Professional Documents
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Policies Related To Hiv
Policies Related To Hiv
Introduction
HIV/AIDS affects fundamental rights at work, particularly with respect to discrimination and
stigmatization of workers and people living with and affected by HIV/AIDS. Stigma and
discrimination at the workplace gets reflected in the form of loss of employment and
livelihood opportunities in addition to ostracism and seclusion faced by workers either due to
known or presumed HIV status.
The threat of HIV to the Indian working population is evident from the fact that nearly 90%
of the reported HIV infections are from the most productive age group of 15-49 years.
Expanding HIV/AIDS policy and programmes in the world of work is a key component
under the mainstreaming strategy in the National AIDS Control Programme phase-III (2007-
2012).
Aim
This policy, based on principles of human rights, aims to guide the national response to
HIV/AIDS in reducing and managing the impact of the epidemic in the world of work.
Specifically the policy aims to:-
i. Prevent transmission of HIV infection amongst workers and their families;
ii. Protect rights of those who are infected and provide access to available care, support and
treatment.
iii. Protect workers from stigma and discrimination related to HIV/AIDS by assuring them
equity and dignity at the workplace;
iv. Ensure safe migration and mobility with access to information services on HIV/AIDS.
Guiding Principles
The policy adopts the key principles of the ILO Code of Practice on HIV/AIDS and the
World of Work that is in line with the Government of India’s National HIV/AIDS policy. The
ten principles are:
1. HIV/AIDS, a workplace issue
HIV/AIDS is a workplace issue because it affects workers and enterprises, increases labour
costs and reduces productivity. The workplace can play a vital role in limiting the spread and
effects of the epidemic.
2. Non-discrimination
There should be no discrimination or stigmatization of workers on the basis of real or
perceived HIV status. Discrimination and stigmatization of people living with HIV/AIDS
inhibits efforts aimed at promoting HIV/AIDS prevention.
3. Gender equality
Women are more likely to become infected and adversely affected by the HIV/AIDS
epidemic than men due to biological, socio-cultural and economic reasons. Equal gender
relations and the empowerment of women are vital to successfully preventing the spread of
HIV infection and enabling women to cope with HIV/AIDS.
4. Healthy work environment
The work environment should be healthy and safe, and adapted to the physical and mental
state of health and capability of workers.
5. Social dialogue
A successful development and implementation of HIV/AIDS policy and programme requires
full cooperation and trust between employers, workers and governments.
6. No Screening for purpose of Employment
HIV/AIDS screening should not be required of job applicants or persons in employment or
for purposes of exclusion from employment or worker benefits. In order to assess the impact
of HIV, employers may wish to do anonymous, unlinked HIV prevalence studies in their
workplace. These studies may occur provided it is undertaken in accordance with the ethical
principles of scientific research, professional ethics and the protection of individual and
confidentiality. Where such research is done, workers should be consulted and informed that
it is occurring. Testing will not be considered anonymous if there is a reasonable possibility
that a person‟s HIV status can be deduced from the result.
7. Confidentiality
There is no justification for asking job applicants or workers to disclose HIV-related personal
information. Nor should co-workers be obliged to reveal personal information about fellow
workers.
Personal data covered by medical confidentiality should be stored only by personnel bound
by rules on medical secrecy and should be maintained apart from all other personal data.
In case of medical examination, the employer should be informed only of the conclusion
relevant to the particular employment decision. The conclusions should contain no
information of a medical nature. They might as appropriate, indicate fitness for the proposed
assignment or specify the kinds of jobs and the conditions of work which are medically
contra-indicated, either temporarily or permanently.
8. Continuation of Employment relationship
HIV infection is not a cause for termination of employment. Persons with HIV-related
illnesses should be able to work for as long as medically fit in appropriate conditions.
9. Prevention
HIV infection is preventable. The social partners are in a unique position to promote
prevention efforts through information and education, and support changes in attitudes and
behaviour
10. Care and support
Solidarity, care and support should guide the response to HIV/AIDS at the workplace. Care
and support includes the provision of voluntary testing and counselling, workplace
accommodation, employee and family assistance programmes, and access to benefits from
health insurance and occupational schemes.
KEY STRATEGIES
a) Prevention of HIV transmission
b) Provide education and training at all levels in workplaces, set up interventions for
behaviour change through peer educators, integrate HIV in the existing / to be initiated
programmes at workplaces like the training of the Human Resource Department, Welfare and
OHS programmes, Corporate Social Responsibility initiatives etc;
c) Set up interventions for unorganized/informal sector workers and migrant workers, based
on vulnerability studies and risk assessment.
d) Enhance access to condoms, treatment of STIs, universal precaution and Post Exposure
Prophylaxis (PEP).
e) Widen scope of social security coverage to include HIV in employee and family assistance
programmes, health insurance etc.
f) Undertake vulnerable studies/epidemiological surveillance at the workplace to gather
data/information for taking informed policy and programmatic decisions.
