HIV/AIDS Control Programme in Goa 

HIV/AIDS epidemic in Goa is more than 16 years old. In this short period it has emerged as one of the most serious public health concerns. The available sentinel surveillance data clearly indicates that HIV infection is prevalent in almost all parts of Goa and in recent years has spread from urban to rural and from individuals practicing high-risk behaviour to general population. With no vaccine or cure till date, prevention is the only way to control the epidemic through promotion of behavioural changes, adoption of healthy lifestyle and reduction of risk of infection. 

In order to alleviate the epidemic’s devastating social and economic impact, concerted efforts are being made at all levels to control the spread of infection, reduce peoples’ vulnerability to HIV and to promote community and family based care to HIV/AIDS cases under AIDS Control Programme.
In Goa HIV/ AIDS control programme was launched in May 1992 with the setting up of the ‘AIDS Cell’ under the Directorate of Health Services. As per the guidelines of Government of India, for smooth flow of funds to the programme and for greater functional autonomy, Goa State AIDS Control Society (GSACS) ( http://goasacs.nic.in ) was established in April 1999. For effective control and prevention of the epidemic, GSACS primarily facilitates and directs various activities at the State and local levels. 

The first phase of the National AIDS Control Programme (NACP) was implemented during 1992-1999 mainly to slow down the spread of HIV, to reduce future morbidity, mortality and the impact of AIDS by initiating a major effort in the prevention of HIV transmission. 

The second phase of NACP (1999-2006) had two key objectives viz.
  (i) Reduce the spread of HIV infection in Goa and
(ii) Strengthen Goa’s response to HIV/AIDS on a long-term basis. 

Some of the strategies adopted in its efforts to prevent and control HIV/AIDS were: 

Prevent further spread of the disease by:
    Improving HIV/AIDS awareness and providing necessary skills/tools to protect themselves.
    Controlling STDs including condom promotion.
    Ensuring availability of safe blood and blood products.

Creating a socio-economic environment that enables individuals to protect themselves from infection and allow families and communities to provide care and support to people living with HIV/AIDS.

Improve services at all levels – hospitals and community based home care – that provide care for people living with HIV/AIDS.

The Phase-III (2007-12) of AIDS Control Programme will no doubt build on the strengths developed, lessons learnt, gaps identified and experiences gained in the previous two phases of NACP, and consolidate the achievements. However, HIV can no more be the sole agenda of one organisation or department. Mainstreaming HIV/ AIDS into the existing responses of various development processes and government / non-government responses is a cost effective and efficient approach to address the direct and indirect causes and impact of the epidemic. 

Strengthened partnerships with traditional and non-traditional stakeholders from Government, Civil society and Private sector are a critical strategy for facilitating sustained outreach and coverage. The long-term vision of NACP III is to make HIV/ AIDS everybody’s responsibility and move towards the goal - to stabilise HIV prevention – zero new HIV infection.

Some of the visions envisaged in the NACP III would be: 

By creating an enabling environment conducive for mobilization and empowerment and achieving saturated coverage (80%) of high-risk population towards reducing the risk of HIV infection by 2012. This includes addressing the core issue of capacity building among all constituencies involved in the planning and implementation of TI.

To have a holistic approach to service delivery and provide all the required services at one stop centre in an integrated mode. Improve quality of care, enhance, and support initiatives for HIV infected ensuring sustained care and support with 90% coverage for OIs/ ART.

To have a cohesive training strategy to translate the overall objectives of strategic planning for HIV/ AIDS prevention and control into reality with capacity building as the guiding principle.
Decentralisation of the entire planning and implementation process down to District/ Taluka/ grass root levels to match the ground realities.

To protect all sexual acts having risk of HIV/ STI transmission and unintended pregnancies by enhancing knowledge and behaviour change, increasing access and minimizing wastage of condoms and directing specific condom promotion strategies.

To prevent further spread of HIV to the general population based on the vulnerability. 
The vision is: Together we will win against HIV/ AIDS through social ownership and social action.
Greater Involvement of People living with HIV/AIDS (GIPA) i.e. empowered involvement of people living or affected by HIV/ AIDS, which is critical for appropriate and effective responses.

Everyone having access to rights without any discrimination, including the highest standard of health, living, services, information, support structures, facilities and networks.

