Programme Response
2006
2007
2008
5
5
2
2
2
1
1
1
-
14.25
32.57
33.25
85.20
STI/RTI
2010
2005
1
-
2009
4636
-
-
6530
1.49
2004
1
-
8428
1.38
No. episodes treated
% Syphilis positivity
-
7328
1.79
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
Comm. care centres
Drop-in-centres
Condom outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); ­4 PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 19
Bhavanagar
Background:
Bhavnagar, located near the Gulf of Khambat along India’s Bhavnagar District
western coast, is a part of the Saurashtra peninsula in the
central part of Gujarat. Bhavnagar shares borders with
Ahmedabad and Botad districts to the North, the Gulf of
Khambatto the East and South, and Amreli and Rajkot
districts to the West. It has a population of 28.77 lakh, a
sex ratio of 931 females per 1,000 males; female literacy
rate of 66.92%, with an overall literacy rate of 76.84%
(Census 2011). Focus industry sectors are diamond cutting
and polishing, cement and gypsum, inorganic salt-based
and marine chemicals, ship building, ship-repairs, etc.
Some sections of the society depend upon agriculture for
their livelihood (58.99% of the total population resides in
rural areas, Census 2011). World’s largest ship breaking
yard is at Alang in the district. National Highway 8E passes through the district connecting it to Junagadh and Amreli districts.
HIV Epidemic Profile: • Based on 2012 HSS-ANC data, HIV prevalence was moderate at 0.50% among the ANC attendees.
• According to 2012 PPTCT data, the level of HIV positivity was low at 0.09% among the PPTCT attendees, with a stable trend in the last three
recordings.
• According to 2012 Blood Bank data, the level of HIV positivity was low at 0.10% among the Blood Bank donors, with a stable trend.
• According to 2010 HSS data, HIV prevalence among FSWs and MSM was at similar rates of 4.02% and 4% respectively.
• In 2012, HIV prevalence among ICTC attendees was relatively low among male (2.12%) and female (0.88%) clients, as well as among
referred (1.86%) and direct walk-in (1.13%) clients. While male and referred clients had a fluctuating trend, female and direct walk-ins had
a declining trend.
• According to HRG mapping data, MSM (4,889; representing 59.97% of the total HRG) was the largest HRG in the district followed by FSW
(3,264; 40.03% of the total HRG). 65% of the FSWs are home-based.
• In 2012, 39,303 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.19%.
• According to the 2001 census, 11.05% of male population was migrants; among them 5.91% migrated to other states and 55.35% migrated
to other districts within the state.
• The top two destinations for out-of-state migration were Thane and Mumbai (Suburban) in Maharashtra.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 34.7% and 13.4%, respectively.
• In 2012, there were seven targeted intervention (TI) sites in operation in the district (2 MSM TI, 2 FSW TI, and 3 composite TI), catering for
8,000 mapped HRGs.
Key Recommendations:
• Presence of large number of MSM should be considered for increase in the number of MSM-TI sites in the district.
• Conduct socio-demo graphic analysis of HSS-ANC attendees to under stand risk factors for HIV epidemic among general population.
• Focus on the outreach efforts for home based FSWs (65% of the total FSWs in the district) to keep HIV prevalence among them at low
level.
• Focused IEC for general population with HIV awareness and sexual risk reduction messages is recommended. Outreach programs for HIV
prevention among spouses and partners of HRG is recommended (to limit the spread of HIV infection), particularly if case of sero-discordant
couple is known.
• Strengthen TI interventions for the IDU population, as the level of positivity among HSS-IDU attendees was high.
20 | District HIV/AIDS Epidemiological Profiles : Gujarat
Bhavnagar
2006
0.75
400
0.45
1782
0.30
10767
-
43058
53345
77795
63047
District Population: 28,77,961 (4.77% of Gujarat Population); Female Literacy1: 66.92%; ANC Utilization2: 58%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
0
0
0.50
0.50
HSS-ANC
400
392
400
400
0.48
0.52
0.23
0.11
0.06
0.09
PPTCT
1049
2889
17139
20052
44710
30290
0.30
0.10
0.19
0.13
0.10
0.10
Blood Bank
13315
14379
28062
32593
36214
37999
6.90
5.94
HSS-STD
203
202
2.02
4.02
HSS-FSW
248
249
5.62
4.00
HSS-MSM
249
250
HSS-IDU
8.07
3.43
2.34
6.05
2.12
ICTC Male
6557
15069
18185
16138
16309
5.21
2.34
1.04
0.35
0.88
ICTC Female
4434
10850
15108
16947
16448
4.05
3.21
2.19
5.21
1.86
ICTC Referred
5037
6286
11032
15900
16414
9.34
2.90
1.53
1.20
1.13
5954
19633
22261
17185
16343
2005
0.88
2046
0.20
9519
4.69
213
-
13880
% Married
-
% Widowed
or Divorced
14
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
1049
% Ill., Prim. Edu.
-
60
1782
% 15-24 yrs
79
2046
% On ART
10
NT
-
47
ICTC Direct
Walk-in
Total tested at
ICTCs 5
ART (3372)
PLHIV Profile, 2012
DLN (NA)
Hetero-sexual
3.26
-
Homo-sexual
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Unknown
89.21
-
-
-
-
-
Parent to
Child
% of Total
(N=491)
-
-
-
-
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
No. HRGFSW
-
-
-
-
1.02
No. HRGMSM
-
-
-
2.85
No. HRGIDU
-
-
Block-Level Details
0
% Pos;
ICTC
-
3.67
% Pos;
PPTCT
% Total HRG
Size Est., (Mapping,
Year: 2008, 2009)
0.11
40.03
3264
FSW
NA
0.17
59.97
4889
MSM
-
NA
-
-
-
IDU
-
11.05
140958
5.91
0.65
8326
55.35
6.12
78026
Male Migration, 2001 Census
InterIntraState
state
38.74
4.28
54606
Intradistrict
Overall
100
2009
2
2
3
36
7
2
1
1
50
1
1
-
2010
2
2
3
44
7
2
1
4
1
50
1
1
-
2011
2
2
3
67
7
3
1
5
1
32
1
1
-
2012
2
2
3
67
7
3
1
5
1
32
1
1
-
Dadra &
Mumbai
Nagar
Thane,
(Subur- Mumbai, Nashik,
Haveli,
Maharash- ban), Maharash- Maharash- Dadra
&
tra
Maharashtra
tra
Nagar
tra
Haveli
Top 5 districts for inter-state out-migration
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
% Total Pop.
NA
-
HRG Size
Program Target
Home
based65%;
Brothel
based25%;
Street
based10%
-
2012
KothiDaily
79.59%; InjectorsNA;
PanthiNA;
Non daily
Double InjectorsNA
decker20.41%
Program Coverage
Typology
% <25 yrs.
% Married
2011
Programme Response
2006
2007
2008
13
18
6
7
7
2
2
1
1
1
1
1
1
-
STI/RTI
2010
2005
5
1
-
2009
40231
-
-
39303
0.19
2004
5
-
41082
0.11
No. episodes treated
% Syphilis positivity
-
36796
0.25
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
Comm. care centres
Drop-in-centres
Condom outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); ­4 PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 21
Dahod
Background:
Dahod is the eastern gateway of Gujarat. It was carved Dahod District
out of Panchmahal district in 1979. This district is bound
by Panchmahal district to the west, Chhota-udepur district
to the south, and shares borders with districts of two
states: Jhabua district and Alirajpur district of Madhya
Pradesh State to the east and southeast respectively, and
Banswara district of Rajasthan State to the north and
northeast. The district has a population of 21.26 lakh, a
sex ratio of 986 females per 1,000 males; female literacy
rate of 49.02%, with an overall literacy rate of 60.60%
(Census 2011). Dahod is predominantly an agricultural
region and the prime share of revenue in the district
comes from agriculture-based products (91.01% of the
total population reside in rural areas, Census 2011). Focus industry sectors are food products, rubber and plastic products, and mineral based
industries. Tourist Destinationsinclude Chhab Lake, Aurangzeb’s Fort, the Shiva Temple at Bavka, Ratanmahal Sanctuary, etc. The district’s
tribal culture and the tribal folklores are anothertourist attraction. National Highway (NH) 59, 8E and State Highway (SH) 2 pass through
the district.
HIV Epidemic Profile: • Based on 2012 HSS-ANC data HIV prevalence was low and has seen a consistent decline over the past 3 rounds.
• According to 2012 PPTCT data, HIV positivity was low at 0.06% among the PPTCT attendees, with a stable trend in the last three
recordings.
• According to 2012 Blood Bank data, HIV positivity was low at 0.04% among the Blood Bank donors.
• In 2012, HIV prevalence among ICTC attendees was low among male (0.78%) and female (0.48%) clients, as well as among referred
(0.54%) and direct walk-in (0.76%) clients. While male and referred clients had a fluctuating trend, female clients had a stable trend and
direct walk-ins observed a declining trend.
• According to 2008 HRG size mapping data, FSW (223; representing 76.63% of the total HRG) was the largest HRG in the district. The
major typology of FSWs was street-based (80.6%).
• In 2012, 6,556 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.72%.
• According to the 2001 census, 3.66% of male population was migrants; among them 4.36% migrated to other states and 49.38%
migrated to other districts within the state.
• The top two destinations for out-of-state migration were Banswara, Rajasthan; and Nashik, Maharashtra.
• According to 2012 ICTC data, HIV transmissions from parent to child accounted for 5.29% of the total transmissions in the district.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 16.2% and 5.6%, respectively.
Key Recommendations:
• District needs to continue attention to decrease and limit the spread of HIV infection further considering the vulnerability and risk factors,
even though both, ANC HIV prevalence and HIV positivity detected at ICTC are low. Parent to child transmission rate was high, thus
more needs to be done to reduce the transmission. Understanding the profile of the attendees through in-depth analysis of ICTC data is
required
• Outreach programs focus on early HIV detection and HIV testing focused on specific population, is needed .
• Focus on outreach efforts for street based FSW (80.6% of the total FSW in the district) to decrease and limit HIV transmission among
them and to their clients to lower levels.
• Strengthen outreach activities with HIV prevention messages for migrants at source and destination sites and among general population,
especially women.
22 | District HIV/AIDS Epidemiological Profiles : Gujarat
Dahod
2006
1.38
363
*
*
0
5277
-
28357
22321
69272
52220
District Population: 21,26,558 (3.52% of Gujarat Population); Female Literacy1: 49.02%; ANC Utilization2: 46.5%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
0.75
1.50
0.50
0
HSS-ANC
400
399
399
400
0.36
0.35
0.06
0.07
0.06
PPTCT
1399
1709
14073
26637
22152
0
0
0.03
0
0.04
0.04
Blood Bank
3187
9613
11612
11100
10895
11049
HSS-STD
HSS-FSW
HSS-MSM
HSS-IDU
3.54
1.90
0.97
4.23
0.78
ICTC Male
2686
6831
11501
22620
15059
2.86
1.19
0.54
0.36
0.48
ICTC Female
2167
7453
10820
20015
15009
2.61
1.08
0.56
3.88
0.54
ICTC Referred
3450
9386
15951
21882
18064
4.78
2.41
1.26
0.86
0.76
1403
4898
6370
20753
12004
2005
0
1154
-
6562
% Married
-
% Widowed
or Divorced
16
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
1399
% Ill., Prim. Edu.
-
65
460
% 15-24 yrs
84
-
% On ART
16
NT
-
42
ICTC Direct
Walk-in
Total tested at
ICTCs 5
ART (578)
PLHIV Profile, 2012
DLN (NA)
Hetero-sexual
1.06
-
Homo-sexual
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Unknown
93.12
-
-
-
-
-
Parent to
Child
% of Total
(N=189)
-
-
-
-
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
No. HRGFSW
-
-
-
-
0.53
No. HRGMSM
-
-
-
5.29
No. HRGIDU
-
-
Block-Level Details
0
% Pos;
ICTC
-
0
% Pos;
PPTCT
% Total HRG
Size Est., (Mapping,
Year: 2008)
0.01
76.63
223
FSW
NA
0
23.37
68
MSM
-
NA
-
-
-
IDU
2012
30171
0.16
1314
49.38
1.81
14898
Male Migration, 2001 Census
InterIntraState
state
46.27
1.69
13959
Intradistrict
Overall
3.66
4.36
-
2011
1
52
4
2
1
1
1
-
-
100
2010
1
51
4
1
1
1
1
-
Nashik,
Thane,
Banswara, MaharashMaharashRajasthan
tra
tra
2011
6556
0.72
2009
1
20
4
1
1
1
1
-
2012
1
52
4
2
1
1
1
-
Top 5 districts for inter-state out-migration
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
% Total Pop.
NA
-
HRG Size
Program Target
-
Brothel
based5.9%;
Home
based13.6%;
Program Coverage
Typology
STI/RTI
2010
4538
1.04
KothiDaily
57.45%; InjectorsNA;
PanthiNA;
Non daily
Double InjectorsNA
decker34.04%
2533
0.74
Street
based80.6%
2009
2005
1
-
-
1083
-
-
-
2004
1
-
% <25 yrs.
% Married
No. episodes treated
% Syphilis positivity
-
Programme Response
2006
2007
2008
4
13
2
3
4
1
1
1
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
Comm. care centres
Drop-in-centres
Condom outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); ­4 PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 23
Gandhinagar
Background:
Gandhinagar district is an administrative division of
Gujarat, India, whose headquarters are at Gandhinagar,
the state capital. It was organized in 1964. The district
has a population of 13.87 lakh, with a sex ratio of 920
females per 1,000 males; female literacy rate of 77.37%,
with an overall literacy rate of 85.78% (Census 2011).
Gandhinagar District
A major section of the working population of Gandhinagar
is employed in public sector services. Small scale industry
sectors such as textiles, electronics, mineral based, wood
products and engineering are the supporting pillars of
the economy, providing direct and indirect employment
to over 40,000 people in the district. National Highway
(NH) 8 and 8C runs through the district connecting it with
major cities of the State as also with the rest of India.
HIV Epidemic Profile:
• Based on 2012 HSS-ANC data, HIV positivity was low among the ANC attendees at 0%, with a declining trend.
• According to 2012 PPTCT data, HIV positivity was low at 0.14% among the PPTCT attendees, with a stable trend.
• According to 2012 Blood Bank data, HIV positivity was low at 0.09% among the Blood Bank donors, with a stable trend.
• In 2012, HIV positivity among ICTC attendees was low among male (1.69%) and female (0.80%) clients, as well as among referred
(0.83%) and direct walk-in (2.14%) clients. Male clients observed a fluctuating trend but female, referred and direct walk-in clients had
a declining trend.
• According to 2008 HRG mapping data, MSM (365; representing 66.36% of the total HRG) was the largest HRG in the district followed
by FSW (185; 33.64% of the total HRG).
• In 2012, 6,416 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.27%.
• According to the 2001 census, out of the overall population, 5.74% of males were migrants; among them 7.64% migrated to other states
and 25.47% migrated to other districts within the state.
• The top two destinations for out-of-state migration were Ganganagar, Rajasthan; and, Mumbai (Suburban), Maharashtra.
• According to 2012 ICTC data, HIV transmissions through unknown routes accounted for 7.19% of the total transmissions in the district.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 59.9% and 23.3%, respectively.
• In 2012, one composite TI was operational and there were over 500 individuals classified as HRG in the district.
Key Recommendations:
• Though HIV prevalence is low, the district needs to continue attention to decrease and limit the spread of HIV infection further.
• Improve counseling at ICTCs, since the rate of unknown HIV transmission is noted high.
• Availability of DLN data would help in better understanding of district vulnerabilities.
• Strengthen outreach activities with HIV prevention messages for migrants at source and destination sites and among general population,
especially women.
• Since the largest HRG was MSM, better assessment of the size and profile of MSM and partner population will help in better understanding
of district vulnerabilities.
24 | District HIV/AIDS Epidemiological Profiles : Gujarat
Gandhinagar
2005
0.12
3318
-
979
2006
0.50
400
0.20
979
0.35
2856
-
1836
10747
17049
24849
36069
26520
District Population: 13,87,478 (2.30% of Gujarat Population); Female Literacy1: 77.37%; ANC Utilization2: 59.3%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
0
1.25
0.25
0
HSS-ANC
400
400
400
400
0.30
0.20
0.23
0.17
0.08
0.14
PPTCT
1836
5599
9936
12019
19704
14468
0.14
0.13
0.17
0.19
0.13
0.09
Blood Bank
4944
4768
11832
13155
15147
14811
HSS-STD
HSS-FSW
HSS-MSM
HSS-IDU
4.53
2.84
1.70
5.00
1.69
ICTC Male
3068
4330
6959
9131
6317
3.46
2.05
1.14
0.58
0.80
ICTC Female
2080
2783
5871
7234
5735
2.92
2.06
1.15
3.82
0.83
ICTC Referred
2911
3880
8201
10391
8031
5.63
3.09
1.97
1.71
2.14
2237
3233
4629
5974
4021
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
-
% Married
-
% Widowed
or Divorced
12
NT
% Ill., Prim. Edu.