1. Creating and ensuring an enabling environment to discourage stigma and
discrimination towards people infected and affected by HIV/AIDS through
following:-
SPECIFIC PROVISIONS
HIV/AIDS policy and programmes should be established in all constituents – Ministries
and their key institutions, employers‟ and workers‟ organisations, public and private
sector enterprises / multi-national companies and civil society organisations, based on the
principles and implementation guidelines. However, specific provisions in these
constituents allow broadening of the opportunity to address the HIV vulnerability and its
impact within its own context.
c) State Council on AIDS are proposed to be set up at the state levels by SACS under the
NACP-III. They will have adequate representation of the state labour departments,
employers‟ and workers‟ organizations, Members of Legislators Forum on HIV/AIDS (LFA)
and will plan and review implementation of the policy at the state levels.
d) MOLE and NACO as part of their steering role will also facilitate implementation of
regular surveys and risks assessments, especially in labour intensive areas to map the
vulnerable populations, migrants, working conditions and other related issues. These studies
undertaken on a regular basis will facilitate identification of gaps in the policy and
implementation, inform appropriate changes in the policy, facilitate identification of work
areas requiring focus from the MOLE and NACO and also facilitate the monitoring of
implementation of the policy guidelines and impact on the HIV vulnerabilities of the work
force.
2 At the workplace
I. Every workplace – organization, institution, businesses, company etc. – should establish an
HIV/AIDS Committee to coordinate and implement the HIV/AIDS workplace policy and
programme. For multinational companies, an HIV/AIDS Committee at corporate level should
be responsible in collaboration with a small team at each plant/location. Alternatively, a team
with representation from concerned departments and led by a senior executive should be
formed to perform this function.
II. The scope and content of the policy and programme will depend on the
organization‟s/company‟s size, needs and resources.
III. A checklist for planning and implementing a workplace policy on HIV/AIDS
IV. Periodic reviewing and monitoring of the policy will allow the organization or the
company to keep up with and adjust to a constantly changing internal and external situation.
V. Regular review of the workplace programme will ensure that it is managed efficiently,
producing the expected results and meeting the needs of the employees.
INTRODUCTION:-
There are an estimated 2.1 million (2011) People Living with HIV (PLHIV) in India, with
National adult HIV prevalence of 0.27% (2011). Of these, women constitute 39% of all
PLHIV while children less than 15 years of age constitute 7% of all infections. Between 2004
and 2013, the number of pregnant women tested annually under the Prevention of Parent-To-
Child –Transmission (PPTCT) programme increased from 0.8 million to 8.83 million and
reach of the services has expandedto the rural areas to a large extent. Mother-to-child-
transmission of HIV is a major route of HIV infection in children.
Statistics in india (2017) 2.1million living with hiv. 0.2% adult hiv prevalence (age 15- 49,
88000 new hiv infections. 69,000 aids related deaths, 56% are in antiretroviral treatment.
Source( UNAIDS DATA 2018)
India has the third largest HIV epidemic in world. In 2017, hiv prevalence among adult ( aged
15-45) was estimated 0,2%. This figure is smallcompaired to most other middle income
countaries bit because if india’s huge population (1.3 billion) this equates to 2.1 million
people living with HIV.
Overall, india’s HIV epidemics is slowing dowmn between 2010 AND 2107 new infections
declined by27% and AIDS related deaths more than halved, falling by 56%. However, in
2017 new infections increased to 88,000 from 80,000 and AIDS related death increased to
69,000 from 62,000. USAIDS(2017)
The National PPTCT programme adopts a public health approach to provide these services to
pregnant women and their children. Currently, the major activities focused under PPTCT
services have been Prong- 3 and 4. However, Prong 1 and prong 2 are also emphasized, to
achieve the overall results of the PPTCT Programme.
Objectives:
1. To detect more than 90 % HIV infected pregnant women in India
2. To provide access to comprehensive PPTCT services to more than 90 % of the detected
pregnant women
3. To provide access to early infant diagnosis to more than 90 % HIV exposed infants
4. To ensure access to anti-retroviral drug (ARVs) prophylaxis or Anti-Retroviral Therapy
(ART) to 100 % HIV exposed infants
5. To ensure more than 95 % adherence with ART in HIV infected pregnant women and
ARV/ ART in exposed children
The PPTCT services provide access to all pregnant women for HIV diagnostic, prevention,
care and treatment services. As such, the key goal is to ensure the integrated PPTCT services
delivery with existing Reproductive & Child Health (RCH) programme.
