VZCZCXRO5642
PP RUEHBI RUEHCI RUEHCN
DE RUEHCI #0250/01 2331130
ZNR UUUUU ZZH
P 211130Z AUG 07
FM AMCONSUL KOLKATA
TO RUEHC/SECSTATE WASHDC PRIORITY 1643
INFO RUEHNE/AMEMBASSY NEW DELHI PRIORITY 1563
RUEHCG/AMCONSUL CHENNAI 0693
RUEHBI/AMCONSUL MUMBAI 0692
RUEHKA/AMEMBASSY DHAKA 0450
RUEHKT/AMEMBASSY KATHMANDU 0456
RUEHGO/AMEMBASSY RANGOON 0305
RUEHCN/AMCONSUL CHENGDU 0096
RUEHIL/AMEMBASSY ISLAMABAD 0369
RUEHLM/AMEMBASSY COLOMBO 0179
RUEHBUL/AMEMBASSY KABUL 0057
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHPH/CDC CDC ATLANTA GA PRIORITY
RUEHC/USAID WASHDC
RUEAIIA/CIA WASHINGTON DC
RUEIDN/DNI WASHINGTON DC
RHEHAAA/NSC WASHINGTON DC
RHMFIUU/CDR USPACOM HONOLULU HI
RUEHCI/AMCONSUL KOLKATA 2019

UNCLAS SECTION 01 OF 02 KOLKATA 000250 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: PHUM KHIV KWMN KGLB TBIO IN
SUBJECT: ORISSA STATE HEALTH OFFICIALS CONCERNED OVER EPIDEMIC LEVELS 
OF HIV/AIDS INFECTION IN MIGRANT POPULATIONS 
 
 
¶1.  (SBU) Summary:  On August 1, ConGen met with Orissa State 
AIDS Control Society (OSACS) officials to discuss the HIV/AIDS 
situation in Orissa.  The interaction revealed worsening 
conditions in this eastern Indian state.  The National Aids 
Control Organization (NACO) characterizes Orissa as a "highly 
vulnerable" state, with a HIV prevalence rate of 0.22 percent 
and 46,141 estimated HIV positive cases according to the 2006 
sentinel surveillance figures.  OSACS officials were concerned 
that the latest surveillance figures showed an increase in the 
number of "high prevalence" districts, from just three districts 
identified in the 2005 survey to four districts in 2006.  These 
high prevalence districts include Ganjam (3.25 percent), Anugul 
(1.75 percent), Bolangir (1.25 percent) and Bhadrak (1 percent). 
 According to the OSACS officials, their efforts are hampered by 
limited funds and NACO's lack of awareness of the seriousness of 
the situation.  The officials believe that the focus on the 
existing high prevalence states, primarily in the South and 
West, by the GOI and international organizations means that 
Orissa is not receiving the attention and resources needed to 
contain effectively HIV/AIDS infections.  Given this existing 
situation, Orissa will likely be ignored by the broader public 
health community until it is too late and it has been graduated 
to the status of a high prevalence state.  End Summary. 
 
 
 
¶2.  (U) NACO identifies Orissa as a highly vulnerable state as 
although it has a low general infection rate of just .22 percent 
of the population, it does have pockets of high prevalence. 
(Note:  Areas are assessed as "high prevalence" if the rate of 
HIV prevalence among ante-natal women is 1% or more.  End Note.) 
 Statewide HIV/AIDS infections are estimated at 46,141 based on 
the .22 prevalence rate within the state population of 36.7 
million.  However, from January 2002 to May 2007 there were 
6,405 actually reported cases of people living with HIV/AIDS. 
The numbers of reported AIDS cases were 883 and deaths due to 
AIDS were 666.  The primary mode of transmission is through 
sexual contact.  An OSACS study estimates that 82 percent of HIV 
infections were contracted through sexual transmission, 6 
percent through parent to child, 3 percent via infected syringes 
and needles and 1 percent through infected blood and blood 
products.  From 2005-06, Orissa had 14 Sentinel Surveillance 
sites covering 10 districts to track HIV/AIDS infections in the 
state.  In 2006-07, 31 new sites were established bringing the 
total to 45 surveillance sites covering all the 30 state 
districts.  According to the 2006 sentinel surveillance, HIV 
prevalence among the ante-natal care (ANC) population was 0.5 
percent, the sexually transmitted diseases (STD) population was 
2.8 percent, the female sexual worker (FSW) population was 1 
percent, the injectable drug user (IDUs) population was 10.4 
percent, the migrant laborer population was 0.4 percent and 
among the truck driver population prevalence was 3.2 percent. 
 
