Health Minister Launches NACP III and revise HIV estimate, 2 to 3.1 million

[Guest guest]

HEALTH MINISTER LAUNCHES THIRD PHASE OF NACP

Friday, July 06, 2007, Ministry of Health and Family Welfare

Minister for Health & Family Welfare, Dr. Anbumani Ramadoss launched

the third Phase of the National AIDS Control Programme (NACP), here

today. Speaking on the occasion, he said that there are an estimated

2 million to 3.1 million people infected with HIV/AIDS with a

prevalence level of about 0.36%. He was optimistic of the country's

ability to win the battle against AIDS.

Smt. Panabaka Lakshmi, Minister of State for Health & Family Welfare,

Shri Naresh Dayal, Secretary, H & FW, Ms. K. Sujatha Rao, AS & DG (NACO)

and Representatives of the UN Group, World Bank, DFID, GFATM, USAID

and Private Foundations also attended the function.

The following is the text of the Minister's speech:

" I am indeed very happy to be here today with you all to launch the

Third Phase of the National AIDS Control Programme. Today is a

momentous day for all of us present here as it brings us to the end

of one critical phase in the evolution of our battle against HIV

AIDS. The strategies and approaches outlined in the NACP III indicate

the maturity of the epidemic and the vast improvement in our

knowledge of this disease which continues to challenge our ability to

find a cure. I am also happy to note that the NACP III is founded on

the important principle of equality and inclusion, demonstrated by

giving primary focus to prevention and behaviour change among the

high risk groups through a process of empowerment.

There is one other reason to be happy today. Many of you know how we

have always been found fault with for underestimating the seriousness

of the epidemic. That was a disturbing allegation as we were and

continue to be very committed to containing and reversing the HIV

AIDS epidemic. Today we have with us a far more reliable estimate of

the burden of HIV disease in India. These estimates are based mainly

on two important sources of data. First, we continue to have the data

from our sentinel surveillance, now expanded to 1122 sites from the

earlier 703 sentinel sites. This year we have the additional inputs

from the National Family Health Survey, which is a country wide

community based household survey.

Experts from India and round the world were consulted and after a lot

of hard work and outstanding support from the WHO, UNAIDS, CDC and

other partners, we have been able to arrive at robust figure that all

our experts feel is as correct an estimate as we can get. The results

show that there are an estimated 2 million to 3.1 million people

infected with HIV/AIDS with a prevalence level of about 0.36%. While

the prevalence appears to be less than the previous estimate of 0.9%,

these figures are not comparable. By using the same methodology for

the past years that we used this year, there is only a marginal

reduction in the prevalence. Moreover, in terms of human lives

affected, the numbers are still large and worrying. There is no doubt

in my mind that we cannot let down our vigil but continue to work

hard to ensure that the HIV/AIDS are under total control.

If I am sounding optimistic of our ability to win this battle, it is

because the programme has achieved its aim of keeping the HIV sero-

prevalence below 5% in the high prevalence states and below 3% in the

moderate prevalence states and below 1-2 % in the other states. A

case in point is Tamil Nadu which has shown a consistent decline in

HIV prevalence in the last 5 years. The surveillance reports of 2006

reinforce the fact that expected outcomes of NACP were broadly

accomplished.

Major policy initiatives were launched in NACP II. Initiatives such

as the National AIDS Prevention and Control Policy, National Blood

Policy, provision of Antiretroviral Therapy (ART), strategy for

Greater Involvement of People with HIV/AIDS (GIPA) were initiated

during the NACP II. Programmatically, we achieved good results. 1033

Targeted Interventions were implemented through NGOs among high risk

groups and bridge populations. Facilities providing voluntary

counseling and testing (VCT) and prevention of parent to child

transmission services (PPTCT) were remodeled as `Integrated

Counseling and Testing Centres' (ICTC).

NACP II saw a massive scale up of counselling and testing services

and today more than 10 million people have been counseled and tested

in more than 4000 ICTCs spread throughout the country. The NACP III

now envisages expansion of testing sites to 5000 and establishing

another 10,000 through a system of franchising by forging

partnerships with the private sector. Such expansion is necessary to

achieve 42 million tests by the end of NACP-III. Launching the

provider initiated testing and counseling for patients referred from

clinics treating tuberculosis, STD or pregnant women in high risk

areas will also help us identify persons infected by this virus.

These measures will not only strengthen the prevention and control of

HIV/AIDS but also be beneficial to the health outcomes of people

living with HIV/AIDS.

Blood safety was a major area of focus in NACP II and modernization

of blood banks and installation of blood component separation centres

were taken up. Through these efforts, we have brought down the

transmission of HIV infection through contaminated blood to less than

2%. But we have a long way to go in this area. We have yet to

satisfactorily address the critical issues of volume, access and

quality of blood. There is a lot of private blood collection and also

a shortage of blood. This year, we will be initiating action to

establish 4 centers of excellence in the four metros that will have a

capacity to collect and process one lakh units of blood annually.

To address the various issues related to blood collection, storage,

distribution and supply, we are working on a regulatory framework to

establish a Blood Transfusion Authority on the lines of the FDA. I am

confident that in the next couple of years, we will be able to have a

world class system of blood collection and distribution. This will

help bringing down blood transmissible diseases such as HIV and

Hepatitis B etc.