-
60
ICTC Direct
Walk-in
Total tested at
ICTCs 5
% 15-24 yrs
60
PLHIV Profile, 2012
% On ART
12
83.66
Hetero-sexual
4.58
Homo-sexual
0
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
0
-
-
-
-
-
Unknown
-
% of Total
(N=153)
-
-
-
-
Parent to
Child
61
No. HRG-FSW
-
-
-
-
7.19
ART (2264)
No. HRG-MSM
-
-
-
Mansa, Dahegam,
1.7
6.6
Other,
8.8
4.58
DLN (NA)
No. HRG- IDU
-
Kalol,
2.2
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
% Pos;
ICTC
Gandhinagar,
3.8
Block-Level Details
% Pos;
PPTCT
% Total Pop.
% Total HRG
Size Est., (Mapping,
Year: 2008)
NA
0.01
33.64
185
FSW
-
NA
0.03
66.36
365
MSM
-
NA
-
-
-
IDU
2011
6416
0.27
2012
40109
0.44
3064
25.47
1.46
10214
Male Migration, 2001 Census
InterIntraState
state
66.90
3.84
26831
Intradistrict
Overall
5.74
7.64
-
2011
1
39
5
1
1
1
2
-
-
100
2010
1
37
5
1
1
1
-
Mumbai
Gan(SuburThane,
ganagar,
ban), MaharashRajasthan Maharashtra
tra
STI/RTI
2010
6028
0.06
2009
1
8
5
1
1
1
-
2012
1
41
5
1
1
1
12
-
Top 5 districts for inter-state out-migration
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
Program Target
-
HRG Size
Program Coverage
Typology
Home
KothibasedDaily
6.64%; 59.96%; InjectorsNA;
Brothel PanthiNA;
baseddaily
77.62%; Double Non
InjectorsdeckerNA
40.04%
4192
0.39
Street
based15.73%
2009
2005
5
1
-
-
1422
0
-
-
2004
5
-
% <25 yrs.
% Married
No. episodes treated
% Syphilis positivity
-
Programme Response
2006
2007
2008
7
7
5
5
5
1
1
1
1
1
1
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
Comm. care centres
Drop-in-centres
Condom outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); ­4 PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 25
Jamnagar
Background:
Jamnagar district is located on the southern coast of
the Gulf of Kutch in the Saurashtra region of western
Gujarat. The district has a population of 21.59 lakh, a
sex ratio of 938 females per 1,000 males; female literacy
rate of 65.97%, with an overall literacy rate of 74.40%
(Census 2011). Focus industry sectors include brass parts,
petroleum and petrochemicals, salt, and port related
business. Other major industry sectors of the district
include engineering and machinery, plastics and oil mills.
Among its attractions include a Marine National Park the
first in India Khijadiya Bird Sanctuary, and the Dwarka dish
temple built in the 16th century. National Highway (NH) 8
Ext. passes through the district.
Jamnagar District
HIV Epidemic Profile: • Based on 2012 HSS-ANC data, HIV prevalence was low among the ANC attendees.
• According to 2012 PPTCT data, HIV positivity was low at 0.13% among the PPTCT attendees, with a stable trend in the last three
recordings.
• According to 2012 Blood Bank data, HIV positivity was low at 0.09% among the Blood Bank donors, with a stable trend.
• According to 2010 HSS data, HIV prevalence was low among FSWs at 0.40% but was moderate among MSMs at 5.20%.
• In 2012, HIV positivity among ICTC attendees was low among male (1.81%) and female (0.99%) clients, as well as among referred
(1.22%) and direct walk-in (2.25%) clients. All the ICTC clients had a declining trend, but male and referred clients showed a steep rise
in 2011.
• According to 2008 HRG mapping data, FSW (2,027; 52% of the total HRG) was the largest HRG in the district followed by MSM (1,871;
48% of the total HRG). The major typology for FSWs was home-based (51.58%). 51.53% of the MSM and 43.23% of FSW respectively
are married.
• In 2012, 23,236 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.03%.
• According to the 2001 census, 10.17% of male population was migrants; among them 9.63% migrated to other states and 42.60%
migrated to other districts within the state.
• The top two destinations for out-of-state migration were Thane and Mumbai (Suburban), Maharashtra.
• According to 2012 ICTC data, HIV transmissions from parent to child accounted for 5.17% of the total reported cases (n=329) in the
district.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women were 50.04% and 28.4%, respectively.
• In 2012, one TI site for each of FSW and MSM, and one composite TI was operational in the district.
Key Recommendations:
• Sustain efforts to contain and limit the spread of HIV infection further.
• Increase the number of TI sites in the district to accommodate and effectively provide services to the large size of HRGs.
• Conduct socio-demographic analysis of HSS-ANC and PPTCT attendees to understand risk factors for HIV infection.
• Focus outreach efforts also for home based FSWs (51.58% of the total FSWs in the district) to reduce their vulnerability to HIV infection,
and prevent the transmission to clients and regular partners.
• Considering high rate of migration to high HIV prevalencedistricts, strengthen outreach programme through awareness campaigns around
source and transit points such asrailway stations and bus stands.
• Strengthen positive prevention and PPTCT programs. Reinforce outreach efforts for HIV testing and linkage to necessary treatment and
care services.
26 | District HIV/AIDS Epidemiological Profiles : Gujarat
Jamnagar
2005
1.60
250
-
-
2006
0.50
400
1.20
250
-
5515
16476
25487
32312
22185
36394
District Population: 21,59,130 (3.58% of Gujarat Population); Female Literacy1: 65.97%; ANC Utilization2: 75%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
0
0.50
0
HSS-ANC
400
400
377
0.40
0.18
0.17
0.27
0.12
0.13
PPTCT
5515
10301
14511
11909
9080
13537
0.24
0.30
0.11
0.14
0.12
0.09
Blood Bank
15640
17526
21158
23643
22796
22339
2.40
0
HSS-STD
250
250
0.40
0.40
HSS-FSW
250
249
5.60
5.20
HSS-MSM
250
250
HSS-IDU
5.65
3.47
1.63
11.90
1.81
ICTC Male
3963
6710
12042
6949
12497
4.61
2.02
1.06
0.44
0.99
ICTC Female
2212
4266
8361
6156
10360
5.82
3.37
1.60
8.89
1.22
ICTC Referred
3935
6026
12664
8865
18006
4.33
2.34
1.06
1.56
2.25
2240
4950
7739
4240
4851
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
-
% Married
-
% Widowed
or Divorced
16
NT
% Ill., Prim. Edu.
-
63
ICTC Direct
Walk-in
Total tested at
ICTCs 5
% 15-24 yrs
83
PLHIV Profile, 2012
% On ART
8
83.89
Hetero-sexual
-
3.95
Homo-sexual
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
0
-
-
-
-
Block-Level Details
-
-
-
Unknown
-
% of Total
(N=329)
-
-
-
Dhrol,
3.92
Parent to
Child
47
No. HRG-FSW
-
-
-
Kalavad,
12.68
2.43
ART (1725)
No. HRG-MSM
-
-
Lalpur,
4.56
Dwarka, Kaliyanpur, Bhanvad,
2.25
13.74
12.88
Jamjodhpur,
11.9
5.17
DLN (NA)
No. HRG- IDU
-
Khambhaliya,
2.25
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
% Pos;
ICTC
Jamnagar,
4.96
4.56
% Pos;
PPTCT
% Total HRG
Size Est., (Mapping,
Year: 2008)
0.09
52.00
2027
FSW
NA
0.09
48.00
1871
MSM
-
NA
0
0
0
IDU
10.17
100248
9.63
0.98
9653
42.60
4.33
42707
Male Migration, 2001 Census
InterIntraState
state
47.77
4.86
47888
Intradistrict
Overall
100
2009
1
1
1
11
5
2
1
1
25
1
1
-
2010
1
1
1
12
5
2
1
1
1
25
1
1
-
2011
1
1
1
18
5
3
1
1
1
4
1
1
-
2012
1
1
1
18
5
3
1
1
1
4
1
1
-
Thane, Mumbai
Pune,
Mumbai,
Maharash- (Suburban)
Maharash- Bangalore,
, Maha- MaharashKarnataka
tra
tra
tra
rashtra
Top 5 districts for inter-state out-migration
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
% Total Pop.
NA
-
HRG Size
Program Target
-
Street
based30.97%
2012
-
Home
KothibasedDaily
51.58%; 64.93%; InjectorsNA;
Brothel PanthiNA;
baseddaily
17.45%; Double Non
InjectorsdeckerNA
35.07%
Program Coverage
Typology
% <25 yrs.
% Married
2011
Programme Response
2006
2007
2008
1
1
1
7
10
4
5
5
2
2
1
1
1
1
1
1
-
18.41
35.86
51.35
43.23
STI/RTI
2010
2005
1
4
1
-
2009
34590
-
-
23236
0.03
2004
1
4
-
22829
0.13
No. episodes treated
% Syphilis positivity
-
25065
0.24
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
Comm. care centres
Drop-in-centres
Condom outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); ­4 PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 27
Junagadh
Background:
Junagadh district is located on the Kathiawar peninsula in
Junagarh District
western Gujarat. It is surrounded by Rajkot district (North),
Porbandar district (North-West); Amreli district (East). To
the South and West is the Arabian Sea. It is the second
least-populous district of Gujarat with a population of
27.42 lakh, a sex ratio of 952 females per 1,000 males;
female literacy rate of 67.59%, with an overall literacy rate
of 74.40% (Census 2011). Agriculture is the backbone of
the district economy. 70% of the population is engaged
in this primary sector, 22% in secondary sector and 8% in
tertiary sector. Junagadh is famous for the Gir Sanctuary,
the only abode to Asiatic lions. The mountain range Girnar
is a pilgrimage destination for Jainism and Hinduism.
Junagadh boasts of some of the best tourist destinations in the State and receives a large influx of tourists every year. National Highway 8D
and 8E passes through the district.
HIV Epidemic Profile: • Based on 2012 HSS-ANC data, HIV positivity was moderate at 0.50% among the ANC attendees. This represents an increase compared
with 0.25% in the three previous HSS rounds..
• According to 2012 PPTCT data, HIV positivity was low at 0.10% among the PPTCT attendees, with a stable trend.
• According to 2012 Blood Bank data, the level of HIV positivity was low at 0.14% among the Blood Bank donors, with a stable trend.
• In 2012, HIV positivity among ICTC attendees was low among male (1.46%) and female (0.72%) clients, as well as among referred
(0.88%) and direct walk-in (1.34%) clients. A decreasing trend was observed over a period of five years among all the ICTC clients.
• According to HRG mapping data, FSW (230; 61.99% of the total HRG) was the largest HRG in the district followed by MSM (141; 38.01%
of the total HRG). 89.16% of the FSWs are married and the major typology for FSWs is home-based (67.47%) Similarly, 77.5% of MSM
are married.
• In 2012, 8,543 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.03%.
• According to the 2001 census, 11.72% of male population was migrants; among them 4.09 migrated to other states and 38.04%
migrated to other districts within the state.
• The top two destinations for out-of-state migration were Mumbai (Suburban) and Thane, Maharashtra.
• According to 2012 ICTC data, HIV transmissions from parent to child accounted for 8.05% of the total reported cases (n=385) in the
district.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 47.1% and 28%, respectively.
• In 2012, one TI site for each of FSW and MSM and one composite TI were operational in the district.
Key Recommendations:
• Considering the HIV prevalence among HSS-ANC attendees, socio-demographic analysis is required to ascertain risk factors.
• Strengthen PPTCT program coverage in the district, as parent to child HIV transmissionis high in the district. Strengthen interventions for
enabling early detection among pregnant mothers and spouses, and linkage to necessary HIV prevention, treatment and care services.
• Analyse the number and profile of migrants to improve understanding of district vulnerabilities, considering high rate of migration.
• Focus interventions also among home based FSW considering their proportion out of those mapped (89.16% married FSW) and consider
options for reaching to their regular partners.
• Analyse vulnerability factors in transmission of HIV from ICTC and STI data, although there is a low level of HIV epidemic in the district.
• Availability of DLN data will help in better understanding of district vulnerabilities.
28 | District HIV/AIDS Epidemiological Profiles : Gujarat
Junagadh
2006
0.50
400
*
*
0.28
9090
1.20
250
-
35684
47881
93305
61507
District Population: 27,42,291 (4.54% of Gujarat Population); Female Literacy1: 67.59%; ANC Utilization2: 74.7%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
0.25
0.25
0.25
0.50
HSS-ANC
400
400
398
400
*
0.30
0.13
0.12
0.10
0.10
PPTCT
*
4511
17497
21406
37518
25827
0.16
0.11
0.10
0.05
0.07
0.14
Blood Bank
9785
16726
18117
19664
18298
18700
2.40
3.20
2.02
HSS-STD
250
250
247
HSS-FSW
HSS-MSM
HSS-IDU
4.56
3.06
2.42
4.58
1.46
ICTC Male
7330
8670
12358
28352
17388
2.60
1.81
1.05
0.44
0.72
ICTC Female
7342
9517
14117
27435
18292
2.26
1.42
0.89
3.02
0.88
ICTC Referred
8419
10042
17276
35662
20492
5.36
3.61
3.19
1.70
1.34
6253
8145
9199
20125
15188
2005
0.25
400
0.26
8590
-
19183
% Married
-
% Widowed
or Divorced
14
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
804
% Ill., Prim. Edu.
-
63
137
% 15-24 yrs
85
-
% On ART
12
NT
-
53
ICTC Direct
Walk-in
Total tested at
ICTCs 5
ART (2290)
PLHIV Profile, 2012
DLN (NA)
Hetero-sexual
0.52
-
Homo-sexual
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Unknown
88.31
-
-
-
-
-
Parent to
Child
% of Total
(N=385)
-
-
-
-
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
No. HRGFSW
-
-
-
-
1.04
No. HRGMSM
-
-
-
8.05
No. HRGIDU
-
-
Block-Level Details
0.52
% Pos;
ICTC
-
1.56
% Pos;
PPTCT
% Total Pop.
% Total HRG
Size Est., (Mapping,
Year: 2008)
NA
0.01
61.99
230
FSW
-
NA
0.01
38.01
141
MSM
-
NA
-
-
-
IDU
11.72
146830
4.09
0.48
6009
38.04
4.46
55858
Male Migration, 2001 Census
InterIntraState
state
57.86
6.78
84963
Intradistrict
Overall
100
2009
1
1
1
13
7
1
2
1
25
-
2010
1
1
1
68
7
1
1
3
1
25
1
-
2011
1
1
1
76
7
2
1
4
1
6
1
-
2012
1
1
1
76
7
2
1
4
1
6
1
-
Dadra &
Mumbai
Nagar
Diu,
Mumbai, Haveli,
(Suburban), Thane,
Maharash- Maharash- Daman & Maharash- Dadra &
tra
Diu
tra
tra
Nagar
Haveli
Top 5 districts for inter-state out-migration
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
Program Target
-
HRG Size
Program Coverage
Non daily
InjectorsNA
Daily
InjectorsNA;
Kothi30%;
PanthiNA;
Double
decker70%
2012
Street
based27.71%
Brothel
based4.82%;
Home
based67.47%;
Typology
% <25 yrs.
% Married
2011
Programme Response
2006
2007
2008
1
1
9
12
4
5
7
1
1
1
-
1.20
27.50
89.16
77.50
STI/RTI
2010
2005
2
4
-
2009
16667
-
-
8543
0.03
2004
1
4
-
9202
0.01
No. episodes treated
% Syphilis positivity
-
6720
0
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
Comm. care centres
Drop-in-centres
Condom outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); ­4 PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 29
Kutch
Background:
Kutch district (also spelled as Kachchh) is the largest Kutch District
district of both Gujarat State and India. The name Kutch
was derived from its Geographical Characteristics and
particularly resemblance of its earth surface with tortoise.