To mitigate the vulnerabilities of children, adolescents, young people, women and other gendered identities in relation to HIV/ AIDS by enhancing their access and participation to comprehensive and appropriate HIV/ AIDS programme in the prevention of HIV, care and support continuum through rights based gender sensitive approach.

To have evidence based strategic planning and better programme management, Strategic Information Management Unit to be set up at the state level and M & E units to be set up at the District levels with requisite capacity building training for M & E and Project Managers on how to use data for management and in conducting self assessment of service quality & client satisfaction.

With these brief visions, it is proposed to halt and reverse the epidemic in Goa by 2012. 
For the control and prevention of HIV/AIDS in Goa, GSACS over the last 15 years has initiated various measures and has also developed certain infrastructure facilities/ services, which are listed below:

I. Blood Safety
• All the blood banks under the state government i.e. the ones attached to the Goa Medical College and the two district hospitals viz. Hospicio and Asilo have been modernised and suitably strengthened with requisite blood bank equipments, trained manpower, consumables, chemicals and other infrastructure.
• Testing of every unit blood for detecting infections for diseases like Hepatitis B & C, Syphilis and Malaria apart from testing for HIV has been made mandatory to ensure that only safe blood is released for transfusion as per the National Blood Safety Policy. For this purpose necessary kits, equipment, reagents, glassware and blood bags are supplied to the above three blood banks by Goa State AIDS Control Society.
• Goa State Blood Transfusion Council has been set up to oversee blood transfusion services and ensure effective implementation of the programme and better management of blood banking services at State/ District levels.
• Professional donors have been totally banned in Goa and efforts are being made to gradually phase out replacement donors and achieve 100% voluntary donation programme. Voluntary donation has increased from 28.7% in 2000 to 62.6% in 2007.
• Regular blood donors and NGOs who organise blood donation camps on a regular basis are felicitated by the Goa State Blood Transfusion Council at the State level function on Voluntary Blood Donation Day i.e. 1st Oct., in recognition of their contribution.

ii) STD Control Programme

In view of the importance of treatment and control of STD in relation to HIV infection, STD control programme has been made an integral component of AIDS control policy. Government of India has 
accorded top priority to the prevention and control of STDs as a strategy for controlling the spread of HIV/ AIDS in the country. Suitable strategies have been devised for the control and prevention of STD as a priority in the overall planning to control the spread of the HIV infection.

In Goa the STD control is being implemented as a part of the National STD Control Programme since mid sixties by the Directorate of Health Services. With the arrival/ spread of HIV infection and because of its strong relation with STD, the programme was brought under the purview of National AIDS Control Programme in the year 1992 as per the national pattern. With this, the programme has received the much needed boost in terms of:

• All the four Government STD clinics in Goa - in the Department of Skin and V.D., Goa Medical College; Hospicio Hospital, Margao; Asilo Hospital, Mapusa and STD Clinic, Baina have been strengthened by providing technical support, equipment, reagents and drugs.
• Funds have been provided by Goa SACS for renovating the STD Clinics at Hospicio, Asilo and Baina.
• Each STD Clinic is provided Rs.1.00 lakh per year for procurement of drugs, equipment, etc. by Goa SACS.
• Adequate and comprehensive case management including diagnosis, treatment, individual counseling, partner notification, provision of condoms, etc.
• Orientation trainings for all the medical and paramedical workers engaged in providing STD/ RTI services through syndromic approach have been organised. 160 doctors (including private practitioners) have been trained in STD case management through syndrome approach i.e. management of STDs based on specific symptoms and not dependent on laboratory investigations.
• Management of STDs has been incorporated/ integrated in the general health service/ peripheral health system, so that unnecessary referrals can be avoided leaving the specialized service free for management of complicated cases.
• Development of appropriate laboratory services for the diagnosis of STD.
• Early diagnosis and treatment of mostly asymptomatic infections through case finding and screening.
• Special emphasis on early detection and prompt treatment of STDs among High-risk groups such as CSWs, MSM, migrant labour, Truckers, etc. STD referral system has been developed under targeted interventions undertaken by the NGOs in their respective project areas.
• Prevention and transmission of STD/ HIV infection through IEC including raising of awareness to educate the people for responsible sexual behavior, safer sex, condom usage and promotion of appropriate health care seeking behaviour.
• Surveillance to assess epidemiological situation and monitor and evaluate the ongoing STD control programme.
• Sensitisation of community about the problems related to RTIs/ STD through Family Health Awareness Campaign for early detection and referral to CHC/ PHC for treatment. In Goa six such rounds have already been carried out.
• Greater emphasis is placed on strategies to prevent STD through integration of STD prevention in “IEC for HIV prevention”. STD services are being made available through integrating STD case management at the first level of the health delivery system.