Condoms, as you know, is the only prophylaxis we have with us to

check transmission of sexually transmitted infection. Its promotion

is essential in India as it has multiple uses – it can avert an

unwanted pregnancies as well as stop the spread of sexually

transmitted diseases. Though some work was done to promote the use of

condoms, it is inadequate. I am pleased to learn that under NACP III,

condom availability and use will be significantly scaled up. I am

happy to learn that the Gates Foundation is providing us funding

support to establish a professional group to help us expand the

market for condoms. Promoting condom use is important. Thailand is

now facing the possibility of a resurgence of the HIV epidemic

because they gave up prevention and condom promotion and focused only

on treatment. So also China. Non-emphasis on condoms is resulting in

the gradual increase of HIV due to unsafe sex. This is the same story

in Nagaland where we neglected the promotion of the condom and are

today facing the spread of HIV on account of unsafe heterosexual

behaviour.

With young men and women bearing the brunt of the disease burden, it

is essential that we educate our youth on healthy lifestyles. While

good work was done under NACP II in training 2 teachers and 2

students in all the 1.4 lakh high schools we need to do more. We are

therefore, currently working on coming up with a health education

package that will focus on healthy lifestyle which will say no to

unsafe sexual behaviour, no to tobacco, no to alcohol and no to

drugs. We hope to harness the abundant energies of youth, as has been

done in Tamil Nadu, in combating HIV/AIDS.

While, prevention will continue to be the mainstay of the NACP III,

strategy and focus on saturating coverage of an estimated 4 million

high risk groups, continued attention will also be on providing care,

support and treatment to the infected. The ART programme which was

launched in 2004 brought hope and expectation in lives of thousands

of people living with HIV/AIDS. The ART programme has been rapidly

scaled up. Today about 80,000 patients are accessing free treatment

in 127 centers. This year another 36 centers are going to be

established. Efforts are being made to identify centers closer to the

community level to make it easier for patients to get their refill of

drugs and save them time and money spent on coming all the way to the

ART center. Such decentralization of drug distribution will greatly

enhance adherence, reduce loss to follow up and alleviate the

economic hardship of the PLHA's. I do hope these centers attached to

the ART centers will come up soon.

India was a global leader in coming out with the treatment protocols

for children. Since the launch of the Pediatric AIDS Initiative on

30th November, we have more than 6000 children on treatment and

12,000 diagnosed.

I would also like to reiterate that HIV/AIDS is not just a public

health problem. It is a disease that is the result of deeply rooted

socio-economic conditions and cultural beliefs, practices, attitudes

and vulnerabilities. The virus spread in India mainly through the

heterosexual route. Sexual behaviours and choices are an intensely

private matter and difficult to change. At one level we have easy

access to information though internet, rapidly changing values and

attitudes as depicted in modern cinema and the TV, greater mobility

etc. and greater impoverishment and unmatched aspirations at another

level are factors that contribute to enhancing risk and increasing

vulnerability to this infection. We cannot, therefore, let our guard

down. We need to understand the significance of the presence of the

virus in some 20 to 30 lakh people in the country against the

backdrop that we also have a very high population of young and

sexually active persons.

Of utmost importance is fighting stigma and discrimination. Even as

we are celebrating our successes, we need to also feel a sense of

shame that we as a society continue to lack compassion and stigmatize

those who have the misfortune of being affected by this disease. Be

it the incident of little children in Kerala being denied admission

or the one in Meerut being denied medical care, it is indeed

unfortunate. I would like on this occasion to appeal to all my fellow

colleagues in the medical profession to live upto their oath of

treating all those who suffer disease and sickness on equal grounds.

I appeal to all faith based organizations and civil society

organizations to come forward and help us to fight irrational

attitudes of stigma against PLHAs.

I would like to thank all the media, the donor partners, the PLHA

networks and the NGO's for all the support that they have been giving

us in our fight against HIV /AIDS. We value their support and

understanding that they have extended to us. I do hope that this

partnership will continue and the NACP III will be implemented

successfully " .

http://pib.nic.in/release/release.asp?relid=29036

[Guest guest]

Dear All,

On this date 07/07/07 ,the day following the launch of the NACP-III , I would

request all to re-dedicate ourselves to the sustained efforts for the

containment of the dual epidemics-the HIV pandemic and the

epidemic proportions and monstrous potential of the stigma, discrimination and

denial of services to the PLHIV, CSWs, sexuality minorities and other

marginalized communities in the society.

Obviously there is no scope for any complacency due to the apparently reduced

numbers of the HIV positive people. Difference in the methodology adopted and

the need of relying on the community based household survey(in the form of

NFHS-III)has helped to finetune

the mechanism to estimate the numbers and we have a more realistic picture of

the scenario.

HIV is not one epidemic. There are multiple epidemics with different

determinants(mainly behavioural)and the local vulnerabilities must take

precedence over any thing else in a scenario like this.

All estimates,models and predictions tell the disease burden which in an

infection like HIV (where primary prevention is important )is not very crucial

from the programmatic point of view.

If the transmission of a disease is dependent on the number of patients/disease

burden and where secondary prevention of the disease is important(like

tuberculosis) the numbers are significant and must be determined meticulously

from the point of view of intervening directly.

The tuberculosis patients have to be found and addressed effectively at the

earliest with regular antituberculour treatment(say DOTS)- important both for

the patient's cure besides the reduction of

transmission to others/reduction of transmissibility in the community.

We have to ensure that all our sustained efforts against the dual epidemics are

strengthened without any dilution of the activities and any alterations in the

prioritization of the relevant issues to be

addressed effectively and timely.

With best wishes and an earnest request for maintaining the tempo of all our

concerted efforts and initiating appropriate endeavours to reverse the epidemic,

Yours truly,

Rajesh Gopal,

Gujarat SACS.

e-mail: <dr_rajeshg@...>