 
 
¶3.  (SBU) The OSACS officials pointed out that in Orissa, the 
problem of HIV/AIDS has certain distinct characteristics. 
Infections are more rampant in the rural rather than urban areas 
and are more present in the marginal or "non-core" population: 
the migrant laborers, fisher folk population along the coast, 
and truck drivers passing through the state; i.e. the "bridge 
population" that is transitory and serves to pass infections 
from community to community.  It is in this bridge population in 
which the infections are spreading the fastest.  OSACS officials 
lamented the fact that NACO budgeted a  nominal amount of money 
for awareness raising and promotional campaigns within the 
bridge populations in Orissa, which according to OSACS are the 
most vulnerable population in the state.  While "core group" 
populations that are typically at risk, such as FSWs, do exist 
and need to be targeted, Orissa is unlike other states with high 
HIV/AIDS prevalence as there are no large identifiable red light 
areas (RLA) in the major cities of Orissa, like Bhubaneswar and 
Cuttack, as compared to larger RLAs in cities, like Mumbai and 
Kolkata.  In 2006-07, OSACS undertook Targeted Intervention (TI) 
 
KOLKATA 00000250  002 OF 002 
 
 
Programs for highly vulnerable core group population such as 
FSWs, men having sex with men (MSMs) and IDUs, and bridge 
groups, like the truck drivers, the migrant workers, the jail 
inmates and the fishing community along the coastal belt, 
through 33 TI projects in 25 districts.  However, OSACS was 
instructed by NACO in March 2007 to stop the jail intervention 
program and truck drivers' intervention program as of March 31. 
OSACS officials felt that NACO did not recognized the fact that 
it is the bridge population that is the most vulnerable group 
and that funds need to be made available for targeted 
interventions for this population, in addition to the core group 
population of FSWs and IDUs. 
 
 
 
¶4.  (U) The state has 35 Voluntary Confidential Counseling and 
Testing Centers (VCCTCs), 26 Integrated Counseling Testing 
Centre (ICTCs) and 32 Prevention of Parent to Child Transmission 
Centers (PPTCTs).  OSACS will set up another 35 ICTCs during the 
current financial year to meet the target of 129 fixed by NACO. 
Primary objectives of ICTC Centres are to provide free pre-, 
post-test counselling; testing of blood samples; free condoms 
and to provide referral services to the patients.  The state has 
three Anti Retroviral Therapy (ART) Centers:  one in MKCG 
Medical College, in the high prevalence district of Ganjam, and 
two recently-opened centers at SCB Medical College Hospital, 
Cuttack and VSS Medical College Hospital, Burla, Sambalpur 
district.  A National AIDS Help Line (1097) is operational in 
OSACS, Bhubaneswar and at the three Medical Colleges for 
tele-counseling of the general public on STD/HIV/AIDS. 
 
 
 
 
 
¶5.  (SBU) OSACS Project Director Parmeshwar Swain appealed to 
ConGen for assistance, noting that his organization is crippled 
by lack of funds for various activities.  Swain said that there 
are hundreds of HIV orphans in the state but that there are no 
homes or any other facility for the care of such children. 
OSACS does not have funds to build a shelter for these children. 
 Swain also requested funds for setting up a pediatric ART 
center in Ganjam district, which as noted has a HIV prevalence 
rate of 3.25 per cent - three times epidemic levels.  Catholic 
Relief Services has offered to provide a certain amount of money 
for treatment per child but funds are first required to set up 
the center.  OSACS runs four community care centers in 
Bhubaneswar, Berhampur, Cuttack and Koraput districts in 
association with local NGOs to provide medicines, psycho-social 
counseling, temporary shelter to people living with HIV/AIDS. 
However, the running of these centers is becoming more and more 
difficult as NACO does not provide OSACS any financial support 
for these centers and the NGOs also lack funds.  OSACS has 
requested if funds could be provided for supporting the running 
of these centers. 
 
 
 
¶6.  (SBU) Comment:  HIV/AIDS infections are increasing in Orissa 
as evidenced by the fact that a new high prevalence district was 
identified this past year.  OSACS is spearheading the fight 
against the spread of the disease in the state but its 
activities are severely constrained by lack of adequate funds 
and understanding from NACO and public health organizations. 
OSACS officials believe that while the broader public health 
focus on high prevalence states is important, ignoring the 
conditions in highly vulnerable states like Orissa will 
ultimately undermine overall efforts to control HIV/AIDS in 
India.  The failure to effectively address the problem now, when 
it can be contained within the bridge populations, means that 
Orissa will likely only receive the appropriate attention when 
it is too late -- once it has graduated to being a high 
prevalence HIV/AIDs state. 
JARDINE