iii). Target Intervention 
Since particular groups of people such as commercial sex workers, MSM, truckers, tourism related workers, migrants, street children, etc. are more vulnerable than others to the HIV/ AIDS epidemic, direct intervention programmes among those groups through a comprehensive and integrated approach beginning from behaviour change communications, counseling, providing health care support, referrals, condom promotion and creating an enabling environment that will facilitate behaviour change have been undertaken through NGOs since Oct. 1999 who are being funded by Goa SACS. 

During the year 2007-08 in all 10 TI project have been funded by Goa SACS to the tune of Rs. 110.23 lakhs- one each covering the core groups namely Sex Workers and Men having Sex with Men, Intravenous drug Users and 6 on migrant and truckers. This number is being fortified.
Dealing with HIV is much more than just creating awareness or use of condom. Since the awareness levels are already very high in Goa, we need to go beyond awareness and bring about attitudinal and behavioural change, empowerment, negotiating skill and creation of enabling environment that will facilitate behaviour change. For effective implementation of the targeted intervention efforts are being made for capacity building of NGOs through regular workshops, training programmes, exposure visits, etc.

iv) Integrated Counseling and Testing Centres (ICTCs)
In order to help people know their HIV status, to get early access to care and treatment, to prevent HIV related illness, to maintain safer sexual practices, to cope with HIV related anxiety and to plan for the future, voluntary testing facilities with pre-test/ post-test counseling have been made available at Goa Medical College, one centre each at the two Dist. Hospitals and one at Chicalim Hospital, Vasco. 

During the year 2006-07, four more ICTCs were set up at the CHCs (Canacona, Pernem, Valpoi and Curchorem),. At present, on an average about 2300 blood samples are screened per month, which is likely to increase with setting up of more stand alone ICTCs, and on Pubic Private partnership based ICTCs. Also HIV testing facilities will be made available at 24 PHCs in a phasic manner. From 2007 the VCTC has been changed to ICTC. Integrated because it caters to both pregnant and direct walk in –clients . 

v) Prevention of Parent-to-Child Transmission (PPTCT) of HIV
The prevalence of HIV infection among antenatal attendents in Goa as per the Sentinel Surveillance data ranged between 0 and 1.38% during the period from 1998 to 2006. and in the last three years it varies from 0.50 to 0.18 The PPTCT programme was first launched in Goa Medical College, Bambolim w.e.f. April 2003. With the progression of the epidemic in general population and increase in the proportion of women among those infected, HIV transmission from HIV infected mothers to infant is on the rise in Goa. 

The programme was extended to both the District Hospitals namely Hospicio Hospital, Margao and Asilo Hospital, Mapusa during the year 2005 – 2006.

 I.C.T.C. services has been extended to 4 new centres namely CHC Pernem and CHC Valpoi in North Goa and CHC Canacona and CHC Curchorem in South Goa during the year 2006 - 07.These centers will also cater to the ANC and direct the clients to the nearest PPTCT center for follow-up.

Some of the critical components of PPTCT programme are: 

• The programme envisages effective reduction of HIV infection from mother to child by providing quality antenatal care including preventive services.
• Provision of reproductive health related interventions in couple-setting
• Promotion of rational use of blood
• Voluntary Counseling and Testing for HIV infection
• Health education to pregnant mothers covering nutrition, infant feeding practices, exclusive breastfeeding, birth spacing methods, etc.
• Interventions to reduce mother to child transmission including antiretroviral drugs
• Care and support to HIV infected mothers and children and reducing their vulnerability.


vi) Information, Education, Communication (IEC) & Social mobilization 
Information, Education and Communication (IEC) is a process that informs, motivates and helps people to adopt and maintain healthy practices and life skills. It aims at empowering individuals and enabling them to make correct decisions about safe behaviour practices. IEC also attempts to create an environment that is conducive and supports access to treatment and services for those already infected. In the absence of a vaccine or a cure, prevention is the most effective strategy for the control of HIV/ AIDS and therefore communication is one of the most important strategies in the fight against HIV/ AIDS and STDs. 