Kutch district is surrounded by the Gulf of Kutch and
the Arabian Sea in south and west, while northern and
eastern parts are surrounded by the Great and Small Rann
(seasonal wetlands) of Kutch. It has a population of 20.90
lakh, with a sex ratio of 907 females per 1,000 males;
female literacy rate of 70.73%, with an overall literacy
rate of 79.31% (Census 2011). The district is famous for
ecologically important Banni grasslands with their seasonal
marshy wetlands which form the outer belt of the Rann of
Kutch. Kutch is a mineral rich region with very large reserves of Lignite, Bauxite, and Gypsum among other minerals. Transportation as a
business has thrived in the district due to the presence of two major ports. National Highway 8A and 15 passes through the district.
HIV Epidemic Profile:
• Based on 2012 HSS-ANC data, HIV prevalence was moderate at 0.75% among the ANC attendees, with an increasing trend.
• According to 2012 PPTCT data, HIV positivity was low at 0.15% among the PPTCT attendees, with a stable trend.
• According to 2012 Blood Bank data, HIV positivity was low at 0.14% among the Blood Bank donors, with a stable trend.
• In 2012, HIV positivity among ICTC attendees was low among male (1.67%) and female (1.76%) clients, as well as among referred
(1.70%) and direct walk-in (1.69%) clients. positivity levels showed a declining trend among all the ICTC attendees.
• According to HRG mapping data, MSM (680; 52.15% of the total HRG) was the largest HRG in the district followed by FSW (624; 47.85%
of the total HRG). The major typology for FSWs was home-based (57.31%). 72.07% of MSM and 82.6% of FSW are married.
• In 2012, 9,394 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.03%.
• As per the 2001 Census, 10.81% of the male population were migrants; among them 24.77% migrated to other states and 17.01%
migrated to other districts within the state.
• The top two destinations for out-of-state migration were Mumbai (Suburban) and Thane, Maharashtra.
• According to 2012 ICTC data, HIV transmissions from parent to child and blood transfusion accounted for 5.14% and 5.44% of the total
reported cases (n=331) in the district.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 40.9% and 22.9%, respectively.
• In 2012, there were two composite TIs operational in the district.
Key Recommendations:
• Conduct socio-demographic analysis of HSS-ANC and PPTCT attendees to ascertain risk factors, considering the increasing trend of
prevalence among HSS-ANC attendees.
• Strengthen interventions for positive prevention among spouses and partners of HRG, migrants and general population, and outreach
efforts for early detection, and linkage to necessary treatment and care centers.
• Strengthen PPTCT program coverage in the district, as parent to child transmissions is high in the district (ICTC program data).
• Improve counseling at ICTCs, since the rate of unknown HIV transmission was high.
• Considering high rate of migration, conduct special awareness campaign especially among pockets of out-migrants transit points and
around truck halting points and highways in the district.
• Strengthen and improve quality of outreach programme for MSM and FSWs.
30 | District HIV/AIDS Epidemiological Profiles : Gujarat
Kutch
2006
0.50
400
*
*
0.09
4627
-
14934
7353
13456
28876
District Population: 20,90,313 (3.46% of Gujarat Population); Female Literacy1: 61.62%; ANC Utilization2: 48.5%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
0
0
0.50
0.75
HSS-ANC
400
398
400
400
*
0.40
0.22
0.16
0.17
0.15
PPTCT
*
4881
7299
7353
13456
9915
0.13
0.14
0.19
0.18
0.14
0.14
Blood Bank
8413
9811
21501
26252
25754
24023
HSS-STD
HSS-FSW
HSS-MSM
HSS-IDU
5.27
3.60
2.19
1.67
ICTC Male
4956
8675
15463
12581
4.29
4.00
2.07
1.76
ICTC Female
2679
3725
7446
6380
3.72
3.12
1.62
1.70
ICTC Referred
5240
8104
10554
8161
7.56
4.84
2.19
1.69
2395
4296
12355
10800
2005
0
400
0.08
3570
-
4881
% Married
-
% Widowed
or Divorced
1
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
391
% Ill., Prim. Edu.
-
17
4
% 15-24 yrs
20
-
% On ART
11
NT
-
48
ICTC Direct
Walk-in
Total tested at
ICTCs 5
ART (1804)
PLHIV Profile, 2012
DLN (NA)
Hetero-sexual
-
11.78
Homo-sexual
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Unknown
74.92
-
-
-
-
-
Parent to
Child
% of Total
(N=331)
-
-
-
-
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
No. HRGFSW
-
-
-
-
0.30
No. HRGMSM
-
-
-
5.14
No. HRGIDU
-
-
Block-Level Details
2.42
% Pos;
ICTC
-
5.44
% Pos;
PPTCT
% Total HRG
Size Est., (Mapping,
Year: 2008)
0.03
47.85
624
FSW
NA
0.03
52.15
680
MSM
-
NA
-
-
-
IDU
Non daily
InjectorsNA
10.81
84586
24.77
2.68
20954
17.01
1.84
14389
Male Migration, 2001 Census
InterIntraState
state
58.22
6.29
49243
Intradistrict
Overall
100
2009
2
8
6
1
1
1
1
-
2010
2
23
6
1
1
1
1
1
-
2011
2
35
6
1
1
2
1
8
1
1
-
2012
2
35
6
1
1
3
1
8
1
1
-
Mumbai
Mumbai, Nashik,
Pune,
(Suburban) Thane, MaharashMaharash- Maharash, Maha- Maharashtra
tra
tra
tra
rashtra
Top 5 districts for inter-state out-migration
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
% Total Pop.
NA
-
HRG Size
Program Target
-
PanthiNA;
Double
decker17.2%
2012
Street
based4.13%
Brothel
based38.94%;
Home
basedKothiDaily
57.31%; 77.34%; InjectorsNA;
Program Coverage
Typology
% <25 yrs.
% Married
2011
Programme Response
2006
2007
2008
3
3
2
7
8
3
5
5
1
1
1
1
1
1
1
1
-
25.29
22.75
82.60
72.07
STI/RTI
2010
2005
3
4
1
-
2009
12389
-
-
9394
0.03
2004
2
4
1
-
11094
0.01
No. episodes treated
% Syphilis positivity
-
9046
0.07
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
Comm. care centres
Drop-in-centres
Condom outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); ­4 PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 31
Kheda
Background:
Kheda, also known as ‘Kaira’ is located 35 km from Kheda District
Ahmedabad, on the bank of river Vatrak. Kheda
district borders with Sabarkantha district in the north,
Panchmahals district in the east, Vadodara district in the
south and Ahmedabad district in the west. The district
has a population of 22.98 lakh, 77.24% residing in
rural areas, a sex ratio of 937 females per 1,000 males;
female literacy rate of 74.67%, with an overall literacy
rate of 84.31% (Census 2011). Focus industry sectors are
agriculture, mineral-based industries, plastics, engineering
and IT sector. Kheda district is also known by the name
golden leaf since it is the major producer of tobacco in
the state. Famous pilgrimage destinations in the district
are Dakortemple, Santram temple, and Mahadev temple. A tourist attraction is Dinosaur and Fossil Park which is a treasure of fossils and
fossilized eggs of a 10 meter long dinosaur. National Highway (NH) 8 passes through the district connecting it to cities such as Ahmedabad,
Surat and Vadodara.
HIV Epidemic Profile: • Based on 2012 HSS-ANC data, HIV prevalence was moderate at 0.75% among the ANC attendees, while it was 0.25% in 2010.
• According to 2012 PPTCT data, HIV positivity was low at 0.14% among the PPTCT attendees, with a stable trend.
• According to 2012 Blood Bank data, HIV positivity was low at 0.16% among the Blood Bank donors, with a stable trend.
• In 2012, HIV positivity among ICTC attendees was low among male (3.90%) and female (2.41%) clients, as well as among referred
(2.10%) clients and moderate among direct walk-in (8.11%) clients. ICTC male, female and referred clients had a stable trend but
observed a steep rise in 2011, whereas direct walk-ins had an increasing trend.
• According to 2008-09 HRG mapping data, FSWs (454;) was the only HRG in the district. 52.78% of them were married and the major
typology was street-based (58.84%).
• In 2012, 12,061 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.60%.
• As per the 2001 Census, 6.94% of the male population were migrants; among them 4.53% migrated to other states and 51.07%
migrated to other districts within the state.
• The top two destinations for out-of-state migration were Thane and Mumbai (Suburban), Maharashtra.
• According to 2012 ICTC data, HIV transmissions from parent to child and through blood transfusion accounted for 6.99% and 9.32%
respectively of the total reported cases (n=515) respectively in the district.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 49.9% and 27.7%, respectively.
• In 2012, there was one composite TI in the district.
Key Recommendations:
• Considering rising prevalence among HSS-ANC attendees, socio-demographic analysis needs to be done to ascertain risk factors.
• Carry out differential analysis of direct walk-in clients at ICTC clinics, (as representative of vulnerable populations) to inform design and
focusing of various efforts aimed at specific vulnerable groups. Since HIV transmission rate through blood transfusion is high, there is a
need to better understand the profile of these positive individuals through in-depth analysis of ICTC data analysis.
• Parent to child transmission rate was high, thus more needs to be done to understand the profile of these attendees through in-depth
analysis of ICTC data. Strengthen outreach efforts and counselling to enable early HIV detection, positive prevention and / or link to
necessary treatment centers.
• Intensify outreach activities with HIV prevention messages for migrants at source and destination sites. Also conduct special awareness
campaign especially at tourist’s destinations.
32 | District HIV/AIDS Epidemiological Profiles : Gujarat
Kheda
2005
0.16
4943
-
2006
*
*
0.20
9793
-
9218
21333
32974
43628
31688
District Population: 22,98,934 (3.81% of Gujarat Population); Female Literacy1: 74.67%; ANC Utilization2: 62.2%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
0.50
0
0.25
0.75
HSS-ANC
400
322
396
400
*
0.41
0.22
0.13
0.12
0.14
PPTCT
*
1703
10737
17935
23924
15674
0.34
0.30
0.25
0.16
0.26
0.16
Blood Bank
9787
9994
12556
13026
14035
13393
HSS-STD
HSS-FSW
HSS-MSM
HSS-IDU
4.51
2.94
2.54
10.11
3.90
ICTC Male
4392
6192
8102
11456
9118
3.81
2.63
1.46
1.33
2.41
ICTC Female
3123
4404
6937
8248
6896
2.55
2.20
1.55
6.68
2.10
ICTC Referred
4675
7783
12365
15818
12933
6.97
4.51
4.30
5.43
8.11
2840
2813
2674
3886
3081
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
705
% Widowed
or Divorced
-
203
% Married
-
-
-
NT
% Ill., Prim. Edu.
-
ICTC Direct
Walk-in
Total tested at
ICTCs 5
% 15-24 yrs
-
PLHIV Profile, 2012
% On ART
-
Hetero-sexual
3.69
-
Homo-sexual
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Block-Level Details
-
-
-
Unknown
-
75.53
-
-
-
-
Parent to
Child
-
% of Total
(N=515)
-
-
-
Kathla, l
7.5
MehmdaThasara, Balasinor,
bad,
5.1
0.14
0.62
Virpur,
0
3.11
ART (NA)
No. HRG-FSW
-
-
-
Mahudha,
0
6.99
DLN (NA)
No. HRG-MSM
-
-
Matar,
2.8
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
No. HRG- IDU
-
Kheda,
5.14
1.36
% Pos;
ICTC
Nadiad,
9.56
9.32
% Pos;
PPTCT
% Total HRG
Size Est., (Mapping,
Year: 2008, 2009)
0.02
100
454
FSW
NA
0
0
0
MSM
-
NA
0
0
0
IDU
-
73046
0.31
3311
51.07
3.54
37308
Male Migration, 2001 Census
InterIntraState
state
44.39
3.08
32427
Intradistrict
Overall
6.94
4.53
2009
1
9
4
2
1
1
-
-
2010
1
60
4
2
1
1
-
-
2011
1
67
4
3
1
1
-
-
2012
1
67
4
3
1
1
-
-
100
Top 5 districts for inter-state out-migration
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
% Total Pop.
NA
-
HRG Size
Program Target
-
-
-
Thane, Mumbai
Pune,
Raigarh,
Maharash- (Suburban)
Maharash, Maha- Maharashtra
tra
tra
rashtra
2012
Street
based58.84%
2011
-
Home
KothibasedDaily
19.37%; 81.58%; InjectorsNA;
Brothel PanthiNA;
baseddaily
21.79%; Double Non
InjectorsdeckerNA
18.42%
Program Coverage
Typology
% <25 yrs.
% Married
47.46
29.63
52.78
STI/RTI
2010
2009
12061
0.60
52693
-
-
Programme Response
2006
2007
2008
6
8
4
4
4
2
2
1
1
1
-
11682
0.90
No. episodes treated
% Syphilis positivity
2005
4
-
9077
0.79
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
2004
4
Comm. care centres
Drop-in-centres
Condom outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); ­4 PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 33
Mahesana
Background:
Mehsana district is located in North Gujarat, about 75 km Mahesana District
from Ahmedabad. It borders with Banaskantha district
in the north, Patan and Surendranagar districts in west,
Gandhinagar and Ahmedabad districts in south and
Sabarkantha district in the east. It has a population of
20.27 lakh, 74.65% of population residing in rural areas,
with a sex ratio of 925 females per 1,000 males; female
literacy rate of 76.12%, with an overall literacy rate of
84.26% (Census 2011). There are more than 70 medium
and large scale industries in Mehsana district primarily
operating in engineering, chemicals, pharmaceuticals,
dairy products, oil and textiles sectors. Asia’s second
largest dairy ‘Dudhsagar Milk Cooperative Dairy’ and
largest market yard ‘Unjha’ is located in Mehsana. ‘Sun Temple’ at Modhera is an important tourist destination of Mehsana district.
HIV Epidemic Profile:
• Based on 2012 HSS-ANC data, HIV prevalence was high at 2.75% among the ANC attendees. Mahesana district is known as high
prevalence district with prevalence at 2.75%, and also higher in the past HSS rounds.
• According to 2012 PPTCT data, HIV positivity was low at 0.13% among the PPTCT attendees.
• According to 2012 Blood Bank data, the level of HIV positivity was low at 0.13% among the Blood Bank donors.
• According to 2010 HSS data, HIV prevalence was low among MSMs at 1.60%.
• In 2012, HIV positivity among ICTC attendees was low among male (1.56%) and female (0.95%) clients, as well as among referred
(1.12%) and direct walk-in (1.45%) clients with an overall declining trend.
• According to 2008 HRG mapping data, MSM (1,886; 58.23% of the total HRG) was the largest HRG in the district followed by FSWs
(1,353; 41.77% of the total HRG).
• In 2012, 6,243 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.65%.
• As per the 2001 Census, 12.32% of the male population were migrants; among them 4.62% migrated to other states and 55.88%
migrated to other districts within the state.
• The top two destinations for out-of-state migration were Mumbai (Suburban) and Thane, Maharashtra.
• According to 2012 ICTC data, HIV transmissions through parent to child transmission and unknown routes accounted for 4.91% and
9.04% respectively of the total HIV reported cases (n=387)-in the district.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 59.2% and 29%, respectively.
• In 2012, there were two composite targeted intervention (TI) sites in operation in the district.
Key Recommendations:
• Strengthen efforts to decrease and limit the spread of the infection further considering the level of epidemic reported by HSS and program
data.
• Establish TI sites exclusively for MSM and FSWs, to provide HIV preventive and referral services, considering their large number in the
district.
• Conduct socio-demographic analysis of HSS-ANC attendees to ascertain risk factors, considering high prevalence among HSS-ANC
attendees. Strengthen efforts for positive prevention focused on couples and also among general population, and linkage to treatment
and care services.
• Since the largest proportion of HRG was MSM, better assessment of the population size and profile of MSM and partner population will
help in better understanding of district vulnerabilities.Availability of typology data will help to analyze risk factors.
34 | District HIV/AIDS Epidemiological Profiles : Gujarat
Mahesana
52050
District Population: 20,27,727 (3.36% of Gujarat Population); Female Literacy1: 76.12%; ANC Utilization2: 59%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
0
1.50
1.00
2.75
HSS-ANC
400
400
400
400
0.46
0.33
0.20
0.12
0.13
PPTCT
1309
8263
21807
38880
21780
0.09
0.12
0.13
Blood Bank
9927
15766
20785
HSS-STD
HSS-FSW
2.87
1.60
HSS-MSM
244
250
HSS-IDU
5.83
4.47
2.31
1.52
1.56
ICTC Male
6121
9112
13748
20945
16628
4.88
3.25
1.57
1.07
0.95
ICTC Female
4243
6333
11082
17585
13642
4.74
3.88
1.78
1.31
1.12
ICTC Referred
6608
9358
14739
20885
15542
6.68
4.11
2.28
1.33
1.45
3756
6087
10091
17645
14728
2006
1.00
400
*
*
0.10
10831
77410
% Widowed
or Divorced
-
24830
% Married
-
37252
-
2005
1.00
400
0.16
10161
-
18627
% Ill., Prim. Edu.
