AIDS in India

1,400,000 to 1,600,000 people infected with HIV/AIDS currently reside in India. However, the HIV population has been declining by approximately 50%, dwindling from 274 thousand 116 thousand in 10 years. Worldwide, in 2011, there were 2,080,000 infections.

Many say these estimates are questionable. Some survey data reveal that in 2001 there were over 5,700,000 HIV cases. In addition, a national control program for AIDS in New Delhi declared that the statistics of AIDS in India were exaggerated.

Epidemiology

India ranks third in gross HIV/AIDS population (after Nigeria and South Africa). However, India has a less significant percentage of the population with HIV/AIDS, ranking 89th worldwide with 0.30% prevalence rate. HIV is mainly concentrated in the northeastern and southern regions. The Indian government has organized a rigorous campaign against AIDS,  spending ($2,500,000,000) for the third National Control Program for AIDS in 2007.

Low literacy levels and widespread migration are major causes of the large HIV population in India. According to a study, there was a 30% decrease in infections of HIV among women from 15-24 years in many southern states due to increased use of condoms. In addition, numerous awareness and educational programs were established to reduce HIV/AIDS prevalence rate. Overall, the national HIV prevalence rate among adults has been minimized, declining by 10% from 2000 to 2009. The HIV prevalence rate specifically in youths 14-24 years has also decreased. Despite this general trend, variations exist among states.

History

In 1986, Dr. Suniti Solomon diagnosed the first HIV case in the city of Chennai, in a female sex worker. HIV then spread quickly among sex workers. Most people believed that the foreign clients who frequently traveled outside the country were carriers of this disease. Since then, the number of HIV cases has continued to grow. The Indian government initially set up screening centers to diagnose this deadly disease. Later, in 1987, it also established the National AIDS Control Program to restrain HIV from spreading and promote national efforts against HIV/AIDS. Examples of efforts include screening blood and improving health education.

The government established the NACO (National AIDS Control Organization) and NACP (the National AIDS Control Program) to oversee policies related to HIV and AIDS prevention in 1992. In addition, SACs (State AIDS Control Societies) were set up to support blood safety.

A second phase (NACP II) emerged in 1999. This second phase promoted behavior change to hinder the spread of HIV such as a program for preventing transmission from mothers to children and providing antiretroviral treatment generally.

In 2007, NACP III, the third phase, delegated local levels and NGOs (non-governmental organization) more responsibilities and jurisdiction over welfare services for those affected. There was also an increased focus on high-risk groups and control outreach programs.

Government policies

The Indian government established the National AIDS Committee in 1986, which set the foundation for the National Control Organization for AIDS (NACO). NACO is currently the major body for HIV surveillance in India. NACO collects data for annual reports anonymously from prenatal clinics and clinic patients who have been infected through sexual transmission. The 1st NACP started in 1992 and lasted until 1999. The program monitored the infection rates of HIV in urban areas among the risky population. The 2nd phase lasted from 1999 to 2006. It targeted risky groups and focused on preventive methods. An AIDS National Council was established. It included 31 ministries, which carefully monitored HIV as a development and health issue. The third phase incorporated prevention, support, care and treatment programs to tackle the epidemic.

Anti-discrimination policies were issued. In 2009, a “National HIV and AIDS Policy and the World of Work” was founded to protect workers with HIV against discrimination. Private and public sectors were encouraged to promote gender equity along with HIV non-discrimination in working places. Immigrants also attracted special attention in anti-discrimination policy because of their vulnerability to discrimination. Unfortunately this policy lacks teeth, as there is no agency to enforce non-discrimination policy for affected HIV/AIDS victims. Awareness campaigns such as HIV-related TV movies and shows have been used to promote tolerance, arouse public concern for HIV/AIDS and instigate governmental action. Since there is not yet a permanent treatment to HIV, India focuses on preventive measures to control HIV/AIDS. Many of these control measures are enacted by several agencies both public and private.

NACO ratified the educational materials of TeachAIDS in 2010. The Karnataka government also approved to use 50 million dollars to 5.5 thousand government schools to fund education.

Funding

HIV spending in India increased 2003–2007 and declined 2008-2009. This spending only makes up 5% of the national health budget yet adds increased burden on services because the Indian health sector also faces problems such as malaria, cancer, diabetes and heart diseases. Therefore, India has found that active participation in initiatives to prevent the spread of HIV/AIDS is the most cost- and resource-effective way to deal with the epidemic.

Second line treatment

Number of ART centers by state in January 2010

Number of ART centers by state in January 2010

The NGO petitioned the Indian Supreme Court to provide ART (a second-line treatment after prevention) to all AIDS patients in December 2010. The Article 21 of the Indian Constitution guarantees the citizens’ right to life. Therefore, NGO built their case on asking the Indian government to refrain from violating their constitutional responsibility. According to NGO, the government cannot preclude treatment to patients tested positive for HIV because of a financial limit. In a previous affidavit, NACO argued that HIV patients who have received treatment from private medical facilities cannot receive second-line ART treatment. Each private medical treatment costs around 6,500 rupees and each second line ART treatment costs around 28,500 rupees. However, the court disapproved NACO’s argument. The Court declines the argument of financial constraint. It also asked the government to open more than 10 test centers for patients to transfer from 1st line to 2nd line treatment.

UN Reports

Since 2000, UN reported a 50% decline in new adult HIV cases in India. The HIV’s transmission rate in India has also slowed down. By 2011, in Asia, there were at least one thousand new adult cases everyday. There were 440 thousand HIV cases in 2001. However, this number declined to 360 thousand in 2011.

UN applauded India for its excellent work in reducing the amount of infections by half from 2000 to 2009. In 2009, there were only 170,000 deaths in India while the world had 1,700,000 deaths due to AIDS. UN praised India’s large, effective contribution to the effort in responding to AIDS.

India’s local manufacture of generic antiretroviral drugs has significantly contributed to its success. According to UNAIDS report, India purchased 80% of the generic drugs and saved billion dollars in the past 5 years. It also provides generous support to other Asian countries. Particularly, in 2011, India supported the country of Bhutan by spending approximately $430 million to fund health, employment, and education. The Indian government ahs also committed to improve technology in African manufacturing industries.


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