The second phase of the National AIDS Control Programme gives highest priority to an effective and sustained strategy to bring about changes in behaviour to prevent further infection. A full range of activities and approaches from mass media campaigns for the general public to target specific interventions to help individuals to negotiate safer practices are being adopted. IEC programmes have also been integrated in various components of the programme such as STD services, condom promotion, Blood safety, TIs, etc.

The basic objectives of the IEC strategy are:

• To raise awareness, improve knowledge and understanding among the general population about AIDS infection and STD, routes of transmission and methods of prevention.
• To promote desirable practices such as avoiding multi-partner sex, condom use, sterilization of needles/ syringes and voluntary donation of blood.
• To mobilise all sectors of society to integrate messages and programmes on HIV/ AIDS into their existing activities.
• To train health workers in AIDS communication and coping strategies for strengthening technical and managerial capabilities.
• To create a supportive environment for the care and rehabilitation of persons with HIV/ AIDS.
The various components of the IEC strategy for raising awareness, behavioural change and social mobilisation are:
• Use of mass media
• Advocacy at various levels
• Inter-sectoral collaboration
• Training
• Involvement of NGOs

In order to develop Information, Education and Communication strategies to key target groups relevant to Goa, a Communication Needs Assessment Study was undertaken by the Tata Institute of Social Sciences, Mumbai in the year 2000. An IEC Committee consisting of qualified and experienced IEC specialists have been formed to strategize, review, provide feedback and extend support to Goa State AIDS Control Society. Some of the activities undertaken by Goa State AIDS Control Society to raise the awareness levels and to bring about behaviour changes are:

A: General 
• General education programmes on HIV/ AIDS are conducted for the youth organisations, voluntary bodies, government departments, women, high risk groups, opinion leaders, schools, colleges, etc.
• Hoardings with messages on HIV/ AIDS displayed at prominent places. 
• Konkani dramas (tiatr) and magic shows on HIV/ AIDS were staged in villages.
• Video spots / audio cassettes/ Awareness promos on HIV/ AIDS. 
• Folk media and floats were organized during the carnival and shigmo parades. 
• Fillers on HIV/AIDS in Konkani has been produced and screened on cable network throughout Goa. 
• Screening of films on stigma discrimination and human rights related to HIV/AIDS.
• Televisions installed in and out-patient departments of GMC for screening of spots on HIV/AIDS during the OPD hours.
• Booklets on (i) Questions and answers on HIV/AIDS (ii) Containing HIV/AIDS in Goa (iii) AIDS in Women and Children and (iv) AIDS Fortnight, etc. were brought out.
• Handbills and pamphlets on STD and HIV/AIDS produced in different languages.
• Posters on STDs/ HIV/ AIDS/ Blood Safety/ Post Exposure Prophylaxis, etc. are produced and distributed to all the hospitals, Health Centres, NGOs, etc.
• Folders on STDs were produced and are being used extensively by field workers for interpersonal communication.
• Six rounds of FHAC were undertaken since 1999 to raise awareness in RTI/ STD/ HIV/ AIDS and encourage treatment seeking behaviour among the general population and marginalized groups.
• House to house awareness by field staff of Health Services and ICDS along with distribution of IEC pamphlets and folders on STD/ HIV/ AIDS.
• World AIDS Day fortnight is observed on 1st December at State level and all the Primary Health Centres as also by the NGOs every year. 
• Voluntary Blood Donation Day is observed on 1st October every year. Regular voluntary blood donors and NGOs who organise regular voluntary Blood Donation Camps are felicitated.
• Posters and greeting cards have been made based on the prize-winning entries of the World AIDS Day commemoration - 2001.
• Informative sessions/ open forum on HIV/ AIDS/ STDs are organised for industrial workers police departments, Postal staff. All queries, doubts, misgivings on sex, sexuality and other related topics are answered by a team of doctors at the work place.

