NACO and HIV/AIDS in India

[Guest guest]

NACO and HIV/AIDS in India

The human immunodeficiency virus (HIV), which causes acquired

immunodeficiency syndrome (AIDS), is the leading infectious cause of

adult deaths in the world. Given the scale of the epidemic, HIV/AIDS is now

considered not only a health problem, but also a developmental and security

threat. Even if a cure is found tomorrow, the toll of death and suffering by

2010 will far exceed any other recorded human catastrophe, any other previous

epidemic, natural disaster, war, or incident of genocidal violence.

India is experiencing rapid and extensive spread of HIV. This is

particularly worrisome since India is home to a population of over 1

billion. As a single nation it has more people than the continents of

Africa, Australia and Latin America combined. The situation is graver in states

like Tamil Nadu, Maharashtra, Andhra Pradesh and Karnataka.

A report by World Bank released at the 16th International AIDS Conference says

that India is home to 60% of South Asia's HIV patients. The NACO and UNAIDS

paints a contrasting pictures of HIV/AIDS estimates in India.

According to UNAIDS 2006 report out of an estimated 46.0 million

people living with HIV worldwide, 5.7 million people are living with the virus

in India, more than any other country in the world. On the other hand, NACO's

projections shows that by the end of 2005 there were 2.5 million people were

infected by HIV. The UNAIDS statistics reveals that India is the most infected

country surpassing South Africa.

On the other hand the Union Health Minister renounces the UNAIDS claims and

asserted that India stands next to South Africa in terms of number of people

living with HIV/AIDS. These figures make it very difficult to ascertain the

exact status of AIDS cases in India. It is unfortunate that even after more than

a decade of existence of National AIDS Control Organization (NACO), the nation

is still debating the accuracy of the HIV/AIDS statistics.

It seems that instead of addressing the issues of primary concerns NACO is

involving itself more in trivial cases of data projections and collections.

The much-needed treatment, healthcare and infrastructural development has taken

a back seat in the current strategies and policies of NACO.

As Piot, Director of UNAIDS in an interview with Associated Press rightly

said, `At the recent meetings in India, I heard great speeches, but as for

action, zero. "

Soon after reporting of the first HIV/AIDS cases in the country in 1986, the

government launched a National AIDS Control Programme in 1987. The programme

stressed on surveillance, screening of blood and blood products, and health

education. By this time, the HIV/AIDS had already attained an epidemic status in

the African region and was rapidly spreading in other parts of the world.

Realizing the intensity of the epidemic, the Government of India with the

support of World Bank established National AIDS Control Organization in 1992 to

enhance the ongoing programmes. The same year that NACO was established the

government launched National AIDS Control Project under which State AIDS Control

Societies were set up.

The purpose of the setting up of State AIDS bodies was to carry out NACO's AIDS

control programmes.

NACO's initial efforts were to control sexually transmitted

diseases, to promote condom use, to provide testing, counseling, care

and support for people with HIV/AIDS, to conduct surveillance, and

minimizing harm for injecting drug users, to provide blood safety and

blood products and supporting research and product development.

Unfortunately, these efforts remain in a dead letter as no serious steps were

taken for effective implementation. Even the prime HIV/AIDS control measure like

making HIV screening mandatory in all blood banks initiated only due to the

landmark Supreme Court directive in 1996.

Still after more than two decades of HIV/AIDS in India, the issues and

concerns remain unaddressed. NACO's initiatives were inadequate in

combating the new millennium pandemic and are focused mainly on urban

populations rather than rural.

Its reluctance to intervene in prevention efforts in rural areas has in a way

increased the epidemicity as the rural populations are more vulnerable and large

proportion of Indian population resides in these areas. The epidemic is

gradually getting concentrated in rural areas with 58 per cent infections being

reported from villages. According to Dr. Meenakshi Datta Ghosh, HIV/AIDS is no

longer affecting only high-risk groups or urban populations, but is gradually

spreading into rural areas and the general population.

