National AIDS control Programme
The State AIDS Society registered in November, 1998 as per the national policy on decentralization of the activities relating to the control and prevention of AIDS through the country had the powers to issue sanction and release of funds for the implementation of the National AIDS Control Programme in the State. The Society had been delegated with the administrative and financial powers in respect of issuance of sanction for undertaking procurement, award of contract etc. These societies are broad based with its members representing all government departments like Social Welfare, Finance, and Education etc.

The Kerala State AIDS Cell, the earlier body constituted for control and prevention of HIV/AIDS was formed in December, 1993 as per guidelines of the National AIDS Control Organization under the Ministry of Health and Family Welfare, Government of India. The National AIDS Control Programme is a totally centrally sponsored programme funded by World Bank. The period of programme (NACP1) was from 1992-97 and was extended till 31st March 1999. The second phase of the programme-the New AIDS project came into force with effect from 1..4.99 and will be in force till 2004.One of the conditions of this project was that the State AIDS Cell be converted to a Society registered under Charitable Societies Act.

Kerala also followed the same pattern and The Kerala State AIDS Control Society was registered under the Travancore Cochin Literacy and Scientific Charitable Societies Registration Act 1955 as per G.O.MS.No.300/98/H&FWD.dt.21/10/98 on 27/11/99 with the Registration No.T-1853 and is functioning from 1/4/99 onwards.

1. Chief Secretary	Chairman
2. Principal Secretary to Govt., Health & FW Dept.	Vice Chairman
3.Addl.Secretary to Govt.  Health & FW Dept.	Member
4.Secretary to Govt.Finance Dept.	Member
5.Secretary to Govt. Social Welfare Dept.	Member
6.Secretary to Govt.general  Education Dept	Member
7.Director of Medical Education	Member
8.Director of Health Services	Member
9.Drugs Controller	Member
10.Inspector General of Police (Law & Order)	Member
11.Project Director, KSACS	Member Secretary
12. State AIDS Programme Officer	Member

The  Executive Committee consists of the following

1. Principal Secretary to Govt.,Health & FW Dept.	Chairman
2. Addl.Secretary to Govt. Health & FW Dept.	Member
3.Secretary to Govt.Finance Dept.	Member
4.Seretary to Govt. Social Welfare Dept.	Member
5. Director of Medical Education	Member
6. Director of Health Services	Member
7. Project Director, KSACS	Member Secretary
8. State AIDS Programme Officer	Member

National AIDS Control Project – Phase I (1992 – 1997)
1992-1997: An acceleration of the programme, backed by World Bank funding and a strong WHO Global Programme on AIDS (GPA) support.

In order to combat the onslaught of the HIV/AIDS epidemic effectively, the Government of India established National AIDS Control Organisation (NACO) in 1992. A National AIDS Board was constituted under the chairmanship of Secretary (Health), Ministry of Health & Family Welfare in order to review NACO policies, to expedite sanction approve procurement and to undertake and award contracts to private agencies. Achievements included much higher levels of awareness creation, the putting in place of State level structures for programme implementation and improvements in “Blood Safety”. The launch and consolidation of successful individual intervention projects such as the innovative work in Sonagachi amongst commercial sex workers and breakthroughs in reaching out to college youth through University Talks AIDS (UTA) programme were amongst its achievements. The scope of these efforts remained, however, on a limited scale; political acceptance was weak and ownership of the programme by the State proved difficult to establish. Involvement of Non Government Organisations (NGOs) at the peripheral level and of quality needed for sustained interventions proved difficult to obtain. And while the emphasis was on blood safety and strengthening of infrastructure, the approach remained primarily medical, with HIV being seen as largely a health issue. Although the Ist phase of the National AIDS Control Programme was for five years, due to slow implementation in the initial period it was extended to March, 1999.

In order to strengthen the programme management at the state level, the State Governments have established their own managerial organisations, which include State AIDS Cells, Technical Advisory Committees and empowered committees as per the guidelines of the strategic plan.

ACHIEVEMENTS OF PHASE I

1. Intensive awareness campaigns through electronic and print media and the field publicity units of the Ministry of Information & Broadcasting in both the urban and rural areas resulted in generation of awareness about the disease both in the high risk groups and the general population. Awareness levels are of the order of 60-65 per cent on an average in urban areas and 35-40 per cent in rural areas. The highest awareness levels are in Tamil Nadu where it is 95% in urban areas and 75% in rural areas.

2. Awareness programs through school and college education has been taken up on a large scale in 18 States.

3. To ensure safe blood to the population, 815 blood banks in Government and voluntary sector modernised in phases and 40 blood component separation facilities have been established throughout the country. Mandatory testing of blood for HIV, Syphilis, Malaria and Hepatitis B, has been introduced throughout the country. Infection through blood transfusion has been brought down appreciably over the last 2-3 years.

4. For control of Sexually Transmitted Disease which have a direct correlation with HIV/AIDS, 504 STD clinics in district hospitals have been taken up for modernisation. Syndromic management of STD cases has been introduced and doctors are being put on intensive training of syndromic management techniques for STDs.