-
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
1309
% 15-24 yrs
-
571
% On ART
-
-
-
NT
-
ICTC Direct
Walk-in
Total tested at
ICTCs 5
ART (NA)
PLHIV Profile, 2012
DLN (NA)
Hetero-sexual
1.03
-
Homo-sexual
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Unknown
83.72
-
-
-
-
-
Parent to
Child
% of Total
(N=387)
-
-
-
-
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
No. HRGFSW
-
-
-
-
9.04
No. HRGMSM
-
-
-
4.91
No. HRGIDU
-
-
Block-Level Details
0
% Pos;
ICTC
-
1.29
% Pos;
PPTCT
% Total Pop.
% Total HRG
Size Est., (Mapping,
Year: 2008)
NA
0.07
41.77
1353
FSW
-
NA
0.09
58.23
1886
MSM
-
NA
0
0
0
IDU
-
Non daily
InjectorsNA
12.32
117554
4.62
0.57
5434
55.88
6.89
65688
Male Migration, 2001 Census
InterIntraState
state
39.50
4.87
46432
Intradistrict
Overall
100
Top 5 districts for inter-state out-migration
2012
2009
2
33
4
1
1
1
55
1
1
-
2010
2
68
4
1
1
1
1
55
1
1
-
2011
2
73
4
2
1
2
1
19
1
1
-
2012
2
78
4
2
1
3
1
38
1
1
-
Mumbai
North
Nashik, Mumbai,
(Suburban) Thane, West
Delhi, Maharash- Maharash, Maha- Maharashtra
Delhi
tra
tra
rashtra
2011
6243
0.65
Programme Response
2006
2007
2008
8
15
4
4
4
1
1
1
1
1
-
9284
-
-
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
Program Target
-
HRG Size
Program Coverage
2005
4
-
Daily
InjectorsNA;
KothiNA;
Double
deckerNA
PanthiNA;
Home
basedNA;
Typology
Brothel
basedNA;
Street
basedNA
-
-
-
% <25 yrs.
% Married
2004
4
-
STI/RTI
2010
No. episodes treated
% Syphilis positivity
-
2009
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
Comm. care centres
Drop-in-centres
Condom outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); 4 ­PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 35
Narmada
Background:
Narmada district is located at the southern part of Gujarat. Narmada District
The district is bounded by Vadodara district in the north,
by Maharashtra state in the east, by Tapi district in the
south and by Bharuch district in the west. It is the third
least populous district of Gujarat with a population of
5.90 lakh, a sex ratio of 960 females per 1,000 males;
female literacy rate of 63.62%, with an overall literacy
rate of 73.29% (Census 2011). Located in Nandod taluka,
Rajpipla is the district headquarters and the main industrial
town of Narmada district. Focus industry sectors include,
textiles, food and agriculture and chemicals. A major
section of the population is dependent upon agriculture
for their livelihood. Some of the main tourist destinations
include Shoolpaneshwar Wildlife Sanctuary and Temple and Rajwant Palace, which accounts for a healthy influx of tourists. Major state roads
connect the district with key industrial centers in the state.
HIV Epidemic Profile: • Based on 2012 HSS-ANC data, HIV prevalence was moderate at 0.75% among the ANC attendees. This represents an increase from the
reported 0.25% in the previous HSS rounds among this population.
• According to 2012 PPTCT data, HIV positivity was low at 0.04% among the PPTCT attendees.
• According to 2011 Blood Bank data, HIV positivity was low at 0.13%among the Blood Bank donors.
• In 2012, HIV positivity among ICTC attendees was low among male (1.10%) and female (1.30%) clients, as well as among referred
(0.67%) and direct walk-ins (2.13%), with a stable trend among all the ICTC clients, but a steep rise in the positivity was observed among
male and referred clients in 2011.
• According to HRG mapping data, there are small numbers of HRG in the district. FSW (130) accounted for 52% of the total HRG and MSM (120) accounted for 48%.
• In 2012, 813 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 2.49%.
• As per the 2001 Census, 8% of the male population were migrants; among them 1.71% migrated to other states and 32.23% migrated
to other districts within the state.
• The top destination for out-of-state migration was Nandurbar in Maharashtra.
• According to 2012 ICTC data, HIV transmissions from parent to child and blood transfusion, each accounted for 15.15% of the total
reported cases (n=33) in the district.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 22.1% and 13.5%, respectively.
• In 2012, there was one composite TI site in operation in the district.
Key Recommendations:
• District needs continued attention to decrease and limit the spread of the infection further.
• Carryout disaggregated analysis of HSS-ANC attendees to identify risk factors for HIV epidemic among general population. Considering
high syphilis positivity in the district, strengthen screening activities and management of syphilis.
• There is a need to better understand the profile of HIV positive individuals through in-depth analysis of ICTC data analysis.
• More needs to be done to understand the profile of the ICTC attendees through in depth analysis of ICTC data as the parent to child
HIV transmission rate was high in the district and accordingly strengthen efforts for early detection and linkage to treatment centers, as
required, and enable positive prevention among spouses.
• Strengthen IEC programme for creating HIV and STI awareness in the district among general population, especially women.
36 | District HIV/AIDS Epidemiological Profiles : Gujarat
Narmada
5306
District Population: 5,90,379 (0.98% of Gujarat Population); Female Literacy1: 63.62%; ANC Utilization2: 48.4%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
0.25
0.25
0.25
0.75
HSS-ANC
400
393
399
399
*
0.20
0.25
*
0.08
0.04
PPTCT
*
999
1192
*
3609
2524
0.13
Blood Bank
15040
HSS-STD
HSS-FSW
HSS-MSM
HSS-IDU
2.62
2.87
1.26
13.15
1.10
ICTC Male
611
698
792
844
1630
2.56
1.59
1.79
0.40
1.30
ICTC Female
352
378
504
752
1152
1.66
2.77
2.01
8.86
0.67
ICTC Referred
483
578
747
1174
1794
3.54
2.01
0.73
2.37
2.13
480
498
549
422
988
2006
0
400
5205
% Widowed
or Divorced
-
1917
% Married
-
2268
-
2005
-
1962
% Ill., Prim. Edu.
-
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
236
% 15-24 yrs
-
-
% On ART
-
-
-
NT
-
ICTC Direct
Walk-in
Total tested at
ICTCs 5
ART (NA)
PLHIV Profile, 2012
DLN (NA)
-
-
-
-
-
-
-
-
-
-
-
-
Unknown
Homo-sexual
-
-
-
Parent to
Child
Hetero-sexual
3.03
-
-
-
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
66.67
-
-
-
-
0
% of Total
(N=33)
-
-
-
15.15
No. HRG-FSW
-
-
-
Block-Level Details
0
No. HRG-MSM
-
-
15.15
No. HRG- IDU
-
-
-
Other,
4.41
-
-
Sagbara,
0
-
-
Dediapada,
1.05
-
-
Nandod, Tilakwada,
3.71
0
% Pos;
ICTC
% Pos;
PPTCT
% Total HRG
Size Est., (Mapping,
Year: NA)
0.02
52.00
130
FSW
NA
0.02
48.00
120
MSM
-
NA
-
-
NA
IDU
2011
813
2.49
2012
Nandurbar
,Maharashtra
52.63
STI/RTI
2010
521
3.41
-
-
-
21116
0.14
361
32.23
2.58
6805
Male Migration, 2001 Census
InterIntraState
state
66.06
5.29
13950
Intradistrict
Overall
8.00
1.71
2009
1
2
1
-
2010
1
11
1
1
-
-
-
2011
1
11
1
1
1
3
-
-
-
-
2012
1
11
1
1
1
3
-
-
100
-
-
Top 5 districts for inter-state out-migration
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
% Total Pop.
NA
-
HRG Size
Program Target
-
Brothel
basedNA;
Home
basedNA;
Program Coverage
Typology
953
1.62
KothiDaily
60.78%; InjectorsNA;
PanthiNA;
Non daily
Double InjectorsNA
decker39.22%
2009
2005
-
Street
basedNA
727
-
-
-
2004
-
-
-
No. episodes treated
% Syphilis positivity
-
% <25 yrs.
% Married
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
Comm. care centres
Drop-in-centres
-
Programme Response
2006
2007
2008
1
2
1
1
Condom Outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); ­4 PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 37
Navsari
Background:
Navsari district is located in the south eastern part of
Navsari District
Gujarat state, in the coastal lowland along Purna River.
It has a population of 13.30 lakh, with a sex ratio of 961
females per 1,000 males; female literacy rate of 79.30%,
with an overall literacy rate of 84.78% (Census 2011). The
district abounds in sugarcane fields, chikoo plantations,
and mango trees. Navsari district is the largest producer
of chikoo in the State and the largest exporter of the fruit
in India. Navsari is known for its floriculture activities
and sugar business. The focus sectors of the district are
agro and food processing industries, textiles, drugs and
pharmaceuticals, mineral related industries, and marine
based industries. Famous historical place include Dandi
and Vansda National Park. National Highway (NH) 8 and 228 passes through the district.
HIV Epidemic Profile:
• Based on 2012 HSS-ANC data, HIV prevalence was moderate at 0.50%, among the ANC attendees. During the previous HSS rounds, ANC
prevalence was always between 0.5% and 1%.
• According to 2012 PPTCT data, HIV positivity was low at 0.09% among the PPTCT attendees.
• According to 2012 Blood Bank data, HIV positivity was low at 0.10% among the Blood Bank donors.
• In 2012, HIV positivity among ICTC attendees was low among male (1.28%) and female (1.06%) clients, as well as among referred
(1.07%) and direct walk-in (1.43%) clients.
• According to 2008 HRG mapping data, FSW (559); was the largest HRG in the district representing 81.49% followed by MSM (127)
representing 18.51%. The major typology for FSWs was home-based (46.69%).
• In 2012, 3,074 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.34%.
• As per the 2001 Census, 7.49% of the male population were migrants; among them 7.36% migrated to other states and 20.68%
migrated to other districts within the state.
• The top two destinations for out-of-state migration were Nawada, Bihar; and, Mumbai (Suburban), Maharashtra.
• According to 2012 ICTC data, HIV transmissions from parent to child accounted for 5.24% of the total reported cases (n=229) in the
district.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 60.2% and 36.6%, respectively.
• In 2012, there was one composite TI in the district.
Key Recommendations:
• Conduct socio-demographic analysis of HSS-ANC attendees to ascertain risk factors for HIV infection, considering varying levels of HIV
prevalence reported among HSS-ANC attendees over HSS rounds.
• Conduct in-depth analysis of ICTC data to understand the profile of these attendees as the parent to child HIV transmission rate is high.
Strengthen efforts for positive prevention focusing on sero-discordant couples.
• Considering high rate of migration to high HIV prevalent districts, strengthen outreach programs through awareness campaigns around
source and transit points such as railway stations and bus stands.
• Since the largest HRG was FSW, better assessment of the population size and the profile of client population, including migrants and
truckers, will help in better understanding of district vulnerabilities Focus efforts on hard to reach sub groups such as home-based FSW.
38 | District HIV/AIDS Epidemiological Profiles : Gujarat
Navsari
2006
1.00
400
*
*
0.68
9366
4.00
250
-
22307
28548
28979
32811
District Population: 13,30,711 (2.20% of Gujarat Population); Female Literacy1: 79.30%; ANC Utilization2: 77.8%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
0.75
0.50
0.75
0.50
HSS-ANC
400
397
399
400
0.80
0.60
0.18
0.09
0.08
0.09
PPTCT
996
1543
10345
12190
11449
13262
0.69
0.54
0.32
0.28
0.24
0.10
Blood Bank
10971
13033
13205
13718
8409
18937
2.00
1.20
9.24
HSS-STD
250
250
249
HSS-FSW
HSS-MSM
HSS-IDU
3.70
2.02
1.68
6.90
1.28
ICTC Male
4346
6787
8700
9280
10261
3.33
1.95
1.37
0.35
1.06
ICTC Female
2793
5175
7658
8250
9288
3.18
1.80
1.32
5.19
1.07
ICTC Referred
5092
8255
10809
11357
14147
4.49
2.40
1.95
1.30
1.43
2047
3707
5549
6173
5402
2005
0.48
8772
-
8682
% Married
-
% Widowed
or Divorced
21
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
996
% Ill., Prim. Edu.
-
59
639
% 15-24 yrs
73
-
% On ART
9
NT
-
51
ICTC Direct
Walk-in
Total tested at
ICTCs 5
ART (1402)
PLHIV Profile, 2012
DLN (NA)
-
-
-
-
-
-
-
-
-
-
-
-
Unknown
Homo-sexual
-
-
-
Parent to
Child
Hetero-sexual
0.87
-
-
-
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
90.83
-
-
-
2.18
% of Total
(N=229)
-
-
-
5.24
No. HRG-FSW
-
-
-
Block-Level Details
0
No. HRG-MSM
-
-
0.87
No. HRG- IDU
-
-
Navsari,
3.87
-
Jalalpor
5.68
-
Vansda,
1.6
-
Chikhli,
3.9
Gandevi,
3.89
% Pos;
ICTC
% Pos;
PPTCT
% Total Pop.
% Total HRG
Size Est., (Mapping,
Year: 2008)
NA
0.04
81.49
559
FSW
-
NA
0.01
18.51
127
MSM
-
NA
0
0
0
IDU
3955
0.49
STI/RTI
2010
931
1.26
2011
3074
0.34
2012
-
-
-
7.49
47079
7.36
0.55
3463
20.68
1.55
9736
Male Migration, 2001 Census
InterIntraState
state
71.96
5.39
33880
Intradistrict
Overall
100
-
2009
1
17
3
1
1
1
1
-
2010
1
21
2
1
1
1
1
1
-
2011
1
28
3
3
1
1
1
9
1
-
2012
1
28
3
3
1
1
1
9
1
Dadra &
Mumbai
Nagar
Thane, Mumbai, Haveli,
Nawada, (Suburban),
MaharashMaharashBihar
Dadra &
Maharashtra
tra
Nagar
tra
Haveli
Top 5 districts for inter-state out-migration
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
Program Target
-
HRG Size
Program Coverage
Typology
Home
basedKothiDaily
46.69%; 37.78%; InjectorsNA;
Brothel PanthibasedNA;
Non daily
13.06%;
Double InjectorsNA
decker62.22%
2009
2005
2
-
Street
based40.25%
7921
-
-
-
2004
2
-
-
-
No. episodes treated
% Syphilis positivity
-
% <25 yrs.
% Married
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
Comm. care centres
Drop-in-centres
-
Programme Response
2006
2007
2008
5
12
2
2
2
1
1
1
Condom Outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); ­4 PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 39
Panchmahals
Background:
Panchmahal, also PanchMahals, is a district in the eastern Panchmahal District
end of Gujarat State. Panch-mahal means “five tehsils/
talukas” (5 sub-divisions), and refers to the five subdivisions namely: Godhra, Dahod, Halol, Kalol and Jhalod
that were transferred by the Maharaja Sindia of Gwalior
to the British. The district has a population of 23.88 lakh,
a sex ratio of 945 females per 1,000 males; female literacy
rate of 59.95%, with an overall literacy rate of 72.32%
(Census 2011). Panchmahals is rich in minerals and
agricultural produce. Major occupations in the district are
dairy farming and agriculture. Main crops cultivated are
wheat, maize and pulses. Tourist attractions in the district
include Champaner-Pavagadh Archeological Park (listed
as World Heritage Site by UNESCO), temple of Mata Kalika in Pavagarh, the Jain pilgrimage center at Pavoli, fairs of ChaitiAtham and Math
Kotal, Kadana Dam, etc. which attract a large number of tourists every year. National Highway (NH) 59, NH-8 and State Highway 4 pass
through the district.
HIV Epidemic Profile: • Based on 2012 HSS-ANC data, HIV prevalence was low (0.25%) among the ANC attendees. This is consistent with the previous HSS
rounds.