The guiding principles for the use of ART to prevent HIV transmission from mother-to-
child are:
• HIV infected pregnant women, in need of ART for their own health should receive life-long
ART.
• Postpartum ART initiation to mother and ARV Prophylaxis to child are aimed at improving
HIVfree
child survival by reducing HIV transmission through breastfeeding.
• HIV exposed infants should be followed-up and managed as per the National Guidelines on
“Care of HIV exposed infants and children”.
In India, the PPTCT programme has been in place for many years, and recommended ARV
prophylaxis was sd of Tab Nevirapine (200mg) to mother during labour and single dose of Sy
Nevirapine to the infant at birth.
CO-TRIMOXAZOLE IN PREGNANCY
The indications for co-trimozaxole initiation in pregnant women are same as those for other
adults (CD4≤250 cells/cmm). Co-trimoxazole prophylaxis is helpful in reducing morbidity
and mortality as it prevents Opportunistic Infections (OIs) such as Pneumocystis jiroveci
pneumonia (PCP), toxoplasmosis, diarrhoea as well as other bacterial infections.
Starting Co-trimoxazole in pregnancy
• Co-trimoxazole should be started if CD4 count is ≤ 250 cells/mm3 and continued through
pregnancy, delivery and breastfeeding as per national guidelines (Dose: Double strength
tablet – 1 tab daily).
• Ensure that pregnant women take their folate supplements regularly.
The alternate regimen if the pregnant women are unable to tolerate preferred first-line
regimen are as below:
Under the national programme, it is recommended to provide lifelong ART for all
pregnant and breastfeeding women living with HIV, in which all pregnant women living
with HIV receive a “single-pill” triple-drug ART regimen (TDF +3TC + EFV)
regardless of CD4 count or clinical stage, both for their own health and to prevent
vertical HIV transmission and for additional HIV prevention benefits.
P.T.O
Pregnant and Breastfeeding women with HIV
Ensure linkage
Ensure
to ART
institutional
immediately in
delivery and
post –partum
follow up
period
ART regieme for pregnant women having prior exposure to NNRTIs for PPTCT :-
HIV infected pregnant women who have had previous exposure to Sd NVP (or EFV) for
PPTCT prophylaxisin prior pregnancies, an NNRTI-based ART regimen such as
TDF+3TC+EFV may not be fully effectivedue to persistence of archived mutation to
NNRTIs. Thus, these women will require a protease-inhibitorbased ART regimen viz:
TDF + 3TC + LPV/r (Lopinavir/ritonavir)
The dose will be TDF+3TC (1tabletdaily)+ LPV (200mg)/r (50mg) (2 tablets BD)
Pregnant and breastfeeding TDF + 3TC + EFV FDC of TDF (300 mg) +
women with HIV (ART 3TC (300
Naïve / mg) + EFV (600 mg)- To be
“Not-already” receiving given 2
ART) hours after low-fat or fat-
free dinner
Pregnant and breastfeeding The same ART regimen E.g. If they are already on
women with HIV already must AZT
receiving ART be continued +3TC +NVP/ EFV, continue
the
same regimen
ART regimen for pregnant TDF + 3TC and LPV/r FDC of TDF (300 mg) +
women having prior 3TC (300
exposure to mg) -- 1-tab OD and
NNRTI for PPTCT FDC of LPV (200 mg)/r (50
mg) -
2-tab BD
• Abacavir + Lamivudine +Efavirenz: First line ART Regimen: for all patients with known
renal disease or who develop toxicity to Tenofovir
• As per PPTCT guidelines, all positive pregnant women exposed to NVP/EFV in past should
be initiated on Lopinavir/ritonavir (LPV/r) instead of Efavirenz (EFV).(3)
• Labour room nurse will offer bed side counselling and HIV screening test
• If the woman consents, screen using the “Whole Blood Finger Prick test” in delivery room
or labour ward
• If detected HIV positive, the medical Officer i/c will initiate TDF + 3TC + EFV and ensure
immediate linkage to ART centre Labour room nurse informs the ICTC counsellor and lab
technician for further confirmation of HIV test as per guidelines
Presenting in active labour, Initiate TDF (300 mg) + Continue TDF (300 mg) +
no 3TC 3TC (300
prior ART (300 mg) + EFV (600 mg) mg) + EFV (600 mg)
Nevirapine prophylaxis for breastfeeding infant should be for 12 weeks, as mother did not
receive any ART during ante-natal period. However, EID should be carried out at 6 weeks as
per guidelines.
In the case of false labour or mistaken ruptured membranes, for women taking ART
should continuewith normal dosing schedule of the combination regimen
Caesarean section is not recommended for prevention of mother-to-child-transmission
and only if there is an Obstetric indication for the same.
Use of ARV drugs during Caesarean Sections
• For planned (elective) Caesarean sections, ART should be given prior to the operation.