One can also find an interesting dichotomy in state response in terms of

HIV/AIDS awareness programmes. The government run awareness programmes are more

concentrated in urban areas as compared to rural areas. Thus increasing

susceptibility and lack of community participation in HIV/AIDS prevention

programmes. NACO's commitment in dealing with children and women living with

HIV/AIDS is quite dismal as there are no specific guidelines for the treatment,

care, and support of HIV positive children and women.

As per UNAIDS 2006 report, approximately 700,000 children become infected with

HIV and 95% of children got the infection from their mothers. The report also

reveals an alarming increase in the number of women with HIV/AIDS, reflecting

the greater vulnerability of

women to HIV/AIDS, especially in rural areas. There are about 16 lakhs

women aged 15 and above living with HIV. Despite of these burgeoning

statistics, NACO's responses were far short to meet the demands and

in their policies, women and children with HIV remains a neglected face.

The AIDS control mechanisms are not well integrated with the basic

public health care infrastructural facilities. Surveillance of HIV/AIDS is the

weakest link in the health infrastructure and preventive strategy. HIV/AIDS

surveillance has been always accorded low priority in national planning and

resource allocation causing discrepancies in surveillance mechanisms. Thus

resulted in inappropriate epidemiological datas causing confusions in policy

planning vis-à-vis policy failure.

Epidemiological data remains a major weakness affecting policy planning and even

today tell us virtually nothing about what is happening in the rural areas. At

the same time, there are discrepancies in the surveillance facilities between

the more urbanized and less urbanized states.

The more urbanized states like Maharashtra, Tamil Nadu and Karnataka have

greater concentration of facilities and technical skills leads them to determine

number of cases while in case of less urbanized

states like Bihar, U.P and Rajasthan lacks these testing facilities.

Thereby HIV/AIDS cases in these states always goes unnoticed. In 2003

both Dr. R. Feachem then executive director of the Global Fund to Fight AIDS and

Dr. Meenakshi Datta Ghosh as a project director NACO in

separate interviews stated that the epidemic is moving into the general

population. Even many surveillance data suggested the same but

unfortunately found no takers. Making the situation worst NACO in their

prevention policies completely neglected general population and clinged to the

approach that the epidemic is limited to high-risk groups such as sex workers,

drug users and truck drivers and targeting them is the best strategy.

The low status accorded to both prevention and facilities for diagnosis and

treatment in rural India is also one of the major reasons for where we are today

on the AIDS epidemic map.

The supply of anti-retroviral drugs in villages is erratic. Unfortunately, these

issues and voices remain relatively unheard. So even 20 years after the entry of

AIDS, the issues here remain just as they were. Public health systems have

virtually ineffective and therefore seeking treatment is difficult and most

villages have no access to these treatment facilities. In general, India's ART

treatment rate at the present stage is also dismal.

The UNAIDS 2006 report says that only 7% of Indians who needed antiretroviral

drug therapy actually received it and a meager number of 1.6% of pregnant women

who needed treatment to prevent mother-to-child HIV transmission are receiving

it. Even as per some official estimates of the 5.5 million people living with

HIV, only 60,000 are on these drugs. Of these, only 30,000 are being supplied

through the public health system. Further NACO's claims on treatment measures

fell flat in Supreme Court, when hearing a bunch of PILs, the court found that

against the target of giving ART to one lakh people by 2005 only 33,000 have got

the medication by the same year. Later the policy makers in NACO in a more

unfortunate way shifted the target year to 2007.

Simplest and the most effective preventive measure like condom promotion was not

taken in massive scale, sidelining this intrinsing care, NACO invested time,

resource and energy in organizing conferences, seminars, which are unreachable

to the majority of the HIV/AIDS patient. The case in point is India's

anxiousness to host International AIDS Conference in 2012, for which the

preliminary preparatory works have commenced on war foot grounds. This gives an

impression that the government is more serious in flourishing tourism industry

rather than spending few bucks on most affordable prevention measures like

condom promotion.