• According to 2012 PPTCT data, HIV positivity was moderate at 0.60% among the PPTCT attendees, with a stable trend till 2011, but a
sudden rise was observed in 2012.
• According to 2012 Blood Bank data, HIV positivity was low at 0.30% among the Blood Bank donors.
• In 2012, HIV positivity among ICTC attendees was low among male (1.47%) and female (1.39%) clients, as well as among referred
(1.36%) and direct walk-in (1.80%) clients, with a stable trend among all the ICTC clients, but an increase in the positivity was observed
among male and referred clients in 2011.
• According to 2008 HRG mapping data, MSM (234) was the largest proportion of HRG in the district representing 55.45% followed
by FSW (188) representing 44.55% of the total HRG. 71.62% of the FSWs were married and the major typology was street-based
(95.83%).
• In 2012, 6,686 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.33%.
• The top two destinations for out-of-state migration were Pune and Mumbai (Suburban), Maharashtra.
• According to 2012 ICTC data, HIV transmissions from parent to child accounted for 9.43% of the total HIV reported cases (n= 159) in
the district.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 36.3% and 26.2%, respectively.
• In 2012, there was one composite TI in the district.
Key Recommendations:
• Although there is low level of the HIV epidemic in the district, continue efforts to contain and limit the spread of HIV infection. Analyse
ICTC and STI data to ascertain vulnerability factors contributing to HIV transmission.
• Conduct disaggregated analysis of PPTCT data to assess risk factors in the district.
• With parent to child transmission high in the district, it is necessary to strengthen PPTCT program coverage in the district. Strengthen
efforts for enabling early detection, and positive prevention among couples.
• Since MSM are the largest proportion of HRG mapped, a better assessment of the population size and profile of MSM and their partner
population will enhance understanding of district vulnerabilities and accordingly inform the response. Availability of typology based data
will help in analyzing risk factors.
40 | District HIV/AIDS Epidemiological Profiles : Gujarat
PanchMahals
2006
0
400
*
*
0.08
2462
0.40
250
-
12735
18280
27457
17935
District Population: 23,88,267(3.96% of Gujarat Population); Female Literacy1: 59.95%; ANC Utilization2: 55.3%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
0
0
0.25
HSS-ANC
400
332
4.00
0.21
0.03
0.19
0.05
0.17
0.60
PPTCT
943
1116
4759
7514
12262
6882
0.27
0.08
0.04
0.20
0.24
0.30
Blood Bank
4082
5039
6918
8652
14154
8927
4.90
HSS-STD
204
HSS-FSW
HSS-MSM
HSS-IDU
2.48
1.83
1.32
6.16
1.47
ICTC Male
3545
5094
7108
9392
6666
2.07
2.01
1.56
0.67
1.39
ICTC Female
2123
2882
3658
5803
4387
1.95
1.60
1.46
4.79
1.36
ICTC Referred
4246
7269
8101
10950
9169
3.45
4.95
1.24
2.19
1.80
1422
707
2665
4245
1884
2005
0.11
2617
1.20
250
-
6784
% Married
-
% Widowed
or Divorced
9
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
943
% Ill., Prim. Edu.
-
34
610
% 15-24 yrs
45
-
% On ART
11
NT
-
32
ICTC Direct
Walk-in
Total tested at
ICTCs 5
ART (1000)
PLHIV Profile, 2012
DLN (NA)
Hetero-sexual
1.26
-
Homo-sexual
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Unknown
86.16
-
-
-
-
-
Parent to
Child
% of Total
(N=159)
-
-
-
-
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
No. HRGFSW
-
-
-
-
3.14
No. HRGMSM
-
-
-
9.43
No. HRGIDU
-
-
Block-Level Details
0
% Pos;
ICTC
-
0
% Pos;
PPTCT
% Total Pop.
% Total HRG
Size Est., (Mapping,
Year: 2008)
NA
0.01
44.55
188
FSW
-
NA
0.01
55.45
234
MSM
-
NA
0
0
0
IDU
-
-
-
-
-
-
Intradistrict
-
-
-
Male Migration, 2001 Census
InterIntraState
state
-
-
Overall
0
Mumbai
Pune,
(SuburThane,
Daman,
Maharash- ban), Maharash- Daman &
tra
Maharashtra
Diu
tra
Dadra &
Nagar
Haveli,
Dadra &
Nagar
Haveli
Top 5 districts for inter-state out-migration
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
Program Target
-
HRG Size
Program Coverage
Non daily
InjectorsNA
Daily
InjectorsNA;
KothiNA;
PanthiNA;
Double
deckerNA
2012
Street
based95.83%
Brothel
based1.67%;
Home
based2.5%;
Typology
% <25 yrs.
% Married
2011
2010
1
34
3
1
1
1
-
2012
1
48
3
2
1
1
-
2009
1
8
3
1
1
1
-
2011
1
44
3
2
1
1
-
Programme Response
2006
2007
2008
5
7
3
3
3
1
1
-
77.60
71.62
STI/RTI
2010
2005
3
-
2009
12444
-
-
6686
0.33
2004
3
-
6381
1.06
No. episodes treated
% Syphilis positivity
-
3681
1.13
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
Comm. care centres
Drop-in-centres
Condom outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); ­4 PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 41
Patan
Background:
Patan district is located in northern Gujarat and bounded
Patan District
by Banas kantha district in the north and northeast,
Mehsana district in the east and southeast, Surendranagar
district in the south and Kutch district and the Kutch nu
Nanu Ran (Little Rann of Kutch) in the west. It has a
population of 13.42 lakh, with a sex ratio of 935 females
per 1,000 males; female literacy rate of 62.01%, with
an overall literacy rate of 73.47% (Census 2011). The
economy of Patan is mainly agrarian but food processing,
agriculture, and textiles are the major vocational and
industrial activities in Patan. There are many Hindu temples
and Jain Temple (nearly 150 temples) in the district. Patan
has a few good tourist spots, to attract people interested
in heritage and history. National Highway 14, 15 and State Highway 7, 8 and 10 run through the district connecting it with major cities of
the state and the rest of India.
HIV Epidemic Profile:
• Based on 2012 HSS-ANC data, HIV positivity was moderate at 0.50%, among the ANC attendees, representing an increasing trend over
the last three data recordings.
• According to 2012 PPTCT data, HIV positivity was low at 0.24% among the PPTCT attendees.
• According to 2012 Blood Bank data, HIV positivity was low at 0.19% among the Blood Bank donors.
• According to 2010 HSS data, the HIV prevalence was moderate among MSMs at 4.15%.
• In 2012, HIV positivity among ICTC attendees was low among male (2.26%) and female (1.33%) clients, as well as among referred
(1.79%) and direct walk-in (1.87%) clients.
• According to 2009 HRG mapping data, FSW (295) represent the largest proportion of HRG in the district with 79.95%. There were 74
MSM mapped.
• In 2012, 10,766 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 1.65%.
• As per the 2001 Census, 7.10% of the male population were migrants; among them 15.09% migrated to other states and 39.11%
migrated to other districts within the state.
• The top two destinations for out-of-state migration were Mumbai (Suburban) in Maharashtra and Ranchi in Jharkhand.
• According to 2012 ICTC data, HIV transmissions from parent to child accounted for 6.10% of the total reported cases (n=295) in the
district.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 46.7% and 29.5%, respectively.
• In 2012, there were a two composite TI sites operational in the district.
Key Recommendations:
• Sustain efforts to contain and limit the spread of HIV infection while noting the available epidemiologic and program data.
• Considering HIV prevalence among HSS-ANC attendees, socio-demographic analysis needs to be done to ascertain risk factors for HIV.
• Given the high proportion of reported parent to child HIV transmission at ICTC, more needs to be done to understand the profile of these
attendees through in-depth analysis of ICTC data and accordingly strengthen efforts for early detection and positive prevention among
couples.
• Focus on the outreach efforts for street based FSW (67.18% of the total FSW in the district) to keep HIV prevalence among them at low
level.
• Availability of DLN data will help in better understanding of district vulnerabilities.
42 | District HIV/AIDS Epidemiological Profiles : Gujarat
Patan
2006
0.50
400
0.08
3629
-
17814
20868
31096
27472
District Population: 13,42,746 (2.22% of Gujarat Population); Female Literacy1: 62.01%; ANC Utilization2: 53.4%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
0.25
0
0.25
0.50
HSS-ANC
400
400
398
799
0.63
0.17
0.32
0.31
0.30
0.24
PPTCT
2383
4632
10278
9211
13170
11300
0.04
0.06
0.19
Blood Bank
5563
7718
13543
HSS-STD
HSS-FSW
4.15
HSS-MSM
241
HSS-IDU
5.19
4.64
3.49
7.99
2.26
ICTC Male
4240
3923
6130
9990
8447
3.09
2.35
1.85
0.53
1.33
ICTC Female
3589
3613
5527
7936
7725
3.05
3.16
2.34
5.29
1.79
ICTC Referred
4922
5374
8817
13466
10991
6.23
4.49
3.87
2.85
1.87
2907
2162
2840
4460
5181
2005
0.19
3150
-
12461
% Married
-
% Widowed
or Divorced
21
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
2383
% Ill., Prim. Edu.
-
57
-
% 15-24 yrs
64
-
% On ART
6
NT
-
49
ICTC Direct
Walk-in
Total tested at
ICTCs 5
ART (1290)
PLHIV Profile, 2012
DLN (NA)
Homo-sexual
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Unknown
Hetero-sexual
3.73
-
-
-
-
Parent to
Child
87.80
-
-
-
-
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
% of Total
(N=295)
-
-
-
Sami,
0
1.69
No. HRG-FSW
-
-
-
Radhanpur,
0
6.10
No. HRG-MSM
-
-
Harij,
1.99
Block-Level Details
Siddhpur, Santalpur, Mehsana,
2.62
0.25
0
0.34
No. HRG- IDU
-
Chansma,
1.69
0.34
% Pos;
ICTC
Patan,
3.94
Bk,
3.11
% Pos;
PPTCT
% Total HRG
Size Est., (Mapping,
Year: 2009)
0.02
79.95
295
FSW
NA
0.01
20.05
74
MSM
-
NA
-
-
-
IDU
7.10
43409
15.09
1.07
6550
39.11
2.78
16976
Male Migration, 2001 Census
InterIntraState
state
45.80
3.25
19883
Intradistrict
Overall
100
South
Delhi,
Delhi
Top 5 districts for inter-state out-migration
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
% Total Pop.
NA
-
HRG Size
Program Target
-
Mumbai
Thane,
(Suburban) Ranchi, Mumbai, Maharash,Maharash- Jharkhand Maharashtra
tra
tra
2012
Street
based67.18%
2011
-
Home
basedKothiDaily
17.52%; 52.94%; InjectorsNA;
Brothel PanthibasedNA;
Non daily
15.31%;
Double InjectorsNA
decker47.06%
Program Coverage
Typology
% <25 yrs.
% Married
6.43
47.06
95.34
57.35
STI/RTI
2010
2009
2010
2
16
3
3
1
1
25
-
2012
2
37
4
3
1
1
1
26
-
2009
2
8
4
2
1
1
25
-
2011
2
27
4
3
1
1
1
9
-
Programme Response
2006
2007
2008
6
7
3
3
3
2
2
1
-
10766
1.65
12775
-
2005
2
-
11382
0.18
No. episodes treated
% Syphilis positivity
2004
2
-
9360
2.29
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
Comm. care centres
Drop-in-centres
Condom Outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); ­4 PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 43
Porbandar
Background:
Porbandar forms a part of the erstwhile Kathiawar Porbandar District
peninsula located in the western part of Gujarat. This
district is surrounded by Jamnagar district to the north,
Junagadh district to the south and the Arabian Sea to the
west. It is the second least-populous district of Gujarat
with a population of 5.86 lakh, a sex ratio of 947 females
per 1,000 males; female literacy rate of 68.32%, with an
overall literacy rate of 76.63% (Census 2011). Porbandar
is the birth place of Father of the Nation Mahatama
Gandhi. Focus industry sectors areport and ship building,
cement industry and mineral-based industries. Fishing
industry is a prominent activity in Porbandar including sea
food processing. The district is very famous for KirtiMandir
(the birth place of Mahatma Gandhi), Bharat Mandir, Nehru Planetarium and Vijay Vilas. National highway 8 B and 8E (Ext.) passes through
the district, connecting Porbandar with Rajkot and Jamnagar.
HIV Epidemic Profile: • Based on 2012 HSS-ANC data, HIV prevalence was moderate at 0.50% among the ANC attendees, with a fluctuating trend.
• According to 2012 PPTCT data, HIV positivity was low at 0.06% among the PPTCT attendees, with a stable trend.
• According to 2012 Blood Bank data, HIV positivity was low among the Blood Bank donors, with a decreasing trend.
• In 2012, HIV positivity among ICTC attendees was low among male (0.85%) and female (0.60%) clients, as well as among referred
(0.48%) and direct walk-in (2.31%) clients a stable trend among all the ICTC clients, but an abrupt upsurge in the positivity was observed
among male and referred clients in 2011.
• According to 2008-09 HRG mapping data, There are 214 FSW representing the total HRG population in the district. The major typology
for FSWs was home-based (69.63%).
• In 2012, 3,400 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.04%.
• As per the 2001 Census, 7.35% of the male population were migrants; among them 5.40% migrated to other states and 45.59%
migrated to other districts within the state.
• The top two destinations for out-of-state migration were Thane and Mumbai (Suburban), Maharashtra.
• According to 2012 ICTC data, HIV transmission through blood transfusion accounted for 6.02% of the total reported cases (n=93) in the
district.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 51.5% and 30.6%, respectively.
• In 2012, there was one composite TI in the district.
Key Recommendations:
• Sustain focus on containing and limiting the HIV epidemic, while noting the available evidences from epidemiologic and program data.
• Conduct socio-demographic analysis of HSS-ANC attendees to understand risk factors for HIV epidemic among general population, and
accordingly strengthen interventions.
• Focus outreach efforts among home based FSWs (69.63% of the total FSWs in the district) to keep HIV transmission among them and
their clients at low level.
• Since reported HIV transmission through blood transfusion is relatively high, there is a need to better understand the profile of these
positive individuals through in-depth analysis of ICTC and ART data.
• Availability of DLN data help in better understanding of district vulnerabilities.
44 | District HIV/AIDS Epidemiological Profiles : Gujarat
Porbandar
2006
0
400
*
*
0.20
3915
-
10851
14658
10814
19567
District Population: 5,86,062 (0.97% of Gujarat Population); Female Literacy1: 68.32%; ANC Utilization2: 71.3%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
0.50
0
0.50
HSS-ANC
400
399
400
0.21
0.19
0.08
0.11
0
0.06
PPTCT
946
2574
5181
6423
3577
8161
0.16
0.21
0.04
0.03
0.11
0
Blood Bank
5762
6592
6755
7676
80939
5756
HSS-STD
HSS-FSW
HSS-MSM
HSS-IDU
2.68
1.74
1.20
14.29
0.85
ICTC Male
2766
3498
4915
3947
6237
2.00
0.87
0.99
0.18
0.60
ICTC Female
1552
2172
3320
3290
5169
2.00
1.47
0.99
10.25
0.48
ICTC Referred
2452
3480
5744
5416
9805
3.00
1.32
1.41
0.82
2.31
1866
2190
2491
1821
1601
2005
0.29
2742
-
6892
% Married
-
% Widowed
or Divorced
13
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
946
% Ill., Prim. Edu.
-
67
175
% 15-24 yrs
86
-
% On ART
4
NT
-
61
ICTC Direct
Walk-in
Total tested at
ICTCs 5
ART (546)
PLHIV Profile, 2012
DLN (NA)
Homo-sexual
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Unknown
Hetero-sexual
3.61
-
-
-
-
Parent to
Child
87.95
-
-
-
-
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
% of Total
(N=83)
-
-
-
0
No. HRG-FSW
-
-
-
2.41
No. HRG-MSM
-
-
-
-
-
-
-
-
Block-Level Details
Porbandar, Ranavav, Kutiyana,
0
0
0
0
No. HRG- IDU
-
6.02
% Pos;
ICTC
% Pos;
PPTCT
% Total HRG
Size Est., (Mapping,
Year: 2009)
0.02
79.95
295
FSW
NA
0.01
20.05
74
MSM
-
NA
-
-
-
IDU
7.10
43409
15.09
1.07
6550
39.11
2.78
16976
Male Migration, 2001 Census
InterIntraState
state
45.80
3.25
19883
Intradistrict
Overall
100
South
Delhi,
Delhi
Top 5 districts for inter-state out-migration
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
% Total Pop.