B: Awareness in educational institutions 
• Talks on HIV/AIDS given by the Health Officers/ M.O.s in schools and colleges in their jurisdiction.
• Programme on HIV/AIDS have been carried out at the PTA meetings in different schools in Goa.
• Question-answer sessions have been held in different educational institutions where a panel of resource persons from the GSACS and GMC answer the questions asked by the students anonymously. 
• ‘Disha 2000’, a student-to-student educational programme was launched. Sessions on HIV/ AIDS have been conducted in different schools to the students of Std. IX and Std X. Under this programme, medical interns of Goa Medical College educate the students of high schools and higher secondary schools on family life values including sexuality and HIV/AIDS. 
• A booklet on sexuality and other related issues based on the frequently asked questions by the students has been prepared, which will address the myths and misconceptions that youth have.
• To catalyze an expanded response towards HIV/ AIDS epidemic, Goa SACS has intersect oral collaboration with all the Govt. Depts., NGOs, industries, political leaders, etc. by networking and advocacy.
• Sports has proved to be an effective means of IEC to raise awareness in the state. The Goa Police Football tournament was hosted by Goa State Aids Society in collaboration with the Goa Football Association. At each match venue information stalls and counselors interacted with people Telling them about HIV/AIDS and demonstrating the use of condoms. Condom mascot was created to break the shyness of condom usage. Brand Ambassador was launched to initiate the Aids awareness among the youth. 
• The first issue of the Quarterly News Bulletin was released on 1st October 2005. Newsletter is an endeavour in making everyone aware of Government’s commitment and its role in tackling the HIV/AIDS epidemic in the state of Goa. 

The National AIDS Control Programme seeks to attain awareness level of not less than 90% among the youth and others in the reproductive age group by the end of the project. It is rather encouraging to note that in some key important areas like generation of awareness about HIV/ AIDS which were almost insignificant at the beginning of the epidemic have increased among the general population both in urban and rural areas as also among the high risk groups. 

The Behavioural Surveillance Survey (BSS) carried out by Government of India in 2001 among the general population in various states has revealed that:

• The overall awareness about HIV/ AIDS among people in the age-group 15-49 years in Goa was 93.6%, males 97.0% and females 90.2%. In urban areas awareness levels were much higher being 99.0% for males and 94.6% for females. The lowest awareness was among rural women (87.2%).
• About 92% of the respondents were aware that HIV/ AIDS is transmitted through sex. This level of awareness was next only to Kerala (95%). (Figures for all-India was 71% and the lowest was in Bihar 38%). The corresponding rates were higher among urban residents (95.5) and males (urban males 97.3%) lowest was among rural females (84.4%).
• Awareness of transmission of HIV/ AIDS through blood and sharing of needles was consistently high (92%). About 75% were aware that the infection could be transmitted through breast-feeding.
• About 80% of the respondents were aware of the potential benefits of consistent and correct condom use in prevention of transmission of HIV/ AIDS.
• More than 74% of the respondents were aware that having one faithful and uninfected sex partner could prevent the transmission. A significantly larger portion of the respondents (92%) were aware that sexual abstinence played an important role in prevention of transmission compared to other modes of transmission.
• Knowledge that the HIV infection cannot be transmitted by mosquito bites and sharing of meals with an infected person and that a healthy looking person may be suffering from HIV/ AIDS was relatively low in Goa. More than two-thirds harboured some incorrect beliefs regarding transmission. 
Future strategies to address the gaps and response to the evolving epidemic inter alia include:
• Setting up of mobile exhibition units, innovative flex print displays, high swinging balloons, promoting folk media, magic shows, etc and also leveraging unconventional media like road shows, merchandise items such as mugs, wobblers, T-shirts, etc. in a bid to create community contact.
• Strengthening adolescent education and behavioural change communication amongst the educational institutions, by having more interactive two way programmes.
• Scaling up of School AIDS Education Programme to cover all the Secondary and Higher Secondary Schools in Goa in collaboration with the Directorate of Education.
• Extending ‘Disha 2000’ programme to all Educational Institutions.

