No Room for Complacency on Fighting Aids

Fighting AidsHIV/AIDS is not a conventional disease. The characteristics of the virus make HIV/AIDS a long and slow episode. By the time a few are identified, many more exist whose condition has not been diagnosed; even more who are well, but infected with the virus. This creates a major problem because by the time significant numbers of people fall ill and die, the epidemic will be already far advanced. That’s why globally AIDS is the fourth most common cause of death. For a country such as India, with a billion-plus population, a mere increase in prevalence rate would fundamentally translate into a lot. Owing to the epidemiological characteristics of AIDS, the age group most susceptible to infection is also the age group that is more economically and socially active. Eighty per cent of the cases reported, occur in the age group of 15 to 44. This means that the spread of AIDS epidemic is detrimental to our country’s demographic dividend. Therefore, collective, socially balanced and biomedically scientific policies and programmes are imperative.

India is a country with low prevalence of HIV/AIDS but it is home to the third largest number of people living with HIV/AIDS. There are an estimated 24.1 lakh (2.41 million) people living with HIV/AIDS in India; the corresponding figure in 2001 was 20.9 lakh (2.09 million.) In 1986, following the detection of the first HIV/AIDS case in India, the Ministry of Health and Family Welfare constituted the National AIDS Committee but as the incidence of the disease spread, a need was felt for a nationwide programme and an organisation to steer the AIDS control measures. Thus was born India’s first National AIDS Control Programme (NACP), in 1992; and National AIDS Control Organisation (NACO) was constituted the same year to implement the NACP. The NACO’s targeted interventions for high-risk groups / population dwells on issues such as blood safety, management of sexually transmitted infections; Information, Education and Communication (IEC), mainstreaming, condom promotion, etc. As per the NACO’s 2010-2011 annual report, the analysis of epidemic projections has revealed that the number of annual new HIV infections has declined by more than 50 per cent during the last decade. This is attributed to the various interventions under the NACP and scaled-up prevention strategies. At the same time, the number of people dying due to HIV/AIDS is declining steadily, too, due to the wider access to the free ART (anti-retroviral therapy) programme in India. (ART is a treatment for HIV/AIDS that can prolong and improve patients’ lives, and potentially reduce the risk that they will infect others.)

The Joint United Nations Programme on HIV and AIDS or UNAIDS’s 2013 Report endorses the findings of the NACO’s 2010-2011 annual report. The UNAIDS report, which was launched on 19 November 2013 in Bangkok at the 11th International Congress on AIDS in Asia and the Pacific, says that the incidence of the HIV in India is decreasing and that new HIV infections dropped by 57 per cent among adults over the last decade. In absolute terms, India and 11 countries in the Asia-Pacific account for over 90 per cent of the nearly 50 lakh (4.9 million) HIV-infected people in the region in 2012. However, an increase/decrease in new infections is seen as a better indicator of a nation’s AIDS control efforts and India has fared reasonably well on that metric. Further, the UNAIDS attributes the reduction in the incidence of HIV/AIDS in India to, among other things, the free ART that is offered to the infected population. Various studies have shown that an effective ART helps to substantially reduce the risk of spread of infection to others.

However, there is no room for complacency. As the NACO’s 2010-2011 annual report shows, while declining trends are evident at national level as well as in most of the states, some low prevalence and vulnerable states have shown rising trends in HIV epidemic, warranting a focussed prevention efforts in these areas. HIV prevalence is showing declining trends among female sex workers both at national level and in most of the states. However, men who have sex with men, injecting drug users and single male migrants are emerging as important risk groups in many states. Regionally, India may have performed better as per the UNAIDS report, but there is always the risk of a relapse. One needs to look at the examples of countries such as Pakistan where new infections have risen eight-fold or Indonesia and the Philippines where it has doubled. There are still more initiatives that India has to consider. A good example of it would be an HIV/AIDS Bill that has been hanging fire for the last nearly eight years. The Bill aims to provide a legal remedy against HIV-related discrimination in the public and private sectors. It is the first time that the private sector has been brought into the ambit. The Bill also provides for free and comprehensive medical treatment to the HIV-infected people in addition to ensuring or protecting the person’s confidentiality, etc. It is imperative that the Bill is passed at the earliest as it deals with other issues such as stigma and protection of certain rights.

Red tape and/or bureaucratic or procedural delays is another issue that should demand the undivided attention of all the stakeholders concerned. Recently, the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), a multilateral funding agency, was reported to have offered a 187 million-dollar grant to the National AIDS Control Programme but the Ministry of Health and Family Welfare did not take a decision on it for over a year. The NACO and the Ministry were accused of endangering the lives of HIV patients in India because the indecision caused shortages in the supply of drugs and diagnostic kits for some months, which affected the million-odd HIV-infected persons who are treated under the NACO’s programmes.


India in numbers (2011)

Rs 158 crore                           Indian HIV AIDS health care market

1.25 billion USD                     India’s anti HIV drug exports

2.39 million                            HIV population

1,20,000                                 New infections

1,04,000                                 Children infected

1,72,000                                 AIDS related deaths

8,22,000                                 Condom promotion outlets

1,112                                       STD clinics

472 million                             Condoms sold under HIV programme

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