5. Over 2200 key trainers for training of doctors have been trained in clinical management of HIV/AIDS diagnosis. The Indian Medical Association (IMA) has so far trained 16,000 general medical practitioners with support from NACO.

6. For the promotion of voluntary counseling and testing, 141 voluntary blood testing centres have been sanctioned. These centres at presently are mostly located in Medical College Hospitals.

7. For tracking the epidemic in the country, 180 sentinel sites have been established. These sites include both high-risk groups like Sex Workers, Intravenous Drug Users as well as low risk group pregnant women attending antenatal clinic. One round of sentinel surveillance is carried out each year during the period of August – October.

8. Targeted Interventions: Several targeted intervention projects have been implemented for groups practicing risky behaviour. These interventions include outreach activities, IEC and interpersonal communication, condom promotion, and general health and STD service provision. Targeted intervention projects such as that for commercial sex workers in Calcutta’s Sonagachi area, the Men who have Sex with Men project in Chennai, truck drivers in Rajasthan and Injecting Drug Users in Assam, Manipur and Nagaland have increased the use of condoms and reduced STD, yielding lessons in best practice.

9. Role of Non-Government Organisations: NGOs have played a major role in initiating and ensuring effective interventions, defending the  human rights of people living with HIV/AIDS and in providing care and support to people living with HIV/AIDS.

The Government of India has also made active efforts to involve NGO participation, State AIDS Cells have been particularly effective in mobilising community involvement. The Maharashtra State AIDS Cell, for example, works through a nodal NGO to coordinate the work of all other NGOs in the state, while the TNSACS has a nodal NGO officer on its staff. An NGO-AIDS Cell has been established at All India Institute for Medical Sciences. The States AIDS Cells are empowered to sanction grants to NGOs.

10. Intersectoral Collaboration: NACO has promoted intersectoral collaboration with other ministries such as Human Resource Development, Information and Broadcasting and the Railways. NACO has successfully collaborated with the Steel Authority of India and the Indian Oil Corporation in HIV/AIDS prevention efforts.
11. Private Sector Collaborations: Effective collaborations have also been built with the private sector through the Confederation of Indian Industry and the Bengal Chamber of Commerce. The Tata Iron and Steel Company, for example, has incorporated HIV/AIDS prevention in their ongoing family welfare programmes.

National AIDS Control Project – Phase II (1999 – 2004)

Giving a major focus to targeted intervention amongst groups with the highest risk behaviors (sex workers (SWs); injecting drug users (IDUs); truck drivers and broadening the approach to a multi-sectoral one. The current phase of the national programme has seen the emergence of a strongly decentralised programme with responsibility for implementation clearly placed with the States. State AIDS Cells were created in all the 32 states and UTs of the country for the effective implementation and management of the National AIDS Control Programme. However to remove the bottlenecks faced by the programme implementation at the State level new and more flexible State structures of State AIDS Control Societies have been formed with strong mechanisms for programme management at state level including a strong NGO component of targeted interventions, supported by efforts for mobilising the community around awareness and treatment of sexually transmitted diseases/reproductive tract infections. Innovative approaches to providing technical support to state programmes have been launched through a network of 12 Technical Resource Groups (TRGs) each covering different thematic areas of the epidemic. Surveillance has been both expanded and strengthened. With a new round of resource mobilised from Government of India, the International Development Agency, major bilateral donors and the UN system, the programme is moving into an important new phase of implementation.

The preparation of the new programme has contributed to a growing momentum behind the national response, symbolised by the Prime Minister’s strong statement to Parliamentarians in December 1998 calling for renewed efforts to combat HIV, not as a health problem but as a threat to India’s development. The country has clearly moved, beyond denial into a new phase of response.

The National AIDS Control Project – Phase – II aims:
(i) To shift the focus from raising awareness to changing behaviour through interventions, particularly for groups at high risk of contracting and spreading HIV;
(ii) To support decentralisation of service delivery to the States and Municipalities and a new facilitating role for National AIDS Control Organization. Program delivery would be flexible, evidence-based, participatory and to rely on local programme implementation plans;
(iii) To protect human rights by encouraging voluntary counseling and testing and discouraging mandatory testing;
(iv) To support structured and evidence-based annual reviews and ongoing operational research; and
(v) To encourage management reforms, such as better managed State level AIDS Control Societies and improved drug and equipment procurement practices. These reforms are proposed with a view to bring about a sense of ‘ownership’ of the programme among the States, Municipal Corporations, NGOs and other implementing agencies.

Project Objectives
Phase II of National AIDS Control Programme has two key objectives namely; (a) To reduce the spread of HIV infection in India; and
(b) Strengthen India capacity to respond to the HIV/AIDS on a long term basis.

