National AIDS Control Programme (NACP)

Seminar Write-Up | BSc Nursing 4th Semester

Introduction

What is NACO?

• NACO = National AIDS Control Organisation
• Established in 1992 under the Ministry of Health and Family Welfare, Government of India
• It plans, implements, and monitors India's national HIV/AIDS response
• Works through State AIDS Control Societies (SACS) in each state
• Coordinates with NGOs, civil society, international donors (World Bank, Global Fund, UNAIDS)

Five Phases of NACP

Phase I - NACP I (1992-1999)

• India's first organized HIV/AIDS programme
• Goal: Slow the spread of HIV, reduce morbidity and mortality
• Key actions: Blood bank safety, awareness campaigns, setting up surveillance
• Established basic infrastructure for HIV response

Phase II - NACP II (1999-2006)

• Goals: Reduce spread + strengthen national capacity
• Shifted focus from just "awareness" to behaviour change
• Set up Voluntary Counselling and Testing Centres (VCTCs)
• Launched PPTCT (Prevention of Parent to Child Transmission) programme
• Became 100% centrally sponsored scheme
• Implemented in 32 states and Union Territories

Phase III - NACP III (2007-2012)

• Goal: Halt and reverse the epidemic
• Scaled up prevention among High-Risk Groups (HRGs) - sex workers, men who have sex with men (MSM), injecting drug users (IDUs), transgender persons
• Expanded Integrated Counselling and Testing Centres (ICTCs)
• Decentralised services to district level
• Focused on universal access to prevention, care, and treatment

Phase IV - NACP IV (2012-2017)

• Goal: Reduce new infections by 50% from 2007 baseline
• Provided comprehensive care for all PLHIV (People Living with HIV)
• Free ART (Antiretroviral Therapy) scaled up significantly
• More focus on involving PLHIV networks to fight stigma
• Introduced oral Pre-Exposure Prophylaxis (PrEP) demonstration projects

Phase V - NACP V (2021-2026) ← CURRENT PHASE

• Budget: Rs. 15,471.94 crore (fully funded by Government of India)
• Goal: End AIDS as a public health threat by 2030
• Aligned with UNAIDS Global AIDS Strategy 2021-2026 and UN SDG 3.3
• Governed under the HIV and AIDS (Prevention and Control) Act, 2017

NACP V - Specific Objectives (Most Important for Exam)

1. Reduce new HIV infections and AIDS-related deaths by 80% from 2010 baseline by 2025-26
2. Achieve 95-95-95 targets (explained below)
3. Dual elimination of vertical transmission of HIV and syphilis
4. Eliminate HIV/AIDS related stigma and discrimination
5. Universal access to quality STI/RTI services for all at-risk populations

The 95-95-95 Targets (UNAIDS Global Target)

• ~81% PLHIV know their status
• ~88% of those diagnosed are on ART

• 95% of those on ART have suppressed viral loads

• Overall, about 69% of all PLHIV have suppressed viral loads

HIV Burden in India - Key Facts

• India has approximately 23.18 lakh (2.3 million) PLHIV (2020 estimates)
• Adult HIV prevalence: 0.22%
• New infections reduced by 46% between 2010 and 2021
• HIV first detected in India in 1986 in Chennai
• High-prevalence states include: Maharashtra, Andhra Pradesh, Karnataka, Tamil Nadu, Telangana, Manipur, Mizoram, Nagaland
• Major routes of transmission: unprotected sex (85%), blood transfusion, injecting drug use, mother to child transmission

Key Services Under NACP

1. ICTC (Integrated Counselling and Testing Centre)

• Free HIV testing and counselling at government facilities
• Both provider-initiated and client-initiated testing
• Pre-test and post-test counselling is mandatory
• Results are confidential

2. ART Centres (Antiretroviral Therapy)

• Free ART available at government ART centres across India
• Treat All policy (2017): Every PLHIV is started on ART regardless of CD4 count or clinical stage
• First-line ART: usually Tenofovir + Lamivudine + Dolutegravir (TLD)
• Over 1,700 ART centres across the country