NA
-
HRG Size
Program Target
-
Mumbai
Thane,
(Suburban) Ranchi, Mumbai, Maharash,Maharash- Jharkhand Maharashtra
tra
tra
2012
Street
based67.18%
2011
-
Home
basedKothiDaily
17.52%; 52.94%; InjectorsNA;
Brothel PanthibasedNA;
Non daily
15.31%;
Double InjectorsNA
decker47.06%
Program Coverage
Typology
% <25 yrs.
% Married
6.43
47.06
95.34
57.35
STI/RTI
2010
2009
2010
1
6
3
1
1
-
2012
1
14
3
1
1
1
2
-
2009
1
5
3
1
-
2011
1
14
3
1
1
1
2
-
Programme Response
2006
2007
2008
1
4
5
3
3
3
1
1
-
10766
1.65
12775
-
2005
2
-
11382
0.18
No. episodes treated
% Syphilis positivity
2004
2
-
9360
2.29
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
Comm. care centres
Drop-in-centres
Condom Outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); ­4 PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 45
Rajkot
Background:
Rajkot is located in the south-west region of Gujarat. Rajkot District
The district headquarter is Rajkot city: the largest city in
Saurashtra and fourth largest in Gujarat state. This district
is surrounded by Kutch district in north, Surendranagar
and Bhavnagar districts in the east, Amreli and Junagadh
districts in south and Jamnagar district in the west.
The district has a population of 37.99 lakh, a sex ratio
of 924 females per 1,000 males; female literacy rate of
75.26%, with an overall literacy rate of 82.20% (Census
2011). Rajkot is one of the biggest centers for engineering
industry. Special Economic Zone (SEZ) for engineering
sector is proposed in the district, which will further boost
the growth of engineering sector as well as increase the
industrial output and exports of the district. The occupational pattern in Rajkot is primarily based on manufacturing and service sector. Rajkot
is well connected to other cities through National Highways (NH) & State Highways (SH).
HIV Epidemic Profile: • Based on 2012 HSS-ANC data, HIV prevalence was moderate at 0.75%, among the ANC attendees. HIV prevalence was 1% in 2011.
• According to 2012 PPTCT data, HIV positivity was low at 0.16% among the PPTCT attendees, with a decreasing trend.
• According to 2012 Blood Bank data, HIV positivity was low at 0.09% among the Blood Bank donors, with a decreasing trend.
• According to 2010 HSS data, HIV positivity was low among FSWs and MSMs at 0.40% and 2.85% respectively, with a decreasing trend
over the years.
• In 2012, HIV positivity among ICTC attendees was low among male (2.53%) and female (1.38%) clients, as well as among referred
(1.99%) and direct walk-in (1.94%) clients, with a decreasing trend among all the ICTC clients.
• According to 2008 HRG mapping data, FSW (2,487) represent 51.07% of HRG in the district and MSM (2,383) represent the remaining
48.93% . The major typologies for FSWs were home-based (37.43%) and street based (34.66%).
• In 2012, 30,318 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.55%.
• As per the 2001 Census, 9.16% of the male population were migrants; among them 5.53% migrated to other states and 33.19%
migrated to other districts within the state.
• The top two destinations for out-of-state migration were Mumbai (Suburban) and Thane in Maharashtra.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 54.6% and 34.3%, respectively.
• In 2012, there were seven TI sites (2 TI sites each for FSW and MSM and 3 composite site) in operation in the district for over 4,800 HRGs
in the district.
Key Recommendations:
• Continue attention on the district to decrease and limit the spread of the infection further.
• Considering the HIV prevalence level, conduct socio-demographic analysis of HSS-ANC attendees to ascertain risk factors to inform
response.
• Presence of large size of HRGs should be considered for strengthening HIV preventive and referral services in the district. Focus positive
prevention also among spouses of HRG and strengthen interventions reaching out to potential clients including migrants .
• Assess the population size and profile of FSWs client population, including migrants and truckers, to better understand the district
vulnerabilities. Also, focus outreach efforts also among home based FSW (37.43% of the total FSWs in the district) to keep HIV prevalence
among them at low level.
• Analyse the population size and profile of migrants to improve understanding of district vulnerabilities, considering high rate of
migration.
46 | District HIV/AIDS Epidemiological Profiles : Gujarat
Rajkot
2005
0
400
1.58
1200
0.32
48215
4.40
250
12.40
250
-
1240
2006
0.75
400
1.45
1240
0.20
45886
2.80
250
14.00
250
-
2310
15873
43019
53218
87188
73298
District Population: 37,99,770 (6.29% of Gujarat Population); Female Literacy1: 75.26%; ANC Utilization2: 82.2%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
0.50
0.50
1.00
0.75
HSS-ANC
400
400
400
400
1.08
0.85
0.23
0.19
0.18
0.16
PPTCT
2310
4838
22607
23232
32787
29088
0.22
0.23
0.16
0.12
0.06
0.09
Blood Bank
44963
56413
65445
77231
20910
83034
HSS-STD
2.80
2.00
0.40
HSS-FSW
250
250
250
15.60
6.40
2.85
HSS-MSM
250
250
246
HSS-IDU
16.81
7.56
4.28
5.86
2.53
ICTC Male
6795
10780
16033
28605
22553
11.11
3.91
1.94
0.70
1.38
ICTC Female
4240
9632
13953
25796
21657
9.75
4.38
3.40
4.47
1.99
ICTC Referred
6018
12596
18367
31193
22670
20.45
8.19
2.86
2.00
1.94
5017
7816
11619
23208
21540
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
1200
% Married
-
% Widowed
or Divorced
11
NT
% Ill., Prim. Edu.
-
70
ICTC Direct
Walk-in
Total tested at
ICTCs 5
% 15-24 yrs
86
PLHIV Profile, 2012
% On ART
10
Hetero-sexual
3.22
-
Homo-sexual
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Block-Level Details
-
-
-
Unknown
-
90.45
-
-
-
-
Parent to
Child
29
% of Total
(N=869)
-
-
-
Morbi,
43.04
KotaJetpur,
Lodhika,
dasangani,
36.59
14.29
26
Maliya
Miyana,
66.67
1.50
ART (9477)
No. HRG-FSW
-
-
-
Jasdan,
34
3.34
DLN (NA)
No. HRG-MSM
-
-
Jamkandorana,
25
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
No. HRG- IDU
-
Gondal,
43.86
0.35
% Pos;
ICTC
Doraji,
53.33
1.15
% Pos;
PPTCT
% Total HRG
Size Est., (Mapping,
Year: 2008)
0.07
51.07
2487
FSW
NA
0.06
48.93
2383
MSM
-
NA
-
-
-
IDU
9.16
149910
5.53
0.51
8285
33.19
3.04
49754
Male Migration, 2001 Census
InterIntraState
state
61.28
5.62
91871
Intradistrict
Overall
100
Top 5 districts for inter-state out-migration
2012
2009
2
2
3
44
11
3
1
1
40
2
1
-
2010
2
2
3
45
11
3
1
2
1
40
2
1
-
2011
2
2
3
46
11
3
1
4
1
10
1
1
-
2012
2
2
3
45
11
3
1
6
1
10
1
1
-
Mumbai
Pune,
Mumbai, Jaipur,
(Suburban) Thane, MaharashMaharash- Rajasthan
,Maharash- Maharashtra
tra
tra
tra
2011
-
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
% Total Pop.
NA
-
HRG Size
Program Target
-
Street
based34.66%
-
STI/RTI
2010
Home
basedKothiDaily
37.43%; 53.76%; InjectorsNA;
Brothel PanthibasedNA;
Non daily
27.91%;
Double InjectorsNA
decker44.15%
Program Coverage
Typology
% <25 yrs.
% Married
2009
Programme Response
2006
2007
2008
1
1
1
1
1
1
2
10
21
5
6
11
3
3
1
1
1
1
1
2
1
1
1
-
30318
0.55
92097
-
2005
1
1
6
1
1
-
32641
0.64
No. episodes treated
% Syphilis positivity
2004
1
1
6
-
23921
1.26
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
Comm. care centres
Drop-in-centres
Condom Outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); ­4 PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 47
Sabarkantha
Background:
Sabarkantha district derives its name from the river Sabarkantha District
Sabarmati that separates Sabarkantha from the
neighbouring districts. The district is bounded by the
Rajasthan State to the north, Banaskantha and Mehsana
districts to the west, Gandhinagar, Kheda, and Panchmahal
districts to the south. It has a population of 24.27 lakh,
85.04% of which reside in rural areas, with a sex ratio
of 950 females per 1,000 males; female literacy rate of
65.29%, with an overall literacy rate of 76.60% (Census
2011). The economy of the district is heavily dependent
on Agriculture and Dairy Farming. Food processing and
textiles are the other emerging sectors which have opened
up new opportunities for investment. Major tourist
destinations are Idar, Shamlaji temple, Polo Forests, Vijaynagar. NH 8 passes through the district connecting it with major cities of the State
and also with the rest of India.
HIV Epidemic Profile:
• Based on 2010 HSS-ANC data, HIV prevalence washigh at 1.50% among the ANC attendees. Sabarkantha is a high HIV prevalence
district with prevalence at 1% of higher in the last HSS round also (1.25% in 2008).
• According to 2012 PPTCT data, HIV positivity was low at 0.23% among the PPTCT attendees, with a decreasing trend.
• According to 2012 Blood Bank data, HIV positivity was low at 0.08% among the Blood Bank donors, with a flat trend.
• In 2012, HIV positivity among ICTC attendees was low among male (2.64%) and female (1.97%) clients, as well as among referred
(1.54%) and direct walk-in (4.16%) clients.
• According to 2008 HRG mapping data, FSW (829; 64.56% of the total HRG) was the largest HRG in the district followed by MSM (455;
35.44% of the total HRG). The major typology for FSWs was street-based (49.58%).
• In 2012, 5,217 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.64%.
• The top two destinations for out-of-state migration were Thane and Mumbai (Suburban), Maharashtra.
• According to 2012 ICTC data, HIV transmissions from parent to child accounted for 7.58% of the total reported cases (n=409) in the
district.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 38.8% and 14%, respectively.
• In 2012, two composite TI sites were operational in the district.
Key Recommendations:
• Increase the number of TI sites in the district to provide HIV preventive and referral services to accommodate the sizeable number of
HRGs.
• Conduct socio-demographic analysis of HSS-ANC attendees to ascertain risk factors, considering high HIV prevalence among HSS-ANC
attendees.
• Noting the level of HIV transmission via parent to child of all reported cases, there is a need to better understand the profile and dynamics
of clinic attendees and their spouses also through analysis of ICTC data. Accordingly strengthen HIV prevention efforts among married
women and encourage early detection and linkage to necessary treatment services.
• Analyse vulnerability factors in transmission of HIV from ICTC and STI data, considering the HIV epidemic in the district.
• Strengthen IEC for general population with HIV awareness and HIV prevention messages, including sexual risk reduction.
48 | District HIV/AIDS Epidemiological Profiles : Gujarat
Sabarkantha
31310
District Population: 24.27,346 (4.02% of Gujarat Population); Female Literacy1: 65.29%; ANC Utilization2: 49.7%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
0.25
1.25
1.50
HSS-ANC
400
399
400
0.55
0.34
0.25
0.28
0.23
0.23
PPTCT
3301
7700
13292
15859
17611
13618
0.10
0.10
0.07
0.16
0.09
0.08
Blood Bank
9419
8954
17164
20381
93788
17829
HSS-STD
HSS-FSW
HSS-MSM
HSS-IDU
8.60
3.90
3.31
2.40
7.72
2.64
ICTC Male
4009
13188
8219
9622
10672
9102
3.59
2.58
1.89
0.90
1.97
ICTC Female
6177
7355
9079
10986
8590
3.22
2.63
1.59
4.45
1.54
ICTC Referred
9739
11635
13635
15135
12501
5.72
3.96
3.67
3.82
4.16
3744
3939
5066
6523
5191
2006
0.75
400
0.85
1170
0.43
4636
*
*
*
*
39269
% Widowed
or Divorced
-
34560
% Married
-
28866
-
2005
0.25
400
0.22
5094
*
*
*
*
-
27065
% Ill., Prim. Edu.
-
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
7310
% 15-24 yrs
-
1715
% On ART
-
214
-
NT
-
ICTC Direct
Walk-in
Total tested at
ICTCs 5
ART (NA)
PLHIV Profile, 2012
DLN (NA)
Hetero-sexual
1.96
-
Homo-sexual
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Unknown
82.15
-
-
-
-
-
Parent to
Child
% of Total
(N=409)
-
-
-
-
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
No. HRGFSW
-
-
-
-
3.42
No. HRGMSM
-
-
-
7.58
No. HRGIDU
-
-
Block-Level Details
0.49
% Pos;
ICTC
-
4.40
% Pos;
PPTCT
% Total Pop.
% Total HRG
Size Est., (Mapping,
Year: 2008)
NA
0.03
64.56
829
FSW
-
NA
0.02
35.44
455
MSM
-
NA
-
-
-
IDU
STI/RTI
2010
7922
0.82
2011
5217
0.64
2012
-
-
-
-
-
-
Intradistrict
-
-
-
Male Migration, 2001 Census
InterIntraState
state
-
-
Overall
0
2009
2
12
5
1
2
1
-
2010
2
36
5
1
1
1
1
-
2011
2
46
5
2
1
1
1
25
-
2012
2
45
5
2
1
2
1
26
-
Mumbai
Thane,
(SuburMumbai,
Maharash- ban), Dungarpur, Udaipur, Maharashtra
Maharash- Rajasthan Rajasthan
tra
tra
Top 5 districts for inter-state out-migration
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
Program Target
-
HRG Size
Program Coverage
Typology
Home
basedKothiDaily
17.61%; 82.85%; InjectorsNA;
Brothel PanthibasedNA;
Non daily
32.81%;
Double InjectorsNA
decker17.15%
6508
0.14
Street
based49.58%
2009
2005
2
-
-
2785
-
-
-
2004
2
-
% <25 yrs.
% Married
No. episodes treated
% Syphilis positivity
-
Programme Response
2006
2007
2008
11
12
2
3
5
1
1
1
1
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
Comm. care centres
Drop-in-centres
Condom outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); ­4 PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 49
Surat
Background:
Surat district is surrounded by Bharuch and Narmada Surat District
districts to the north, Navsari district to the southand east
Tapi district. To the west is the Gulf of Khambat. Surat
is the second most populous district of Gujarat with a
population of 60.79 lakh, 79.68% of the population reside
in urban areas, a sex ratio of 788 females per 1,000 males;
female literacy rate of 81.02%, with an overall literacy
rate of 86.65% (Census 2011). Focus industry sectors
include textiles and apparels, gems and jewelry, chemicals
and petrochemicals, ports, IT enabled services and bio
technology. Emergence of a petro chemical complex, gems
and jewelry park and the centrally promoted Surat SEZ
are expected to further fuel the industrial and economic
growth of the city. Famous tourist places are The Surat Castle, Mughalsarai, Andrews Library, Sardar Vallabhai Patel Museum and Marjan
Shami Roza. Surat is well connected to various locations through national and state highways.
HIV Epidemic Profile:
• Based on 2012 HSS-ANC data, HIV prevalence was high at 1% among the ANC attendees. Surat is known as a high HIV prevalence district
with 1% or more prevalence reported over HSS rounds (1.26% HIV prevalence among ANC in 2010).
• According to 2012 PPTCT data, HIV positivity was low at 0.27% among the PPTCT attendees.
• According to 2012 Blood Bank data, HIV positivity was low at 0.07% among the Blood Bank donors.
• According to 2010 HSS data, HIV prevalence was low among FSWs (0.80%), MSM (1.20%) and IDUs (1.60%).
• In 2012, HIV positivity among ICTC attendees was low among male (2.93%) and female (2.12%) clients, as well as among referred
(2.31%) and direct walk-in (3.01%) clients.
• According to HRG mapping data, MSM (9,816; 56.44% of the total HRG) was the largest HRG in the district followed by FSW (5,775;
33.21% of the total HRG) and IDU (1,800;10.35% of the total HRG). 55.09% of the mapped MSM and 67.67% of the mapped FSW
were reported married. The major typology for FSWs was home-based (61.93%).
• In 2012, 1,43,237 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.13%.
• According to 2012 ICTC data, HIV transmission from parent to child accounted for 4.85% of the total reported cases (n= 1731).
