National AIDS Control Program In India
By V. Palanichamy
The First AIDS case in India was detected in 1986, since then HIV infection has been reported from all States and Union Territories of the country. It is estimated that there are about 5.134 million HIV infections in India as per the 2003 estimates. Sexual transmission continues to be the major mode of transmission, followed by infection via other routes like infected syringes and needles by IDUs, through infected blood and blood products and from mother to child. Realizing the gravity of epidemiological situation of HIV infection prevailing in the country, the Government of India launched a National AIDS Control Program in 1987. A comprehensive five-year project was launched in 1992. Learning with the experience of Phase-I, there was a paradigm shift in the present Phase-II of the project addressing larger issues in prevention and control of the epidemic. NACP-II was formulated by Government of India with two key objectives: (I) to reduce the spread of HIV infection in India; and (II) strengthen India’s capacity to respond to HIV/AIDS on a long-term basis. The total outlay for the Second Phase of NACP-II is Rs. 2064.65 crore. The NACP -II Project has five components: Priority targeted intervention for populations at high risk This component of the project aims to reduce the spread of HIV in groups at high risk by identifying target populations and providing personal counseling, condom promotion, treatment of sexually transmitted infections etc. This component would be delivered largely through non-governmental organizations, community based organizations and the public sector. 965 targeted Intervention projects have been taken up for various risk groups, which are poor and marginalized and are more vulnerable to HIV transmission. Preventive interventions for the general population It focuses on IEC and awareness campaigns; provision of voluntary testing and counseling; reduction of transmission by blood transfusion and occupational exposure. Under IEC activities, multimedia campaigns are being taken up. Special communication packages are developed for vulnerable groups like sex workers, IDUs, truckers and street children etc. Focused radio programs are broadcast on a regular basis, to provide information about prevention and control of HIV/AIDS. Field publicity units and song and drama division have been undertaking extensive campaigns in rural areas. Over 90 universities, 953 colleges, 12.5 lakhs students have been covered under “University Talks AIDS” programs. AIDS hotlines with 1097 toll free numbers have been established in major cities in the country answering queries relating to sexuality, HIV/AIDS and STDs. This has met with an extremely overwhelming response. To ensure safety of blood and blood products, mandatory screening of all blood units is being done for HIV, Hepatitis-B, Hepatitis-C, Syphilis and Malaria. 10 model blood banks will be set up this year. Focused activities are being taken up to promote “Voluntary Blood Donation” in the country. There are 1854 licensed blood banks in the country. In order to provide access for HIV testing facilities, to those who volunteer to know their HIV status, it has been decided to establish minimum of one VCTC (Voluntary Counseling and Testing Centers) in each district of the country. The HIV testing in these centers is done with pre and post test counseling after obtaining informed consent from the individual. Low cost care for people living with HIV/AIDS Under this component activities would provide financial assistance for home based and community based care, including increasing the availability of cost effective interventions for common opportunistic infections. Necessary funds have been provided to all medical colleges and large hospitals in the country to ensure availability of drugs for management of opportunistic infections in HIV/AIDS patients. 60 Community care centers have been established in high prevalent States to provide palliative care to terminally ill AIDS patients. 39 Govt. medical college and referral hospitals have started free anti-retro-viral therapy. Institutional strengthening This component aims to strengthen effectiveness and technical managerial and financial sustainability at National, State and Municipal levels. The State AIDS Control Societies have been established as autonomous bodies in all States/UT/Municipal Corporations of Mumbai, Chennai and Ahmedabad. Necessary staff has been provided to these societies to ensure enhancement of technical and managerial capacity of these societies for the implementation of the program. HIV Sentinel surveillance through 670 Sentinel sites, AIDS case surveillance by adopting standard AIDS case definition in Indian context & development of information system, STD surveillance for reporting on both etiological and syndromic approach and Behavioral surveillance through an outside agency are key activities to monitor the progression of HIV/AIDS epidemic in the country. Development of indigenous vaccine and Operational Research are the main activities under research priorities of the program. Inter-Sectoral collaboration This component would promote collaborations amongst the public, private and voluntary sectors. The activities would be co-ordinated with other programs within the Ministry of Health & Family Welfare and other central ministries and departments. Collaboration would focus on - Learning from the innovative HIV/AIDS programs that exist in other sectors and sharing in the working of generating awareness, advocacy at delivering interventions. The present program is based on sound public health principles. It targets high risk and general populations with emphasis on voluntary testing instead of mandatory testing, prioritizing care and support needs with human right concerns and laying emphasis on prevention programs. It is possible to reduce the number of new infections to a minimal level in next 3-4 years with large-scale intervention programs. Conclusion HIV infection has become a pandemic in last 20 years. India currently has 5.134 million HIV infected individuals. National AIDS Control Program is presently focusing on up scaling of services to improve coverage and to improve the quality of services provided. The epidemic poses a severe challenge to health care infrastructure. However, a joint coordinated effort by all of us can reduce the rate of spread of this epidemic. The Ministry of Health, NACO and the State AIDS Control Societies as part of their mass mobilization efforts mounted the AASHA (AIDS Awareness Sustained Holistic Action) campaign in Andhra Pradesh, followed by GOONJ in Chandigarh. Mass rallies led by leading film stars were undertaken, celebrities endorsed HIV related messages, nukkad nataks and other folk activities were taken at the village and panchayat level and the entire state’s attention was brought about to the seriousness relating to the epidemic. The slogan, “One Nation, One Resolve, we shall defeat HIV/AIDS” was the objective. The entire political machinery vowed to shatter the silence that surrounded AIDS and to work towards improving the status of Andhra which had the highest number of HIV cases. Forthcoming events include an International Marathon in Pune on December 4, the World AIDS Day celebrations across the country with a Walk for Life being planned in New Delhi in addition to the National Youth Convention which would have youth political leaders of all parties. The theme for the World AIDS Day this year is “Stop AIDS. Keep the Promise”. Every stakeholder has to take stock of the promises he or she has made and to assess how much of that has been achieved. Every effort has to be made to not let India go the Africa way. HIV/AIDS is no longer just a health problem but a social and developmental issue of grave concern. In the absence of a cure for HIV/AIDS the only vaccine right now is the ‘Knowledge Vaccine’. Empowering people with correct and authentic information is the need of the hour. Sex education is being made part of the school curriculum with specific chapters being incorporated from Class VIII. NACO is in the process of developing a book on sexual health for the youth, addressing all issues of concern in an extremely reader friendly format. The national media is being sensitized on reportage through workshops and training programs, enabling reporters on the field, specifically health journalists to be equipped with correct information. Advertising campaigns have been conceptualized with the objective of reaching out to different segments and safe sex messages have been endorsed by celebrities. A lot has been accomplished but a lot more needs to be done still. With the epidemic moving from the high risk groups to the general population, efforts have to be made to strengthen messaging, communication and advocacy and to bring about the desired behavior change. *** The writer is the Deputy Director, National AIDS Control Organization *** The article was published earlier in 2005.
(Courtesy: The Sangai Express)