AIDS: No time for complacency

AIDS: No time for complacency

After many years there appeared some positive news on the HIV status in India when the corrected figures for 2008 showed that the actual prevalence of HIV infection in India was lower than anticipated. But the government has shown necessary resolve in not resting on its laurels but initiating fresh programmes in tandem with private efforts to drive this number down further.
Although it appeared later in India, HIV infection rates rose rapidly in the ‘90s and it was feared that the task of containing this dreaded disease would be particularly difficult in our country, given the levels of education, awareness, poverty, public health and the formidable size of the population.

However, the large scale media blitz, education strategies in schools and colleges, countrywide testing, screening and treatment has resulted in containing what could well have been a devastating epidemic. The National Aids Control Organisation set up in1992 has improved its effectiveness and has been ably assisted by numerous NGO efforts and privately sponsored partnerships. With the numbers of infected cases rising from thousands to millions, the government adopted a National AIDS prevention and control policy in 2001.

After the success achieved through initial efforts, the third stage of the National AIDS Control Programme was  launched in July 2007 and it runs until 2012. The programme has a budget of around $2.6 billion, two thirds of which is for prevention and one sixth for treatment. Aside from the government, this money will come from non-governmental organizations, companies, and international agencies, such as the World Bank and the Bill and Melinda Gates Foundation. The focus will be on creative methods to spread awareness in every state and sensitizing members of high-risk groups on preventing infections.

Social challenges
There are still many social challenges that must be addressed so that the control policy can be effective. In line with international opinion, HIV testing may only be out voluntarily, with consent of the patient concerned. NACO has set up thousands of Integrated Counseling and Testing Centers (ICTI’s) in India which facilitate such voluntary testing. However, it is well known that many hospitals routinely test patients before delivery or surgery without their knowledge. It is supposedly done to take necessary precautions but results in unnecessary fears and discrimination, or the surgery getting cancelled.

Another challenge is the availability of antiretroviral drugs which slows the progression of HIV infection to AIDS. Most of the drugs have been accessed from the private sector and are prohibitively expensive leaving large populations of HIV infected persons without access to the drugs. The government provided more than a hundred treatment sites by 2007 but ran into another problem, that of drug-resistance. Second line drugs, which are always more expensive, have been made available in eight Indian states since 2009. Even so, given the size of populations to be covered and the widespread nature of the disease, access to treatment remains a second crisis experienced by every person diagnosed with HIV infection.

The irony is that India is a major provider of cheaper generic copies of antiretroviral drugs for other developed countries of the world but the prevailing patent regimes restrict their availability in India. This bizarre imbalance is soon to be corrected with world pressure on pharmaceutical companies to relax this stranglehold in view of the urgent nature of the pandemic. Over 100 countries have set a target to ensure 80 per cent of their HIV infected patients with treatment by 2010.

The third area of concern is the stigma and discrimination that still exist in Indian society today with regard to this disease. This epidemic is still misunderstood among the general public, preventing persons from coming forward to be tested or treated. Some parents are alarmed when awareness programmes in school lead their children to talk so freely about the disease. This fear and secrecy has hampered efforts at prevention and control sending possibly infected patients into hiding. Hospitals too have to take their share of the blame in this regard with ill-advised personnel creating a panic of sorts around any patient found to test positive.

High-risk groups
Although a higher prevalence of infection is still located within high risk groups, HIV infection has made its way into all parts of society and is today a concern for everyone. The sterling work done by rehabilitation centers and orphanages is an example to all, leading us to belief that each one has a role even if merely to accept those among us who are infected.

Even though the problem has not been as great as earlier predicted in India, and we are better off than many African nations, many millions will continue to get infected and need care in the years ahead. Clearly, we have all the resources we need and it only remains to channel our efforts to achieving complete access to prevention and treatment in the next few years.
(The writer is a medical consultant and ethicist)