HIV-AIDS in India Part 2: Government Policies, Funding, Second Line, Number of ART Centers, Litigation and 2012 UN Report

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Government Policies

  • Soon after the first cases emerged in 1986, the Government of India established the National AIDS Committee within the Ministry of Health and Family Welfare. This formed the basis for the current apex Government of India body for HIV surveillance, the National AIDS Control Organisation (NACO). The majority of HIV surveillance data collected by the NACO is done through annual unlinked anonymous testing of prenatal clinic (or antenatal clinics) and sexually transmitted infection clinic attendees. Annual reports of HIV surveillance are freely available on NACO’s website.

  • The first National AIDS Control Programme (NACP) was implemented over seven years (1992-1999), focused on monitoring HIV infection rates among risk populations in selected urban areas. The second phase ran between 1999 and 2006 and the original program was expanded at state level, focusing on targeted interventions for high-risk groups and preventive interventions among the general population. A National Council on AIDS was formed during this phase, consisting of 31 ministries and chaired by the Prime Minister. HIV/Aids were understood not purely as a health issues, but also a development issue and as such it was mainstreamed into all ministries and departments. The third stage dramatically increased targeted interventions, aiming to halt and reverse the epidemic by integrating programmes for prevention, care, support and treatment. By the end of 2008, targeted interventions covered almost 932,000 of those most at risk, or 52% of the target groups (49% of FSWs, 65% of IDUs and 66% of MSM). In 2009 India established a “National HIV and AIDS Policy and the World of Work”, which sough to end discrimination against workers on the basis of their real or perceived HIV status. Under this policy all enterprises in the public, private, formal and informal sectors are encouraged to establish workplace policies and programmes based on the principles of non-discrimination, gender equity, health work environment, non-screening for the purpose of employment, confidentiality, prevention and care and support. Researchers at the Overseas Development Institute have called for greater attention to migrant workers, whose concerns about their immigration status may exclude them from these policies and leave them particularly vulnerable.

  • No agency is tasked with enforcing non-discrimination policy, instead multi-sectoral approach has been developed involving awareness campaigns in the private sector. HIV/AIDS-related television shows and movies have appeared in the past few years, mostly in an effort to appeal to the middle class. An important component of these programs has been the depiction of HIV/AIDS affected persons interacting with non-infected persons in everyday life. Vilification of infected persons has occurred, as the disease has become more popularly associated with sex workers These efforts have focused on increasing tolerance and awareness among the middle class in an effort to diminish the portion of the population affected by HIV/AIDS by developing public concern and calls for greater governmental action. The HIV/AIDS is one of the greatest killers of human beings on earth. There is no absolute reliable drug so far available that can cure the diseases. Controlling HIV/AID is an alternate best solution. In control measures, large number of stakeholders can play important role. The following paragraphs are excerpts on how Supreme Court of India gave exhaustive recommendations to such stakeholders.

  • In 2010, NACO approved the Teach AIDS educational materials marking the first time HIV/AIDS education could be provided decoupled from sex education. Later that year, the Government of Karnataka approved the materials for their state of 50 million and committed to distributing them in 5,500 government schools.

Funding

  • HIV spending increased in India from 2003 to 2007, and fell by 15% in 2008 to 2009. Currently, India spends about 5% of its health budget on HIV/AIDS. Spending on HIV/AIDS may create a burden in the health sector which faces a variety of other challenges like malaria, diabetes, heart disease and cancer. Thus, it is crucial for India to step up on its prevention efforts to decrease its spending of the health budget on HIV/AIDS in future.

Second-Line Treatment Issue

  • Responding to a petition made by NGO’s, in December 2010, the Supreme Court of India directed Indian government to provide second-line Antiretroviral Therapy (ART) to all AIDS patients in the country, by warning the government against abdicating its constitutional duty of providing treatment to HIV positive patients on grounds of financial constraint, as it was issue of the right to life guaranteed under Article 21 of the Indian Constitution. Previously in an affidavit before the Supreme Court, NACO had said second-line ART treatment for HIV patients, costing Rs 28, 500 each, could not be extended to those who had received “irrational treatment” by private medical practitioners for the first round, which costs around Rs6, 500.

  • The court rejected both the arguments of financial constraints and only 10 viral load testing centers needed for test patients for migrating from first line of treatment to the second line being are available, raised by the Solicitor General representing the government. The court further asked the government to give a clear-cut and “workable” solution response within a week’s time.

Number of ART Centres and Patients Alive and on ART by State, January 2010

Number of ART Centres and Patients Alive
Number of ART Centres and patients alive

State

No. of ART Centres

Total (Adult)

Total (Paediatric)

Total

Andhra Pradesh

31

60,328

3,304

63,832

Karnataka

33

36,220

3,003

39,223

Maharashtra

43

65,409

5,102

70,511

Tamil Nadu

36

36,947

2,439

39,586

Gujarat

9

12,765

669

13,678

Uttar Pradesh

10

10,039

594

10,633

Grand Total

2,81,453

18,889

300,743

Litigation for Access to Treatment

  • Voluntary Health Association of Punjab v. Union of India

  • Love Life Society v. Union of India & Others

  • Wahengbam Joykumar v. Union of India & Others

  • Delhi Network of Positive People & Another v. Union of India & Others

2012 UN Report

  • New HIV cases among adults have declined by half in India since 2000, according to a new UN report which praised India’s contribution to AIDS response through manufacture of generic antiretroviral drugs.

  • Though rate of HIV transmission in Asia is slowing down, at least 1,000 new infections among adults continue to be reported in the continent every day in 2011.

  • An estimated 360,000 adults were newly infected with HIV in Asia in 2011, considerably fewer than 440,000 estimated for 2001, a new UNAIDS report has said.

  • “This reflects slowing HIV incidence in the larger epidemics, with seven countries accounting for more than 90 per cent of people (in Asia) living with HIV - China, India, Indonesia, Malaysia, Myanmar, Thailand and Vietnam,” the report ‘Together We Will End AIDS’ said.

  • The UNAIDS lauded India for doing “particularly well” in halving the number of adults newly infected between 2000 and 2009 and said some smaller countries in Asia like Afghanistan and Philippines are experiencing increases in the number of people acquiring HIV infection.

  • It said a total 1.7 million people had died across the world due to AIDS related illness. In India, the figure for such deaths stood at 170,000 in 2009. The report says India has contributed enormously to the AIDS response.

  • “With 80 per cent of these drugs being generics purchased in India, several billion dollars have been saved over the past five years. The country is also committed to new forms of partnership with low- income countries through innovative support mechanisms and South & South cooperation,” the UNAIDS report says.

  • It also points out that India already provides substantial support to neighboring countries and other Asian countries - in 2011, it allocated USD 430 million to 68 projects in Bhutan across key socio-economic sectors, including health, education and capacity- building. In 2011 at Addis Ababa, the Government of India further committed to accelerating technology transfer between its pharmaceutical sector and African manufacturers.

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