In the absence of a vaccine or a cure, prevention is the most effective strategy for the control of HIV/ AIDS. IEC is a process that informs, motivates and helps people to adopt and maintain healthy practices and life skills. A full range of activities and approaches from mass media campaigns for the general public to target specific interventions to help individuals to negotiate safer practices are being adopted.

vii) Community Care Centre 
To take care of AIDS patients two Community Care Centers with 10 beds each, have been set up in Goa which are run by the NGOs and are being funded by Goa State AIDS Control Society. The one in North Goa is located at Guirim, Bardez, which is run, by Freedom Foundation and the other at South Goa is located at Cavellosim, Salcete which is run by Caritas, Goa. This Community Care Centre provides services required in between a home and a hospital. 

viii) Drop in Centre
Two Drop-in-Centres for People Living with HIV/AIDS is run by NGOs funded by GSACS. These centres are Zindagai in South Goa and Positive Life Foundation in North Goa. 

ix) Toll free AIDS helpline 1097
To provide information pertaining to HIV/ AIDS/ STDs, particulars of services available and other related issues including providing psychological support to those already infected, help families and partners of infected persons to receive prevention services, etc., a toll free AIDS Helpline 1097 has been set up. An Interactive Voice Response System has been set up for providing round the clock access to information on HIV/ AIDS, available services and other related issues including providing psychological support to those already infected. 

x) Opportunistic Infection Management
The facilities for the management of the Opportunistic Infections are provided at Goa Medical College at tertiary level and two District Hospitals at Secondary level. The Goa State AIDS Control Society supports all the activities undertaken by Goa Medical College and the hospitals under Directorate of Health Services for OI management. There is absolute co-ordination between the National TB Control Programme, TB and Chest Disease Hospitals and Goa State AIDS Control Society when it come to management of TB-HIV co-infections.

The drugs for OI management shall be procured as per NACO guidelines and approved list of drugs. Estimating 2 episodes per person per year, nearly 6000 episodes would require treatment. The estimated cost would be Rs. 2, 00,000.00. 

Xi) Post Exposure Prophylaxis
The Goa State AIDS Control Society has ensured the Post Exposure Prophylaxis is made available at all the Government hospitals/ health centres. The Health units are either provided finance to procure the drugs or the said drugs are supplied to them. Training sessions and Continuing Medical Education programme are conducted for Government as well as private sector medical professionals and others.

Xii) Workplace Intervention
For strengthening the world of work response to HIV/ AIDS both in the formal and informal sectors a comprehensive work plan has been drawn in close collaboration with the International Labour Organisation, New Delhi and is being implemented w.e.f. December 2004 in Goa. GSACS is working in collaboration with Goa Chamber of Commerce and Industries in this regard. In all eleven industrial organizations have taken the initiatives for the intervention. 

xiii) Training 
Regular training programmes on HIV/AIDS/STD are being organized for doctors and other para medical staff by Goa SACS. Goa SACS also organized regular capacity building trainings for NGO staff. 

xiv) CD4/ CD8 blood count facility: 

For management of HIV/ AIDS patients, CD4/ CD8 count facility has been established at Goa Medical College in July 2001. With the setting up of ART centre at Goa Medical College on an average 6 to 8 patients are screened per day for CD4/ CD8 blood count to verify and assess the immune status of a HIV patient. It is proposed to have additional CD4/CD8 testing facilities in Goa keeping in view the expansion plan of the ART Centres and also increasing number of patients on ART.

Xv) TB / HIV
Collaborative activities

As per NACO sentinel Surveillance report of the year 2006, the prevalence of HIV infection is estimated to be 0.36% of the population, which translated to 2.5 million people living with HIV/AIDS in India. Tuberculosis (TB) continues to be a public health challenge in India and it is estimated that 1.8 cases of TB occur in India annually. Active TB diseases is the commonest opportunistic infection amongst HIV infected individuals, A low cost and high quality cure for TB is provided under the Revised National Tuberculosis Control Programme (RNTCP) which implements the DOTs strategy of treatment for TB nationwide. Standard Short –course anti-TB regimens have been shown to be effective in TB patients with or without HIV infection, In Goa as per estimates 3415 TB occurred annually of which 70% are to be detected. i.e. about 2391 cases. Assuming that 5% of TB patients are HIV positive, it works out to be about 120 patients annually co-infected with TB/HIV. TB HIV cross referrals activities are being carried out with the involvements of DMCs and ICTCs.
TB/HIV collaborative activities were started in the year 2001 in the six high prevalence states and by 2007-2008 are to be extended to the entire country. Goa is being identified as one of the 9 high sero-prevalence states and brought under the Intensified TB Package of Services.

