Challenges in HIV/AIDS Prevention, Care and Treatment Program in India

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Dear All,

The paper entitled, ‘Challenges in HIV/AIDS Prevention, Care and Treatment

Program in India : Policies and Priorities under National AIDS Control Programme

Phase-III (2007-12)’ has been published in SAARC-Journal of Tuberculosis, Lung

Diseases and HIV/AIDS, Vol II(1), 2010 (pp 1-7).

http://www.nepjol.info/index.php/SAARCTB/issue/current

This paper explores the pertinent challenges of Government’s HIV/AIDS

prevention, care and treatment program in India. It also provides an opportunity

to assess the HIV response to understand what must be done to ensure that India

is on course to achieve the goal of universal access to prevention and

treatment. The paper is based on the review of annual action reports, policy

documents, etc published by national and international, governmental and

non-governmental organizations (UNAIDS, WHO, UNGASS, Ministry of Health and

Family Welfare) and interactions with key program managers and implementers at

state, district and various facility levels.

Study findings conclude that program is well–structured and well–tailored

considering the national as well as local needs, ensuring implementation of

evidence-informed policies and programs. Being a large country with wide

variations in social, geo-physical and health service patterns across the States

and regions, it was necessary to prepare a plan that is technically sound and

uniform but allows flexibility and adaptability at the local level.

The National AIDS Control Programme Phase III (NACP-III) is guided by the

three-ones principle and this acts as a unifying factor for the national

response and helps to set standards of quality for HIV/AIDS prevention and

treatment programs. Strategic and program interventions are evidence-based and

result-oriented with scope for innovations and flexibility. Priority is accorded

to specific local contexts and interventions planned accordingly.

To maintain quality and standards of the services uniformly across the country

and monitor the programs consistently to assess progress against the national

goals, operational guidelines for State AIDS Control Society (SACS), DAPCU and

all facilities have been developed. These guidelines work as referral document

for implementing units and service delivery systems.

Setting up of District AIDS Prevention Control Unit (DAPCU) has made program

management and implementation easier, which has helped in better monitoring,

linkages within the program and with general health systems at the district

level. However, it has been suggested that DAPCU should be set up in a

need-based and state specific manner depending upon the size of the district,

extent of the problem and estimated number of high-risk population. DAPCU should

be set up irrespective of categorization of district based HIV Sentinel

Surveillance alone. Districts not having DAPCU should have some alternate

arrangement for monitoring at district level.

The convergence of decentralized delivery system with other health system is

helpful in long term sustainability of the program. The main challenge lies in

increasing the availability of prevention and treatment in resource-limited

areas. The expansion of HIV prevention and treatment services is currently

hindered by weak infrastructure, limited human and financial resources, and poor

integration of HIV-specific interventions within broader reproductive and child

health services.

Technical staff appointed for program implementation and service delivery is

contractual. The attrition rate of contractual staff is high due to job

insecurity, lack of benefits/incentives and lack of growth options. High

turnover of staff and frequent transfer of regular staff especially Project

Directors is also a constraint in some States.

There is need to strengthen monitoring and supervision of program managers at

SACS and DAPCU to take informed decisions.

It would be important to examine these issues at national and State levels and

take corrective actions to achieve the goal of halting and later reversing the

epidemic of HIV/AIDS in India.

The study is based on the observations of a few program sites, DAPCU and SACS

Offices as representativeness of sites was not the goal of the study.

Dr. Ruchi Sogarwal

Program Officer-Evaluation & Research

National AIDS Control Organization

6th Floor, Chandralok Building,

36 Janpath, New Delhi, INDIA

E-mail: ruchi.dr@...