3. PPTCT / eMTCT Programme

• PPTCT = Prevention of Parent to Child Transmission
• eMTCT = Elimination of Mother to Child Transmission
• All pregnant women tested for HIV at antenatal clinics
• HIV-positive mothers get ART to reduce transmission to baby to <2%
• Baby given Nevirapine syrup after birth

4. Targeted Interventions (TI)

• Special programmes for high-risk groups: female sex workers, MSM, transgender, IDUs
• Run through NGOs and community-based organisations
• Services include condom distribution, STI treatment, counselling, harm reduction

5. Link Worker Scheme (LWS)

• Extends HIV services to rural areas
• Community workers (Link Workers) identify at-risk individuals and link them to services

6. Opioid Substitution Therapy (OST)

• For injecting drug users
• Reduces needle sharing and HIV transmission among IDUs

7. Blood Safety

• Strict regulations for blood banks
• Mandatory testing of all donated blood for HIV, Hepatitis B, Hepatitis C, syphilis, malaria
• Phased out professional blood donors

8. Condom Promotion

• Free condom distribution and social marketing
• Red Ribbon Express - train-based awareness campaign across India

HIV and AIDS (Prevention and Control) Act, 2017

• Informed consent is mandatory for HIV testing (except court orders, research)
• Confidentiality of HIV status must be maintained - sharing without consent is an offence
• No discrimination in employment, healthcare, education, or housing on the basis of HIV status
• Right to treatment - no PLHIV can be denied healthcare
• Ombudsman in each state to handle complaints of discrimination
• Age of consent for testing reduced to 12 years for orphaned or vulnerable children

Role of Nurses in NACP (Very Important for BSc Nursing)

1. Counselling - Pre-test and post-test HIV counselling at ICTC
2. Testing - Collecting blood samples, conducting rapid HIV tests
3. Patient education - About disease progression, ART adherence, safe sex, nutrition
4. ART support - Monitoring for side effects, ensuring adherence, tracking patients lost to follow-up
5. PPTCT - Antenatal counselling, testing, and follow-up of HIV-positive mothers
6. Infection control - Universal precautions, safe needle disposal, PEP (Post-Exposure Prophylaxis) after needle-stick injury
7. Reducing stigma - Treating PLHIV with dignity and educating community
8. Referral - Linking patients to support groups, social welfare schemes, legal help

Post-Exposure Prophylaxis (PEP) - Important for Nurses

• Report immediately to supervisor
• Wash the wound with soap and water
• Start PEP within 72 hours (sooner is better)
• PEP drugs are taken for 28 days
• Follow-up HIV testing at 6 weeks, 3 months, 6 months

Stigma and Discrimination - A Key Challenge

• People fear testing because of discrimination
• PLHIV face rejection from family, loss of jobs, denial of healthcare
• Nurses have a professional and ethical duty to treat every patient equally
• Use person-first language: say "person living with HIV" - not "AIDS patient" or "HIV victim"
• Red Ribbon is the universal symbol of HIV/AIDS awareness and solidarity

World AIDS Day

• Observed every year on December 1
• Theme for 2025: "Overcoming Disruption, Transforming the AIDS Response"
• Red ribbon is worn to show support for PLHIV
• Nurses can participate in awareness walks, health camps, school programmes

India's Progress - Quick Summary

Conclusion

Quick Revision Points

• NACO established: 1992
• HIV first detected in India: 1986 (Chennai)
• NACP phases: 5 (current is NACP V, 2021-2026)
• Budget of NACP V: Rs. 15,471.94 crore
• Goal: End AIDS by 2030
• 95-95-95 target: Know status / On ART / Viral suppression
• Treat All policy: Since 2017 (all PLHIV on ART regardless of CD4)
• HIV Act: 2017 (protects rights of PLHIV)
• PEP: Start within 72 hours of exposure, continue for 28 days
• World AIDS Day: December 1 every year
• PLHIV in India: ~23.18 lakh
• Adult HIV prevalence: 0.22%