Objectivities of TB /HIV Collaborative Activities:

1. To establish mechanisms for Co-ordination between RNTCP & GSACS at, State and District levels.
2. To decrease morbidity and mortality due to tuberculosis among Persons Living with HIV/AIDS.
3. To decrease the impact of HIV in tuberculosis patients and provide access to HIV related care and support to HIV infected TB patients 

Key activities identified under TB/HIV Co-ordination to be carried out: 

1. Formation of State Co-ordination Committee and State Technical Working Group (STWG)
State Co-ordination Committee formation is already in process. As Goa is a small State, for better co-ordination and proper implementation among the various functionaries it will be proper to form only the State- Co-ordination Committee and State Technical Working Group (TWG) 
2. Services delivery co-ordination and cross –referrals through training of the programme officials and the field staffs and establishment of linkage between services delivery sites of GSCAS in ART Centers, ICTCs, Care & Support Centers and RNTCP diagnostic and treatment services.
3. Involvement of NGOs working in under GSACS and RNTCP in TB /HIV 
4. Operational Research to improve the implementation of TB/HIV Collaborative activities.
5. Implementation of feasible and effective infection control measures.

The service delivery that is to be carried out 

1. Training of Programme Officials and field staff in TB/HIV.
2. Intensified TB Cases finding at ICTCs, ART, Care & Support Centers.
3. Routine Referrals of all TB patients for voluntary HIV Counselling and Testing.
4. Referrals of HIV infected TB patients to NACP for additional Care & Support including ART.
5. Provision of Co-Trimoxazole Preventative therapy (CPT) to HIV infected TB patients
6. Expanded recording and reporting.
7. IEC activities on RNTCP

Xvi) Inter sectoral Collaboration

HIV/ AIDS epidemic is not a health problem alone but every facet of human life is affected. It is therefore imperative for every sector of the society, Government, non-governmental organizations, business, industry, leaders, policy makers and media to be actively involved in the AIDS control programme. Goa State AIDS Control Society has adopted a policy of involving the various sections by effective networking and advocacy. Goa State AIDS Control Society has intersectoral collaboration with different departments such as Health, Education, Social Welfare, Women and Child Development, Labour, Youth Affairs, Industries, etc. The overall goal of collaboration is to catalyse an expanded response towards the HIV/ AIDS epidemic in order to improve prevention and care, reduce people’s vulnerability to HIV and alleviate the devastating social and economic impact of this impact. 

Xvii) School AIDS Education Program (SAEP)

Adolescence Education program has been initiated through the Education Department where safe sex education with health related information and life skill education will be provided. Under the School AIDS Education program about 50% schools have been covered, the balance 50% will be covered this year along with sustaining the ongoing program.

Xviii). Red Ribbon Club (RRC)

Red Ribbon club is a voluntary on campus intervention for youth. These programs will be started in 2007 and plans to cover 60% of the campuses in the State, through multisectoral collaboration with Educations Dept., Indian Red Cross, NSS and Department of Youth and Sports Affairs. 

Xix). Condom Promotion 
 
1. Free Supply: Condom promotion strategies will aim to position condoms for dual benefits of Prevention of STD including HIV and prevention of unwanted pregnancies. Communication messages towards normalization of condom will be developed and disseminated to the population using varieties of media vehicles. The TI sites will have mid –media activities like street plays, and condom demonstrations to ensure correct and consistent use of condoms. 

Under free supply condoms 989800 condoms were distributed to target populations through NGOs
2007-08. GSACS.50 CVM have been installed trough HLLFPPT in the Sulabhs however these are not functioning to the optimum either because of breakdowns or refilling problems. Earlier GSACS had provided condom outlet boxes to TIs this year with a increase in the area of TIs more such outlet boxes are being supplied.
2 Social Marketing: TIs will be imparted training on activities designed to ensure increasing the use and demands for social marketing of condoms