• As per the 2001 Census, 5.97% of the male population were migrants; among them 14.50% migrated to other states and 18.36%
migrated to other districts within the state.
• The top two destinations for out-of-state migration were Ganjam, Odisha; and Nandurbar, Maharashtra.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 60.5% and 33.6%, respectively.
Key Recommendations:
• Continue attention to decrease and limit the spread of HIV infection further, noting the HSS ANC HIV prevalence, HRG population size
estimate, migration levels, and other vulnerability factors.
• Conduct socio-demographic analysis of HSS-ANC attendees to understand risk factors for high HIV epidemic among general population.
• Since the largest HRG are MSM, better assessment of the size and profile of MSM and partner population will help in better understanding
of district vulnerabilities.
• Focus on IDU-FSW sexual networks and address the dual risk that is posed due to the rate of infection among IDUs and the large number
of FSWs in a district with multiple industries.
• Considering high rate of migration, strengthen outreach programme through awareness campaigns around source and transit points such
as railway stations and bus stands.
50 | District HIV/AIDS Epidemiological Profiles : Gujarat
Surat
2006
1.25
400
8.00
250
12.80
250
-
96869
132563
162478
103224
District Population: 60,79,231 (10.07% of Gujarat Population); Female Literacy1: 81.02%; ANC Utilization2: 78.4%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
1.50
0.76
1.26
1.00
HSS-ANC
400
394
398
400
2.53
0.66
0.38
0.27
0.21
0.27
PPTCT
8647
24437
48001
47928
50401
36235
0.23
0.17
0.17
0.12
0.09
0.07
Blood Bank
79930
87583
83304
88889
93788
89976
HSS-STD
7.20
4.40
0.80
HSS-FSW
250
250
250
7.60
10
1.20
HSS-MSM
250
250
250
1.60
HSS-IDU
250
14.19
4.99
2.59
1.95
2.93
ICTC Male
13245
31049
52406
69332
38342
14.66
4.98
2.13
1.81
2.12
ICTC Female
7013
17819
32229
42745
28647
10.62
4.33
2.79
2.45
2.31
ICTC Referred
7885
24961
43483
55537
40971
16.74
5.67
2.01
1.35
3.01
12373
23907
41152
56540
26018
2005
1.25
400
13.20
250
15.60
250
-
44695
% Married
-
% Widowed
or Divorced
13
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
8647
% Ill., Prim. Edu.
-
57
-
% 15-24 yrs
63
-
% On ART
10
NT
-
33
ICTC Direct
Walk-in
Total tested at
ICTCs 5
ART (20049)
PLHIV Profile, 2012
DLN (NA)
Homo-sexual
-
-
-
-
-
-
Valod,
0
-
-
-
-
-
-
-
-
-
Unknown
Hetero-sexual
2.31
-
-
-
Mandvi,
2.63
-
Parent to
Child
89.95
-
-
-
Vyara,
3.29
-
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
% of Total
(N=1731)
-
-
Bardoli,
5.3
-
1.04
No. HRG-FSW
-
-
Kamrej,
0.81
-
4.85
No. HRG-MSM
-
Palsana,
2.52
-
Block-Level Details
0.23
No. HRG- IDU
Olpad,
4.43
-
1.62
% Pos;
ICTC
-
-
-
Mahuva, Mangrol,
2.92
3.35
% Pos;
PPTCT
% Total HRG
Size Est., (Mapping,
Year: NA
0.09
33.21
5775
FSW
NA
0.16
56.44
9816
MSM
-
NA
0.03
10.35
1800
IDU
5.97
162547
14.50
0.87
23574
18.36
1.10
29839
Male Migration, 2001 Census
InterIntraState
state
67.14
4.01
109134
Intradistrict
Overall
100
Top 5 districts for inter-state out-migration
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
% Total Pop.
NA
-
HRG Size
Program Target
-
2009
5
5
1
4
50
9
3
2
2
50
2
3
-
2010
5
5
1
4
83
8
4
3
1
2
50
2
3
-
2011
5
5
1
4
91
7
4
3
1
2
18
2
3
-
2012
5
5
1
4
93
7
4
3
1
2
18
2
3
-
Mumbai
Ganjam, Nandurbar, Thane, (Suburban), Dhule,
MaharashOdisha MaharashMaharash- Maharashtra
tra
tra
tra
2012
Street
based1.51%
2011
-
Home
basedKothiDaily
61.93%; 32.92%; InjectorsNA;
Brothel PanthibasedNA;
Non daily
36.56%;
Double InjectorsNA
decker66.08%
Program Coverage
Typology
% <25 yrs.
% Married
28.63
11.93
67.67
55.09
STI/RTI
2010
2009
143237
0.13
Programme Response
2006
2007
2008
1
1
3
1
1
1
1
8
42
8
8
8
3
3
1
1
2
2
2
2
2
3
3
3
-
163724
0.12
2005
1
1
8
1
3
-
190388
0.30
2004
1
1
8
1
-
No. episodes treated 484477
% Syphilis positivity
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
Comm. care centres
Drop-in-centres
Condom Outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); ­4 PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 51
Surendranagar
Background:
Surendranagar district is located in the central region Surendranagar District
ofGujarat, in the Saurashtra peninsula. The district has a
population of 17.55 lakh, a sex ratio of 929 females per
1,000 males; female literacy rate of 62.20%, with an overall
literacy rate of 73.19% (Census 2011). Surendranagar
is one of the largest producers of “Shankar” Cotton
in the world and, is also the home to the first cotton
trading exchange in India. Surendranagar is a base for
industrial sectors such as textiles, chemicals, ceramics
and food processing industries. Some of the major tourist
destinations in the district are Tarnetar Mela, Chotila Hills
and Ranak devi Temple. Surendranagar’s dry air is believed
to be the best place in Gujarat to cure tuberculosis patients,
since the colonial times. National Highway 8A passes through the district connecting it to Ahmedabad and Kutch.
HIV Epidemic Profile: • Based on 2012 HSS-ANC data,HIV prevalence was moderate at 0.50% among the ANC attendees. It was reported at 0.25% in both the
2010 and 2007 HSS rounds.
• According to 2012 PPTCT data, HIV positivity was low at 0.11% among the PPTCT attendees, with a stable trend.
• According to 2012 Blood Bank data, HIV positivity was low at 0.12% among the Blood Bank donors, with a stable trend.
• According to 2010 HSS-FSW data, HIV prevalence was low among FSWs.
• In 2012, HIV prevalence among ICTC attendees was low among male (1.46%) and female (0.54%) clients, as well as among referred
(1.18%) and direct walk-in clients (0.79%).
• According to 2008 HRG mapping data, FSW (1,793; 51.82% of the total HRG) was the largest HRG in the district followed by MSM
(1,667; 48.18% of the total HRG). 80.41% and 45.49% of the mapped MSM and FSW were married. The major typology for FSWs was
home-based (94.69%).
• In 2012, 7,397 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.53%.
• As per the 2001 Census, 8.43% of the male population were migrants; among them 4.34% migrated to other states and 46.66%
migrated to other districts within the state.
• The top two destinations for out-of-state migration were Thane and Mumbai (Suburban), Maharashtra.
• According to 2012 ICTC data, HIV transmissions from parent to child, through unknown routes at and through homosexual routes was
at 8.70%, 6.52% 5.80%, respectively, out of the total reported cases in the district.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 37.9% and 24.1%, respectively.
• In 2012, there were only two composite TI sites in operation,for the over 3,000 estimated HRGs in the district.
Key Recommendations:
• Initiate at least two TI sites each for FSW and MSM in the district immediately, as there is a sizable HRG population in the district.
• Considering the HIV prevalence among HSS-ANC attendees, socio-demographic analysis is needed to ascertain risk factors.
• Improve the quality of counseling at ICTCs, since the rate of unknown HIV transmission is high. Reinforce positive prevention messages.
• Conduct in-depth analysis of ICTC data to understand the profile of these attendees, as the transmission from parent to child (8.70% of
all reported cases) and through MSM (5.80% of all reported cases) is notable.
• Vulnerability factors for HIV transmission needs to be analysed from ICTC and STI data. This accordingly can inform HIV prevention
interventions
52 | District HIV/AIDS Epidemiological Profiles : Gujarat
Surendranagar
2005
*
*
*
*
0
250
-
400
2006
1.75
400
*
*
0.18
1126
3.27
214
-
470
14648
26585
32644
67071
47146
District Population: 17,55,873 (2.91% of Gujarat Population); Female Literacy1: 62.20%; ANC Utilization2: 39%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
0.25
0.25
0.50
HSS-ANC
400
397
400
*
0.10
0.18
0.06
0.10
0.11
PPTCT
*
7033
12422
12472
19336
19560
*
0.25
0.18
0.17
0.04
0.12
Blood Bank
*
1187
8562
8470
5489
9669
HSS-STD
0
HSS-FSW
249
HSS-MSM
HSS-IDU
4.75
3.13
1.74
3.57
1.46
ICTC Male
4382
7659
10432
26441
13856
2.85
1.69
0.91
0.24
0.54
ICTC Female
3233
6504
9740
21294
13730
3.63
2.17
1.37
3.68
1.18
ICTC Referred
4741
8881
12712
23642
14814
4.45
2.97
1.29
0.51
0.79
2874
5282
7460
24093
12772
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
833
% Married
-
% Widowed
or Divorced
13
NT
% Ill., Prim. Edu.
-
62
ICTC Direct
Walk-in
Total tested at
ICTCs 5
% 15-24 yrs
79
PLHIV Profile, 2012
% On ART
11
75.72
Hetero-sexual
5.80
Homo-sexual
2.54
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
0.72
-
-
-
-
Total,
4.6
Unknown
-
% of Total
(N=276)
-
-
-
Other,
5.7
Parent to
Child
57
No. HRG-FSW
-
-
-
Patdi,
0.64
6.52
ART (1554)
No. HRG-MSM
-
-
Halvad,
3.2
Wadhwan, Chotila,
2.2
3.4
Dhangadhra,
2.9
8.70
DLN (NA)
No. HRG- IDU
-
Sayla,
4.76
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
% Pos;
ICTC
Limbdi,
5.4
Block-Level Details
% Pos;
PPTCT
% Total HRG
Size Est., (Mapping,
Year: 2008)
0.10
51.82
1793
FSW
NA
0.09
48.18
1667
MSM
-
NA
-
-
NA
IDU
8.43
66401
4.34
0.37
2879
46.66
3.93
30980
Male Migration, 2001 Census
InterIntraState
state
49.01
4.13
32542
Intradistrict
Overall
100
Top 5 districts for inter-state out-migration
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
% Total Pop.
NA
-
HRG Size
Program Target
-
2009
2
15
5
2
1
1
1
1
-
2010
2
30
5
2
1
1
1
1
1
-
2011
2
36
5
3
1
2
1
8
1
-
2012
2
47
5
3
1
2
1
8
1
-
Mumbai AhmadnaThane,
(SuburNashik,
Pune,
gar,
Maharash- ban),
Maharash- Maharashtra
Maharash- Maharashtra
tra
tra
tra
2012
Street
basedNA
2011
-
Home
basedKothiDaily
94.69%; 59.23%; InjectorsNA;
Brothel PanthibasedNA;
Non daily
5.31%;
Double InjectorsNA
decker40.77%
Program Coverage
Typology
% <25 yrs.
% Married
14.69
47.27
80.41
45.49
STI/RTI
2010
2009
Programme Response
2006
2007
2008
11
14
2
4
5
2
2
1
1
-
7739
0.53
21358
-
2005
2
-
7027
1.52
No. episodes treated
% Syphilis positivity
2004
2
-
7731
1.82
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
Comm. care centres
Drop-in-centres
Condom Outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); ­4 PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 53
The Dangs
Background:
Dangs is a tribal district located in southern Gujarat. The The Dangs District
district shares its border with the State of Maharashtra and
is covered with high hills and dense forests. It is the least
populous district of Gujarat with a population of 2.26 lakh,
with a sex ratio of 1007 females per 1,000 males; female
literacy rate of 68.75%, with an overall literacy rate of
76.80% (Census 2011). As per the Planning Commission,
Dangs is the most backward district in India. In Dangs,
50% of population is working. Majority of population
is dependent on agriculture for their livelihood. Animal
husbandry and bamboo cutting are the other economic
activities in the region. Dangs district is gradually emerging
into an agro processing and tourism hub. The reserved
forests in Dangs are amongst the richest forests in the State. Saputara is an important tourist destination in the district. Rich wildlife, gardens,
ropeway, sunrise point and echo point are some of the main tourist attractions in Dangs. Dangs is well connected with Maharashtra state
by roads.
HIV Epidemic Profile:
• Based on 2010 HSS-ANC data, HIV prevalence was low at 0.28% among the ANC attendees compared to 0.27% and 0% ANC HIV
prevalence in 2010 and 2008 respectively .
• According to 2010 PPTCT data, HIV positivity was low among the PPTCT attendees.
• In 2012, HIV positivity among ICTC attendees was low among male (0.89%) and female (0.67%) clients, and also among referred
(0.95%) and direct walk-in (0.47%) clients, with a stable trend among all the ICTC clients, but an abrupt increase in the positivity was
observed among male and referred clients in 2011.
• In 2012, 1,362 STI/RTI episodes were treated.
• As per the 2001 Census, 13.30% of the male population were migrants; among them 3.97% migrated to other states and 50.51%
migrated to other districts within the state.
• The top two destinations for out-of-state migration were Nandurbar and Nashik, Maharashtra.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 15.2% and 8.8%, respectively.
• In 2012, there was no information about the presence of a functional TI in the district.
Key Recommendations:
• Continuation of HIV prevention efforts to contain and reduce the HIV epidemic.
• Conduct socio-demographic analysis of HSS-ANC attendees to ascertain risk factors, considering the HIV prevalence and HIV positivity
rate among ANC attendees.
• Conduct disaggregated analysis of PPTCT data to assess risk factors in the district.
• Considering high rate of migration, strengthen outreach programme through awareness campaigns around source and transit points such
as railway stations and bus stands. Conduct special awareness campaign especially among general population, pockets of out-migrants
transit points and around truck halting points and highways in the district.
• Availability of ART or DLN data will help in better understanding of district vulnerabilities.
54 | District HIV/AIDS Epidemiological Profiles : Gujarat
The Dangs
2442
3446
District Population: 2,26,769 (0.38% of Gujarat Population); Female Literacy1: 68.75%; ANC Utilization2: 20.9%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
0
0.27
0.28
HSS-ANC
400
376
361
*
0
0
0
PPTCT
*
1133
1198
1111
*
*
Blood Bank
*
*
HSS-STD
HSS-FSW
HSS-MSM
HSS-IDU
1.06
0.66
0.82
11.46
0.89
ICTC Male
658
455
972
803
1119
1.40
1.09
1.25
0
0.67
ICTC Female
571
460
878
528
893
2.12
1.52
1.39
9.54
0.95
ICTC Referred
660
526
1151
922
1375
0.18
0
0.43
0.98
0.47
569
389
699
409
637
2006
*
*
-
1850
% Widowed
or Divorced
-
2113
% Married
-
2005
*
*
-
2362
-
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
519
% Ill., Prim. Edu.
-
52
% 15-24 yrs
-
-
% On ART
-
NT
-
ICTC Direct
Walk-in
Total tested at
ICTCs 5
-
PLHIV Profile, 2012
ART (NA)
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Unknown
-
-
-
-
-
Parent to
Child
-
-
-
-
0
No. HRGFSW
-
-
-
-
0
No. HRGMSM
-
-
-
0
DLN (NA)
Homo-sexual
0
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
Hetero-sexual
0
No. HRGIDU
-
-
Block-Level Details
100
% Pos;
ICTC
-
% of Total
(N=16)
% Pos;
PPTCT
% Total Pop.
% Total HRG
Size Est., (Mapping,
Year: 2008)
NA
0.03
100
57
FSW
-
NA
0
0
0
MSM
-
NA
0
0
0
IDU
12506
0.53
496
50.51
6.72
6317
Male Migration, 2001 Census
InterIntraState
state
45.52
6.06
5693
Intradistrict
Overall
13.30
3.97
-
2011
4
1
1
1
-
-
2012
4
1
1
1
3
-
-
100
2010
4
1
1
-
Top 5 districts for inter-state out-migration
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
Program Target
-
HRG Size
Program Coverage
2012
2009
1
1
1
-
Nandurbar, Nashik,
Maharash- Maharashtra
tra
2011
1362
-
Non daily
InjectorsNA
Daily
InjectorsNA;
KothiNA;
PanthiNA;
Home
basedNA;
Typology
Brothel
basedNA;
STI/RTI
2010
2179
2.57
Double
deckerNA
3792
2.56
Street
basedNA
2009
2005
1
-
-
9718
1.97
-
-
2004
1
-
% <25 yrs.