Some special features of program delivery and management in Phase II:
> Delegated financial and administrative authority to NACO
> Ownership of the state and decentralised program at the state level Ø Involvement of the community in social mobilization and awareness at the grass-root level
> Major role of the NGOs in the implementation of intervention programs for marginalized population
>Involvement of democratic institutions (Panchayati Raj) and youth organisation at the district, block and village level.

Project Scope
Reflecting the extreme urgency with which HIV prevention and control need to be pursued in India, the AIDS – II project of the National AIDS Control Programme covers across all State and Union Territories as a Centrally Sponsored Scheme with 100% financial assistance from Government of India direct to State AIDS Control Societies and selected Municipal Corporation AIDS Control Societies. The scope of the project would vary with each intervention taking into account the need and absorptive capacity, feasibility and efficiency. The immediate need is to have a paradigm shift in our response against HIV/AIDS at all levels with the overall goal to contain the further spread of HIV at a fairly low level of HIV prevalence.

Project Targets
The programme has the following firm targets t be achieved during project period:-
(i) To reduce blood-borne transmission of HIV to less than one percent of the total transmissions.
(ii) To introduce Hepatitis C as the fifth mandatory test for blood screening. (iii) To set up 10 new modern blood banks in uncovered areas, upgrading of 20 major blood banks setting up of 80 new district level blood banks in uncovered districts, establishing another 40 blood component separation units, promotion of voluntary blood donation and increase its share in total blood collected to at least 60%. The total blood collection in the country which is now around 3 – 3.5 million units is sought to be raised to 5 – 5.5 million units by the end of the project.
(iv) To attain awareness level of not less than 90% among the youth and those in the reproductive age group.
(v) To train up at least 600 NGOs in the country in conducting targeted intervention programmes among high-risk groups and through them promote condom use of not less than 90% among these groups and control of STDs. (vi) To conduct annual Family Health Awareness Campaigns among the general population and provide service-delivery in terms of medical advice and provision of drugs for control of STDs and Reproductive Tract Infections (RTIs). These campaigns will be conducted jointly by NACO and RHC programme managers at the State level. Through this it is proposed to reduce the prevalence of STDs / RTIs in the general community from the present level of about 15 – 20%.
(vii) Promotion of voluntary testing facilities across the country at the end of the project. It is visualised that every district in the country would have at least one voluntary testing facility.
(viii) Awareness campaigns will now be more interactive and use of traditional media such as folk arts and street theatre will be given greater priority in the rural areas. It is proposed to cover all the schools in the country targeting students studying in Class IX and Class XI through school education programmes and all the universities through the “Universities Talk AIDS” programme during the project period.
(ix) Promotion of Organisations of people living with HIV/AIDS and giving them financial support to form self-help groups.

COMPONENTS OF PHASE – II
1. Priority targeted interventions for populations at high risk
This component of the project aims to reduce the spread of HIV in groups at high risk by identifying target populations and providing peer counseling, condom promotion, treatment of sexually transmitted infections etc. This component would be delivered largely through Non Government Organisations, Community based Organisations and the Public sector.
2. Preventive interventions for the general population
The main activities would be: (a) IEC and awareness campaigns; (b) provide voluntary testing and counseling; (c) reduction of transmission by blood transfusion; an (d) prevention of occupational exposure.
3. Low Cost care for people living with HIV/AIDS Under this component activities would provide financial assistance for home based and community based care, including increasing the availability of cost effective interventions for common opportunistic infections.
4. Institutional strengthening
This component aims to strengthen effectiveness and technical managerial and financial sustainability at National, State and Municipal levels, strengthening surveillance activities and building strong Research & Development component, including operational research etc.
5. Inter-sectoral collaboration
This component would promote collaboration amongst the public, private and voluntary sectors. The activities would be co-ordinated with other programmes within the Ministry of Health & Family Welfare and other central ministries and departments. Collaboration would focussed on:
(I) learning from the innovative HIV/AIDS programmes that exist in other sectors; and
(II) sharing in the working, generating awareness, advocacy and delivering interventions.
Monitoring and Evaluation of the Progamme
For the effective monitoring and evaluation to asses the implementation of the Phase-II of the National AIDS Control Project at National and State level, the following mechanism has been envisaged.
(i) Creating a Computerised Management Information System (CMIS) at the National and State levels;
(ii) Training NACO Staff and Health specialists in evidence based health programme management.
(iii) Conducting base line, mid term and final evaluation;
(iv) Conducting the Annual Performance and Expenditure Review (APER); and (v) Conducting the National Performance Review (NPR) under the National AIDS Control Board.
A National level independent outside agency is being identified who would b assigned the responsibility of development of CMIS conduct of base line, mid-term and end term evaluation.
Financial Management System
It is envisaged to maintain an adequate project financial management system to provide accurate and timely information regarding project resources and expenditure t facilitate efficient project management. For this purpose an consultancy agency is being selected for developing a Project Financial Management System for NACP-II
The financial management system would be integrated one for the whole project. A common set of policies and procedures would apply to the entire project and a consolidated set of financial reports for the project would be prepared from the FMS.