AIDS in India: The next agenda. By Piot UNAIDS

[Guest guest]

AIDS: the next agenda

By Piot

Unless the cycle of infections that feeds the disease

is stopped, treatment will prove unsustainable.

THE INTERNATIONAL AIDS conference held in Bangkok in

July 2004 witnessed intense debates around the

response to AIDS. Although prevention was widely

discussed, it was not the central issue it used to be.

It became clear during the conference that the theme

" Access for All " really meant treatment. For sure,

massive scale up of treatment programmes is a moral

and practical imperative — it will save lives and

protect the economies of many countries by keeping

alive their most productive populations. India too,

has announced plans to roll out treatment. Yet,

prevention will still need to remain the first line of

defence in its quest to stop the spread of the

epidemic.

India has to acknowledge the implications of greatly

expanded access to anti-retroviral treatment. Hundreds

of thousands will need to remain on treatment for

life. New infections will add hundreds of thousands

more to the `treatment list' each year. Unless the

cycle of infections that feeds the disease is stopped,

treatment will prove unsustainable and the goal of

universal access will be only a dream.

Today fewer than one in five persons worldwide has

access to HIV prevention services. The time has come

to reinvigorate prevention efforts and to move beyond

the current, reactive methods. And simply adding the

`V' for vulnerable groups to the important " ABC "

prevention approach is not enough (ABC stands for

abstinence, being safer, and correct and consistent

condom use). India has painfully learnt that in the

past few years as shown by the steady increase in HIV

infections among women. Much longer term strategies

are needed.

First, information and awareness will not be enough to

address the plight of women in India. Close to half of

those living with HIV worldwide are women and young

girls. They are more vulnerable to infection than men

because they are disempowered. Women's rights must be

translated from an ideal into legal reality.

Secondly, the youth of India must be protected. India

has nearly 200 million young people. Most of them have

little access to prevention programmes and services.

Protecting them at the very least includes promoting

girls' education, increasing employment opportunities,

reducing child exploitation and abuse, reducing stigma

and discrimination, and creating an enabling

environment for youth participation in

decision-making.

Thirdly, national and State Governments together with

donors, multilateral organisations should recognise

that prevention is not the unscientific, feel-good

issue best left to NGOs, community and faith-based

organisations. Preventing the spread of AIDS is a

science and must be embedded in every aspect of the

national response to AIDS.

Each prevented infection means one less person to

treat, thereby easing the pressure on health systems.

HIV prevention is a classic " public good " — it is

needed by whole communities, but, unlike treatment,

there are few immediate profit incentives for the

private sector to be involved. Governments, State and

Central, must take responsibility for making

prevention available. Only with stepped up commitment

on treatment and prevention can the AIDS epidemic be

controlled.

(Dr. Piot is Executive Director of the Joint

United Nations Programme on HIV/AIDS, UNAIDS, and

Under Secretary-General of the United Nations

http://www.hindu.com/2004/11/13/stories/2004111307221000.htm