% Married
No. episodes treated
% Syphilis positivity
-
Programme Response
2006
2007
2008
1
1
1
1
1
1
1
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
Comm. care centres
Drop-in-centres
Condom outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); ­4 PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 55
Vadodra
Background:
Vadodara, one of India’s most cosmopolitan cities, is Vadodara District
located to the south east of Ahmedabad, on the banks of
river Vishwamitri. The district is bounded by Panch mahal
and Dahod districts to the north, Anand and Kheda districts
to the west, Bharuch and Narmada districts to the south,
and the state of Madhya Pradesh to the east. The district
has a population of 41.57 lakh, a sex ratio of 934 females
per 1,000 males; female literacy rate of 74.40%, with an
overall literacy rate of 81.21% (Census 2011). The district
is referred to as the “Sanskar Nagari” (City of Culture) due
to its rich cultural traditions. The industrial clusters include
chemicals and fertilizers, pharmaceuticals, biotechnology,
cotton textiles, machine tools, glass, engineering, tobacco,
fisheries and dairy. It has major tourist attractions including The Baroda Museum and Art Gallery, Sursagar Lake, The Tribal Museum, etc.
National Highway (NH) 8 and State Highway 6 pass through the district.
HIV Epidemic Profile: • Based on 2012 HSS-ANC data, HIV prevalence was moderate at 0.50% among the ANC attendees, with a fluctuating trend.
• According to 2012 PPTCT data, HIV positivity was low at 0.16% among the PPTCT attendees, with a stable trend.
• According to 2012 Blood Bank data, HIV positivity was low at 0.11% among the Blood Bank donors, with a stable trend.
• According to 2010 HSS data, HIV prevalence was low among FSWs (3.61%) and MSM (2.01%), with an overall declining trend.
• In 2012, HIV positivity among ICTC attendees was low among male (2.82%) and female (2.19%) clients, as well as among referred
(2.47%) and direct walk-in (2.91%) clients, with a fluctuating trend among male and referred client, but a declining trend among female
and direct walk-in clients.
• According to 2008 HRG size mapping data, MSM (5,894; 65.21% of the total HRG; 54.04% married) was the largest HRG in the district
followed by FSW (2,770; 30.65% of the total HRG; married) and IDU (374; 4.14% of the total HRG). 54.04% and 84.04% of the mapped
MSM and FSW respectively, were married. The major typology for FSWs was home-based (34.13%).
• In 2012, 22,826 STI/RTI episodes were treated and the syphilis positivity rate among STI clinic attendees was 0.52%.
• As per the 2001 Census, 6.85% of the male population were migrants; among them 8.89% migrated to other states and 28.39%
migrated to other districts within the state.
• The top two destinations for out-of-state migration were Thane and Mumbai (Suburban), Maharashtra.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women was 37.2% and 17.7%, respectively.
• In 2012, seven TI sites (4 MSM TI, 2 FSW TI and 1 composite TI) were in operation, while there were over 8,500 estimated number of HRG
in the district.
Key Recommendations:
• Continue efforts to decrease and limit the spread of the infection further, considering the number of HIV positive cases, HRG size estimate,
and other vulnerability factors.
• Increase the number of TI sites in the district considering the large number of mapped HRGs.
• Conduct socio-demographic analysis of HSS-ANC attendees to understand risk factors associated with HIV transmission among the
general population. Strengthen HIV prevention efforts among married women.
• Focus on IDU-FSW sexual networks and address the dual risk that is posed due to infection among IDUs and a large number of FSWs.
Strengthen and improve quality of outreach programme for IDUs and FSWs.
• Since the largest HRG are MSM, a better assessment of the size and profile of MSM and partner population, will help in better understanding
of district vulnerabilities.
56 | District HIV/AIDS Epidemiological Profiles : Gujarat
Vadodra
2006
0.25
400
*
*
0.15
25366
3.35
239
8.40
250
6.80
250
-
48332
57743
87542
68870
District Population: 41,57,568 (6.89% of Gujarat Population); Female Literacy1: 74.40%; ANC Utilization2: 50.2%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
0.50
0
0
0.50
HSS-ANC
400
399
400
400
0.74
0.40
0.28
0.22
0.12
0.16
PPTCT
1760
4712
25656
26775
43523
35611
0.09
0.11
0.16
0.16
0.13
0.11
Blood Bank
27675
35627
65478
70915
31246
80823
HSS-STD
9.60
7.20
3.61
HSS-FSW
250
250
249
2.00
3.35
2.01
HSS-MSM
250
239
249
HSS-IDU
8.65
5.47
3.37
8.60
2.82
ICTC Male
5423
14400
18463
23455
19895
8.88
5.10
2.95
0.63
2.19
ICTC Female
2996
8276
12505
20564
13364
7.29
4.63
3.08
5.88
2.47
ICTC Referred
5569
16838
25629
31125
25391
11.54
7.37
3.78
2.45
2.91
2850
5838
5339
12894
7868
2005
0.25
400
*
*
0.20
20326
2.40
250
6.80
250
4.00
250
-
13131
% Married
-
% Widowed
or Divorced
13
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
1760
% Ill., Prim. Edu.
-
61
470
% 15-24 yrs
72
318
% On ART
11
NT
-
36
ICTC Direct
Walk-in
Total tested at
ICTCs 5
ART (6063)
PLHIV Profile, 2012
DLN (NA)
Hetero-sexual
1.75
-
Homo-sexual
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Unknown
88.07
-
-
-
-
-
Parent to
Child
% of Total
(N=855)
-
-
-
-
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
No. HRGFSW
-
-
-
-
3.16
No. HRGMSM
-
-
-
4.44
No. HRGIDU
-
-
Block-Level Details
0.58
% Pos;
ICTC
-
1.99
% Pos;
PPTCT
% Total HRG
Size Est., (Mapping,
Year: 2008)
0.07
30.65
2770
FSW
NA
0.14
65.21
5894
MSM
-
NA
0.01
4.14
374
IDU
6.85
130022
8.89
0.61
11557
28.39
1.95
36917
Male Migration, 2001 Census
InterIntraState
state
62.72
4.30
81548
Intradistrict
Overall
100
2009
2
4
1
26
9
2
1
1
50
1
1
-
2010
2
4
1
62
8
2
1
1
50
1
1
-
2011
2
4
1
89
9
3
1
1
1
-
2012
2
4
1
119
9
3
1
1
1
-
Mumbai
Thane,
(SuburPune,
Raigarh, Jhabua,
Maharash- ban), Maharash- Maharash- Madhya
tra
Mahatra
tra
Pradesh
rashtra
Top 5 districts for inter-state out-migration
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
% Total Pop.
NA
-
HRG Size
Program Target
-
Street
based32.74%
2012
-
Home
basedKothiDaily
34.13%; 66.67%; InjectorsNA;
Brothel PanthibasedNA;
Non daily
33.13%;
Double InjectorsNA
decker33.33%
Program Coverage
Typology
% <25 yrs.
% Married
2011
Programme Response
2006
2007
2008
1
1
1
1
1
1
8
18
7
7
8
2
2
1
1
1
1
1
1
1
-
18.65
46.67
84.04
54.04
STI/RTI
2010
2009
37575
-
-
2005
1
1
5
1
1
22826
0.52
2004
1
1
5
1
-
24215
0.62
No. episodes treated
% Syphilis positivity
-
18713
1.37
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
Comm. care centres
Drop-in-centres
Condom outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); ­4 PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 57
Valsad
Background:
Valsad district is located at the southern most tip of
Valsad District
Gujarat, near the Gulf of Khambhat. It is bound by Navsari
district to the north, Nashik district of Maharashtra state
to the east, and Union Territory of Dadra and Nagar Haveli
and Thane district of Maharashtra to the south. The district
has a population of 17.03 lakh, a sex ratio of 926 females
per 1,000 males; female literacy rate of 74.96%, with
an overall literacy rate of 80.94% (Census 2011). Focus
industry sectors include chemicals, textiles, horticulture
industry and paper industry. Tourism is a major economic
activity observed in the district. Udawada City is an
important tourist destination in Valsad district for the Parsi
pilgrims due to the presence of the Fire Temple which is a
World Heritage Site, Daman and Lady Wilson Museum. National Highway (NH) 8 passes through the district.
HIV Epidemic Profile:
• Based on 2012 HSS-ANC, HIV prevalence was low at 0.25% among the ANC attendees.
• According to 2012 PPTCT data, HIV positivity was low at 0.25% among the PPTCT attendees.
• According to 2012 Blood Bank data, HIV positivity was low at 0.12% among the Blood Bank donors.
• In 2012, HIV positivity among ICTC attendees was low among male (2.18%) and female (1.55%) clients, as well as among referred
(2.12%) and direct walk-in (1.41%) clients, with overall decreasing trend among all the ICTC attendees.
• According to 2008 HRG mapping data, MSM (492; 53.83% of the total HRG) was the largest HRG in the district followed by FSW (422;
46.17% of the total HRG). The major typology for FSWs was street-based (100%). 63.35% and 80.56% of mapped FSW and MSM
respectively were married.
• In 2012, 7,995 STI/RTI episodes were treated.
• As per the 2001 Census, 8.52% of the male population were migrants; among them 17.84% migrated to other states and 21.37%
migrated to other districts within the state.
• The top two destinations for out-of-state migration were Thane, Maharashtra and Daman, Daman & Diu.
• According to 2012 ICTC data, HIV transmissions from parent to child and through unknown routes accounted for 7.40% and 8.68% of
the total reported cases (n=311) respectively in the district.
• According to DLHS-III data, the HIV and STI/RTI awareness rate among women were50.5% and 22.7%, respectively.
• In 2012, two composite TI sites were operational, and around 900 individuals identified as HRGs in the district.
Key Recommendations:
• Continue attention to limit the spread of HIV infection in the district, noting the number of HIV positive cases, HRG size and other
vulnerability factors.
• Improve counseling at ICTCs, since the rate of unknown HIV transmission reported out of all cases is high. Strengthen efforts for positive
prevention.
• Considering the reported parent to child transmission cases (7.40% of all reported cases) it is necessary to strengthen PPTCT program
coverage in the district, and reinforce HIV prevention messages to married women.
• Considering the high rate of migration (to high HIV prevalent districts), strengthen outreach programme through awareness campaigns
around source and transit points such as railway stations, bus stands, around truck halting points and highways and also at the tourist
spots in the district.
• Availability of DLN data would help in better understanding of district vulnerabilities.
58 | District HIV/AIDS Epidemiological Profiles : Gujarat
Valsad
2005
1.10
19255
-
438
2006
0
400
*
*
0.45
20017
-
1109
12260
15987
24521
24279
26471
District Population: 17,03,068 (2.82% of Gujarat Population); Female Literacy1: 74.96%; ANC Utilization2: 47%
HIV Levels and Trends3
2007
2008
2009
2010
2011
2012
0.50
0.76
0
0.25
HSS-ANC
400
397
399
399
0.54
0.31
0.33
0.16
0.22
0.25
PPTCT
1109
6522
8808
9589
8177
10010
0.28
0.21
0.12
0.12
0
0.12
Blood Bank
22268
21654
28033
30388
31268
21624
HSS-STD
HSS-FSW
HSS-MSM
HSS-IDU
5.77
3.33
1.96
5.73
2.18
ICTC Male
3604
4325
8657
9657
8956
5.95
2.66
1.51
0.81
1.55
ICTC Female
2134
2854
6275
6445
7505
5.22
2.91
1.78
5.25
2.12
ICTC Referred
4369
5182
8000
9348
11124
7.82
3.46
1.77
1.69
1.41
1369
1997
6932
6754
5337
PP4
NT4
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
PP
NT
-
% Married
-
% Widowed
or Divorced
5
NT
% Ill., Prim. Edu.
-
20
ICTC Direct
Walk-in
Total tested at
ICTCs 5
% 15-24 yrs
21
PLHIV Profile, 2012
% On ART
16
79.74
Hetero-sexual
-
2.57
-
-
Homo-sexual
-
-
-
-
-
-
-
-
-
-
-
-
-
-
0
-
-
-
-
Block-Level Details
-
-
-
-
Unknown
-
% of Total
(N=311)
-
-
Other,
5.26
-
-
-
DharamKaparada,
pur,
4.16
3.42
-
Parent to
Child
54
No. HRG-FSW
-
-
Umargam,
4.69
-
8.68
ART (1454)
No. HRG-MSM
-
Pardi,
9.04
-
7.40
DLN (NA)
No. HRG- IDU
Valsad,
7.41
-
Route of HIV Transmission, ICTC 2012
Blood
Needle/
Transfusion
Syringe
% Pos;
ICTC
-
1.61
% Pos;
PPTCT
% Total Pop.
% Total HRG
Size Est., (Mapping,
Year: 2008)
NA
0.02
46.17
422
FSW
-
NA
0.03
53.83
492
MSM
-
NA
-
-
-
IDU
8.52
62594
17.84
1.52
11164
21.37
1.82
13376
Male Migration, 2001 Census
InterIntraState
state
60.79
5.18
38054
Intradistrict
Overall
100
2009
2
7
6
1
1
1
-
Thane,
Daman,
Maharash- Daman &
tra
Diu
2010
2
21
5
1
1
1
-
2011
2
21
5
1
1
1
1
9
-
2012
2
21
5
1
1
1
1
9
-
Dadra &
Nagar
Mumbai
Haveli, Mumbai, (Suburban),
Dadra & MaharashMaharashtra
Nagar
tra
Haveli
Top 5 districts for inter-state out-migration
No. outmigration
% of male
pop.
% total
migration
Vulnerabilities
Program Target
-
HRG Size
Program Coverage
Non daily
InjectorsNA
Daily
InjectorsNA;
Kothi84.3%;
PanthiNA;
Double
decker15.7%
2012
2011
Street
based100%
Brothel
based0%;
Home
based0%;
Typology
% <25 yrs.
% Married
10.42
29.85
80.56
63.35
STI/RTI
2010
2009
Programme Response
2006
2007
2008
5
7
5
5
5
1
1
1
-
7995
0
11200
-
2005
4
-
20065
0.07
No. episodes treated
% Syphilis positivity
2004
4
-
14712
0.05
No.
FSW TIs
MSM TIs
IDU TIs
Comp. TIs
ICTCs
Blood Banks
STI clinics
ART centres
Link ART centres
PLHIV Networks
Red Ribbon Clubs
Comm. care centres
Drop-in-centres
Condom Outlets
* Inadequate sample size; - Data not available; 1 2011 Census; 2 Source: DLHS III; 3 Data presented only for years where sample size is valid (HSS-ANC ≥ 300, HSS-HRG/STD ≥ 187, ICTC ≥ 600, PPTCT ≥ 900 and BB ≥ 900); ­4 PP = percent
positive, NT = number tested; 5 General clients & pregnant women.
District HIV/AIDS Epidemiological Profiles : Gujarat | 59
The National AIDS Control Programme has a strong focus on district level planning,
implementation and monitoring of interventions for prevention and control of HIV. The
Programme is generating a rich evidence base on HIV/AIDS through a robust and expanded
HIV Sentinel Surveillance system, monthly reporting from programme units, mapping and
size estimations, behavioural surveys as well as several studies, research projects and
evaluations.
In this context of increased availability of data and the requirement of decentralized planning
at the district level, a project titled “Epidemiological Profiling of HIV/AIDS Situation at district
and Sub-district Level using Data Triangulation” was undertaken by the National AIDS Control
Organisation in 25 states (539 districts). The objective of this exercise was to develop district
HIV/ AIDS epidemic profiles, by consolidating all the available information for a district at one
place and drawing meaningful inferences using Data Triangulation approaches.
This technical document is an outcome of the data triangulation process and consists of
a snapshot on the district background, and on the HIV epidemic profile of each district
based on the available updated information, thereby giving an overview of the HIV epidemic
scenario in each of the districts of the State.
This document would be useful for the HIV programme managers and policy makers at all
levels to help in decision making, as well as for researchers and academicians as a quick
reference guide to the HIV/AIDS situation in the districts.
National AIDS Control Organisation
India’s voice against AIDS
Ministry of Health & Family Welfare, Government of India
th
6 & 9th Floors, Chandralok Building, 36, Janpath, New Delhi - 110001
www.naco.gov.in

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