Last but not the least insufficient budgetary allocation and HIV

discrimination strains many preventive efforts. This is evident from the

previous experiences where NACO was allotted a meager $38 million of the

government's own funds over the period of 1999-2004. Social reaction to people

with HIV/AIDS in India further fuels up the crisis.

The negative attitudes from health care professionals and responsible

institutions industry rather than spending few bucks on more a has

further worsen the situation. For instance in Orissa a young HIV+ couple

committed suicide after being ostracized by their locality and

surprisingly the State AIDS Cell's anti discrimination unit claims

ignorance about the episode. Similarly in another instance Orissa State AIDS

Cell was completely unaware of the killing of a youth by his communities in Puri

as he was HIV+. Such cases are alarmingly

proliferating in various parts of the country.

To check this injustice NACO is yet to come up with a concrete legislation. The

proposed draft bill against HIV/AIDS discrimination which was initiated in 2002

is still under considerations of our lawmakers. The lack of such legislation

till this date raises questions on seriousness of government's commitment and

strategies.

Thus far India has struggled to curb the AIDS epidemic and its high time that we

should initiate the measures to overcome the weakness and should draw lessons

from other successful countries like Brazil, Thailand, Combodia, Uganda and

Senegal. Here Brazil's case is important and unique because of similar

socio-economic and political set up it shares with India and India can emulate

Brazilian model. Firstly, Brazil has enacted a law which ensures HIV+ people and

others having opportunistic infections right to free access to treatment.

Secondly, a strong relationship between the government and other civil society

groups including Catholic Church has reduced stigma and discrimination

associated with the virus thereby allowing the government to work swiftly.

Thirdly, an innovative and mass campaign on condom promotion resulted in

incredible increase in condom use among general population.

This strategy is believed to be one of the most important factor in

bringing down the AIDS cases. Fourthly, its greater emphasis on

treatment and care further proved effective in preventing the spread of the

virus. As a result, the AIDS cases in Brazil dropped to 620000

cases, which is far lesser than the previous records.

It seems that our policy makers perceive the new millennium pandemic

just as a health problem rather than a politico-economic threat or

national problem. However, Brazil and other successful countries

conceive HIV/AIDS as a national malady. It is true to some extent that

there is simply no substitute for state action but at the same time it

would be unfair to shift the burden of action or inaction on the state.

We should also recognized the importance of collective commitment

between individual and the state as a factor for an effective fight

against AIDS as reflected in Brazil's case. Finally we should be

less defensive about the issues and statistics rather more offensive in actions

and interventions. We should recognize that there is a global commitment in

combating HIV/AIDS and it is time to act and deliver to all.

Javed M. Iqbal

Research Scholar

Centre for International Politics, Organization and Disarmament,

School of International Studies,

JNU, New Delhi.

e-mail: javednaqi@..., loving_naqi@...

0-9873258274

[Guest guest]

Dear All,

Re: /message/8215

I am not aware when the above article was written. But few

clarifications would not be out of order:

1. UNAIDS has released their 2007 updates (available at their

website)and they are completely in sync with the NACO estimates.

There is no discrepency.

" These improved data present us with a clearer picture of the AIDS

epidemic, one that reveals both challenges and opportunities, " said

UNAIDS Executive Director Dr Piot.

2. India is not the only country where the estimates have been

revised. " The revised estimates for India, combined with important

revisions of estimates in five sub-Saharan African countries

(Angola, Kenya, Mozambique, Nigeria, and Zimbabwe) account for 70%

of the reduction in HIV prevalence as compared to 2006 estimates " .

Both the above quotes are from UNAIDS 2007 " AIDS Epidemic update " .

3. We learn as we move on - from one phase of the epidemic to the

next one. Today, we have better data based on various reasons, and

we should use that.

With Regards,

Dr Umang Kochhar

HIV/AIDS Consultant

e-mail: <umang.groups@...>