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National Prevention Efforts
Educating people about HIV/AIDS and prevention is
complicated as India has many major languages and hundreds of
different dialects. So although some HIV/AIDS prevention and
education can be done at the national level many of the efforts are
best carried out at the state and local level.
With the second phase of the National AIDS Control
Program (1999-2004), NACO has expanded its program. NACO provides
funds to state AIDS control societies for targeted interventions,
blood safety, youth campaigns, VCT, care and support and social
mobilisation. The second phase of the program aims to promote
cooperation among public, private and voluntary sectors.
NACO sponsored prevention efforts have included
concerts, TV spots with a popular Indian film-star, radio drama,
radio programme and organising a voluntary blood donation day.
School AIDS education programme in India include training teachers
and peer educator among students, role-playing, debates and
discussions. The programme has worked towards student youth to raise
awareness levels, help young people to resist peer pressure and
develop a safe and responsible life-style.
In 2001, the government adopted the National AIDS
Prevention and Control Policy. During that year, Prime Minister
Vajpayee addressed parliament and referred to HIV/AIDS as one of the
most serious health challenges facing the country. The Prime
Minister also met the chief ministers of the six high-prevalence
states to plan implementation of strategies for HIV/AIDS prevention.
However it is still debatable as to whether there is
sufficient commitment to combating the epidemic at government level.
Many Indians in positions of power refuse to accept that their
country faces a grave threat from the epidemic. And as the epidemic
spreads, the battle against AIDS is mired by a lack of consensus on
the extent of the pandemic, the "right strategy" to combat it, and
how to deal frankly with sexuality.
In early 2003 the Indian Health Minister Sushma
Swaraj told the press that the country's AIDS program had to focus
on sexual abstinence and faith rather than just condoms. But
according to Peter Piot of UNAIDS:
"In order to prevent the spread of HIV, a
combination approach is required. We need to promote abstinence,
delay of sex, faithfulness and the use of condoms. No single
approach will work." Peter Piot
Many people have been disappointed with the
allocation of only $38.8 million of the government's own funds over
the period of 1999-2004. The government has also been criticised of
poor ability in implementing HIV/AIDS programs and inadequate
efforts with injecting drug users and men who have sex with men.
The Indian government is also criticized for
clinging to the idea that the epidemic is limited to "high risk
groups", such as sex workers, drug users and truck drivers, and that
targeting them is the best strategy to contain the epidemic further.
But this approach no longer reflects the reality of at least some
Indian states, where the epidemic is in the general population. In
these states women who only have sex with their husbands may be the
group at highest risk of HIV transmission, and although in Indian
society men can experiment with sex outside of marriage, women do
not have the status to demand condom use of their husbands.
NACO has developed a VCT policy that states that "no
individual should be made to undergo mandatory testing for HIV" and
that "no mandatory testing should be imposed as a precondition for
employment or for provision of health care facilities during
employment" (India's armed forces are exempt from this condition).
NACO has also developed guidelines for VCT centres, which deal with
consent and confidentiality issues.
However, many Indians are tested for HIV without their consent or
knowledge. It has been reported that over 95% of patients listed for
surgical procedures are involuntary tested for HIV; for those who
test positive, their treatment/surgery is cancelled. Another issue
for anyone undergoing an HIV test is that his or her test will in
most instances be neither anonymous nor confidential. Some
Government officials (inc. legislators in Goa and Andhra Pradesh)
have even voiced their support of mandatory premarital testing for
HIV and are proposing related legislation.
Since the launch of the second phase of the National
AIDS Control Program in 1999, the Indian government has established
25 community HIV/AIDS care centres across the country. But the
standard of care that NACO supports is limited to the provision of
drugs for the treatment of opportunistic infections. And the
distribution of these drugs is limited to those institutions that
qualify through a NACO state-level selection process. Many people
living with HIV only have access to centres not selected to receive
drugs, so cannot have access to treatment for most opportunistic
infections. Just as importantly, a major obstacle to the provision
of care for HIV positive people, is the stigma surrounding the
disease as described earlier.
With regard to antiretroviral drugs, India is a
major producer of cheap generic copies of many HIV/AIDS drugs that
are being sold to many countries all over the world. Despite that
antiretroviral drugs are affordable to a tiny fraction of people in
need of treatment in India.
"It is a sad irony that India is one of the biggest
producers of the drugs that have transformed the lives of people
with AIDS in wealthy countries. But for millions of Indians, access
to these medicines is a distant dream" Joanne Csete, Director
of the HIV/AIDS programme at Human Rights Watch
In December 2003, the Indian Health Minister Sushma
Swaraj announced that more than $40 million would be allocated from
April 2004 to provide antiretroviral drugs in government run
hospitals. The first projects will be in the worst-affected states:
Karnataka, Maharashtra, Tamil Nadu, Manipur and Nagaland. |