• Women on life-long ART should continue their standard ART regimen.
• In case of an emergency Caesarean section in pregnant women who are not on ART, ensure
that the women receive ART prior to the procedure and continues thereafter.
All HIV-infected women who undergo Caesarean section should receive the standard
prophylactic antibiotics. Complications of Caesarean section are higher in women with HIV,
with the most frequently reported complication being post-partum fever.(3)
Safer surgical techniques are useful in conducting any operative procedures such as the
Caesarean section, repairing wounds/lacerations etc.:-
Use of ‘dry’ haemostatic techniques to minimize bleeding; i.e. good observation and
following of surgical fascial planes during dissection, judicious use of electro-cautery during
Caesarean section etc.
During Caesarean section, wherever possible, the membranes are left intact until the head is
delivered through the surgical incision. The cord should be clamped as early as possible after
delivery;
• Use of round-tip blunt needles for Caesarean section
• Do not use fingers to hold the needle;
• Use forceps to receive and hold the needle
• Observe good practice when transferring sharps to surgical assistant eg. holding container
for sharps.
For disposal of tissues, placenta and other medical/infectious waste material from the
delivery of HIV-infected deliveries Standard waste disposal management guidelines should
be followed.
Infants with birth 2 mg/kg once 0.2 ml/kg once daily Upto minimum of 6 weeks of
weight < 2000 g daily age
regardless of whether
exclusively
breast fed or exclusively
replacement fed
Birth weight 2000 10 mg once 1 ml once daily Extended to 12 weeks, if the
– 2500 g daily duration of ART received by
the
Birth weight > 15 mg once 1.5 ml once daily mother is less than 24 weeks
2500 g daily and
she is breast feeding
When exclusive breast feeding is not possible for any reason (maternal sickness,
twins), Mothers and health care workers can be reassured that maternal ART reduces
the risk of postnatal HIV transmission in the context of mixed feeding as well.
During the post-delivery period, it is important to continue follow-up and support the
postpartum mother, considering the fact that this is a stressful period and she has to assume
multiple roles and responisbilities as mother, wife and HIV infected person. Wherever
possible, include family counselling (of husband, in-laws, direct family members) to support
care of the HIV infected mother and HIV exposed infant. Postpartum depression & psychosis
is common in HIV infected women.
Involvement of men (husband/close male family members) is important so that the family
support to the HIV-infected mother and infant is optimal. Husband’s support to the
motherbaby pair (m-b pair) should be encouraged so as to:
To remind the HIV positive mother to take ART regularly
Support administration of daily infant NVP prophylaxis medications for 6 weeks to
the baby.
Be involved in care and follow-up of the infant including clinic visits and
immunizationfollow-up; EID and CPT initiation and continuation up to 18 months at
least.
Be involved in care of mother for ART centre visits
Support exclusive breastfeeding for a minimum period of 6 months and continuation
ofbreastfeeds for 1 year in EID negative babies, and up to 2 years in EID positive
babies withinitiation of Paediatric ART. Weaning foods should be introduced from 6
months onwards inall babies whether breast fed or replacement feeds fed.
Insertion of Cu-T (temporary contraceptive method) for HIV infected mother at 6
weeks if apost-partum IUD (PP-IUD) has already not been inserted within 48 hours in
addition tothe use of condoms will prevent unwanted pregnancies (dual protection)
Encourage male sterilization in father (No Scalpel Vasectomy (NSV) between 18
monthsto 2 years when baby’s survival has been ensured).
Post-partum Follow-up and Care Extends Beyond the Six-week Postpartum Period and
Includes:
• Assessment of maternal healing after delivery and evaluation for post-partum infectious
Complications.
• Continued counselling and information on fertility choices and effective post-partum
Contraceptive methods as well as condom promotion and ensuring Cu-T IUD adoption and
Continued motivation for NSV for males at 18 months specifically, in HIV infected pregnant
Women, there should be linking of the baby to the Early Infant Diagnosis (EID) programme
And ART programme for mother/child as indicated.
CONCLUSION :-
As India embarks on the goal of eliminating parent to child transmission of HIV, it is evident
that good coverage with ANC, high rates of HIV testing, effective ART for pregnant and
breastfeeding mothers with ARV prophylaxis to infants will remain key factors contributing
to the success of preventing the vertical transmission.
BIBLIOGRAPHY :-
1. World THE, Work OF. National Policy on HIV / AIDS and the World of Work. :1–32.
CONTENT
ON
POLICY &
GUIDELINE RELATED TO
HIV/AIDS
SUBMITTED TO SUBMITTED BY
MRS. DEBJANI NAYAK Mrs. Sandhya Sahoo
Assistant professior M.Sc. (N) 2nd year
O & G speciality O & G speciality