NACP III and Universal Access

[Guest guest]

An NACP III Goal: " Universal access to HIV prevention, care and

treatment for all- particularly for women and children by 2010 "

Joe

On March 7th and 8th members of the civil society along with the

representative of the government of India, various UN agencies,

bilateral agencies and other international agencies are meeting in

Delhi to review the call for " Universal access to HIV prevention,

care and treatment for all- particularly for women and children by

2010 "

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Hope this national consultation may specifically address, how well

the 3rd National AIDS Control Programme (NACP III) may address the

challenges of " Universal access by 2010. An opportunity to review the

progress made on " Universal Access " plan until 2010 and to think

about timeframes, resources, monitoring, stakeholders' involvement,

targets, challenges, and opportunities.

The government of India, through, National AIDS Control organization

(NACO) has achieved substantial progress in ensuring access to HIV

Prevention, Care, and Treatment in India. All over the country, there

are more than 100 dedicated ARV treatment centers. This is an

unprecedented achievement in the history of public health response in

India.

However, significant gaps exist in ensuring Universal Access to

Prevention, Care, and Treatment, particularly for women and children

by 2010.

" The Millennium Development Goals 6 states that, combat HIV/AIDS,

Malaria and other diseases (Target 7) have halted by 2015 and begun

to reverse the spread of HIV/AIDS. And (the indicators No18). HIV

prevalence among pregnant women aged 15-24 years (And 20) Ratio of

school attendance of orphans to school attendance of non-orphans aged

10-14 years " .

On June 26, 2001 Mrs. Gandhi, Member of Parliament and then

Leader of the Opposition, of Lok Sabha, Parliament of India

addressing the Twenty-Sixth Special Session of the UN General

Assembly on HIV/AIDS in New York, on behalf of the country and the

government committed to the world

" We endorse the Secretary General's call for global, regional and

national level initiatives to meet the challenge " ….. " I would like

to assure you of our deep commitment in India at the highest

political level to do everything we can to control this epidemic "

The declaration of commitment signed by the Indian leaders along with

other global leaders at the UN General Assembly special session on

HIV/AIDS (25 – 27 June 2001) noted among other key issues that

`Care, support and treatment are fundamental elements of an effective

response' and they emphasized " The vulnerable must be given priority

in the response empowering women is essential for reducing

vulnerability. And the global leaders along with the Indian political

leaders acknowledged " Children orphaned and affected by HIV/AIDS need

special assistance "

The article 54 of the statement noted the need " By 2005, reduce the

proportion of infants infected with HIV by 20 per cent, and by 50 per

cent by 2010, by ensuring that 80 per cent of pregnant women

accessing antenatal care have information , counselling and other HIV-

prevention services available to them, increasing the availability

of and providing access for HIV-infected women and babies to

effective treatment to reduce mother-to-child transmission of HIV, as

well as through effective interventions for HIV-infected women,

including voluntary and confidential counselling and testing, access

to treatment, especially anti-retroviral therapy and, where

appropriate, breast-milk substitutes and the provision of a

continuum of care " ;

This was further elaborated in the declaration. " By 2003, develop

and by 2005 implement national policies and strategies to build and

strengthen governmental, family and community capacities to provide a

supportive environment for orphans and girls and boys infected and

affected by HIV/AIDS, including by providing appropriate counselling

and psychosocial support, ensuring their enrolment in school and

access to shelter, good nutrition and health and social services on

an equal basis with other children; and protect orphans and

vulnerable children from all forms of abuse, violence, exploitation,

discrimination , trafficking and loss of inheritance; ensure non-

discrimination and full and equal enjoyment of all human rights

through the promotion of an active and visible policy of de-

stigmatization of children orphaned and made vulnerable by HIV/AIDS " .

The proposed 3rd National AIDS Control Programme (NACP III) provides

an opportunity to ensure Universal access to prevention, care and

treatment for women and Children infected, affected and vulnerable to

HIV & AIDS by 2010.

However, advocacy for " universal access " also raise several

fundamental questions.

1. Advocacy for Universal access to prevention, care and treatment

for women and Children infected, affected and vulnerable to HIV &

AIDS by 2010: Is this demand distorting health care priorities of

the country? Or is it complements the health care needs of the women

and children in India?

2. There is no agreed understanding of what is meant by universal

access to prevention, treatment and care (e.g.100% access to all,

access to all those that need services). What should be our shared

understanding of universal access means in India?

3. What are the key barriers to scaling up responses to HIV/AIDS

prevention, treatment and care to achieve universal access in

India2010? How can these be overcome?

4. Specifically, what kinds of actions are required, and by whom, in

India to overcome the barriers to addressing the following:

a) Financing and macroeconomic constraints (e.g., TRIPS, patents,

budget ceilings);

Addressing Human resource capacity and health and social service

systems constraints;

c) Ensuring Access to affordable commodities and low-cost

technologies (Bactrium, generic ARVs, HIV testing, pediatric

formulations);

d) How to deal with Human rights violations, stigma and

discrimination, and lack of equity

e) Clinical and bio medical research needs

f) Scalable, theory driven pilot intervention models.

5. What support activities are needed for creating awareness-raising

on the Government of India's declaration of Commitment at the UNGASS

and the Universal Access process in India?

6. What are the priority targets (quantity and quality) that need to

be set to reach universal access to prevention, treatment and care

for women and children in India by 2010?

(The following are some of the priory targets for consideration)

• Specific treatment target of women and children on advanced ARV

therapy,

• A white paper on Children infected and affected by HIV/AIDS in

India,

• A national PEP protocol developed,

• PEP available for survivors of sexual violence through all ARV

centers,

• Compulsory license secured for next line of ARV treatment,

• Clinical and social research needs of " Universal access " identified

and addressed,

• A national budgeted initiative to reduce HIV stigma,

discrimination and rights violations

• Annual progress report of " Universal access "

• Civil society included in monitoring the progress of universal

access,

• A regular mechanism to identify Policy challenges of Universal

access,

• CCM agrees to call Global Fund Round 7 exclusively to address the

needs of women and Children,

• A new department for the protection of the best interest of

clinical trial participants/Research ethics regulatory issues are

identified and addressed,

• National AIDS Law is enacted etc..

It is becoming evident that, unless corrective measures have been

initiated, universal access to HIV prevention, care and treatment for

all- particularly for women and children by 2010 would remain as yet

another slogan. Indian HIV/AIDS civil society may not be able blame

the government alone on this situation. It will also be a spectacular

failure of the leaders of Indian civil society engaged in HIV

response. It appears that the call for universal access by 2010 as

development goal failed to attract the imagination of the Indian

civil society engaged in HIV response. Perhaps, this provides an

opportunity for introspection for the leaders of Indian civil society

engaged in HIV response.