AIDS growth in India can be stopped in five years, claims government

More than 16 years after the first case of HIV/AIDS was detected in India, the Indian government announced on 3 April a National AIDS Prevention and Control Policy that seeks to "contain" the virus in five years. According to the national policy document the goal is now "to achieve zero level of new infections by 2007" — an extremely ambitious target.

J. V. R. Prasada Rao, Director of the Indian National AIDS Control Organization (NACO) told the Bulletin that the policy was prepared by NACO and submitted to the government two years ago, and has since been under consideration by many departments and ministries.

"The new national policy is for every ministry and the entire country," says Rao, explaining that the government felt AIDS was so important that it needed to involve every state and ministry. "This is not just a public health issue, it's a national issue," he said.

So how big is the problem? According to NACO, in 2001 the proportion of women who tested positive for HIV (the HIV prevalence) in antenatal clinics varied from 0% in Assam (North India; measured in three clinics) to 1.75% in Maharashtra and Mumbai (West India; measured in 14 clinics). The average prevalence works out as a low 0.7%, but with more than 500 million adults in the country, NACO calculates that 3.8 million people in India are infected.

The government admits that the virus has spread from commercial sex workers and injecting drug users in a few parts of the country in its initial phase to the general population. Given India's large population, even a 0.1% rise in the prevalence rate would increase the number of people with HIV by half a million.

But India's health minister, C P Thakur, is optimistic. "With this policy, we want to provide care for HIV- positive people, spread awareness on AIDS and HIV and bring the level of new infections in the general population to zero by 2007."

The national policy pledges support and care for people living with HIV/ AIDS and protection of their human rights. The 43-page booklet presenting the policy admits that people living with HIV/AIDS have been denied access to medical treatment and care. There have been instances of people being turned out of government hospitals and losing their jobs because of HIV/AIDS. "The effects of stigma are devastating," it says, and the government will strengthen anti-discrimination laws to protect vulnerable groups "such as people living with HIV/AIDS" from discrimination.

The policy stresses that an HIV- positive person should enjoy the same rights to education and employment as others. HIV-positive women should be enabled to take their own decisions regarding pregnancy and childbirth, and no one should be forced to have an abortion or be sterilized.

Doctors, nurses and other medical staff will be sensitized to ensure that people living with HIV/AIDS are not discriminated against. The government says it will also build up — by generating resources from the private sector coupled with its own funds — a comprehensive system of medical care with adequate counselling and psychological support for people with HIV or AIDS.

The government also plans to unfurl a national awareness campaign on AIDS and HIV. According to a study carried out by the government in 2000 and 2001, over 76% of men and women in the 15–49 year age group had an "overall awareness" of AIDS and HIV. "But to be aware of AIDS or HIV — as the government survey indicates — and to have information about it are two different things," says Irfan Khan of Naz India, a nongovernmental organization (NGO) dealing with AIDS. "Going by the people who come to our clinic in New Delhi, I would say that the level of information about HIV/AIDS is still very low," he says.

The new policy will focus on implementation. "We are dealing with this issue by decentralizing the process of implementation," Health Minister Thakur says. Every state will have an HIV/AIDS committee to be headed by a civil servant with representation from the districts. Every district will have at least one testing and counselling centre. In Pune, a city in western India, for instance, a committee has been formed with local businessmen, prominent citizens and parliamentarians. "This will be a highly effective way of ensuring the implementation of the policy," Thakur maintains.

The policy deals with advocacy, surveillance, and control of sexually transmitted infections, and says that condoms — the use of which prevents the virus from spreading through sex — will be distributed at hospitals, clinics, counselling centres and private medical centres.

The policy document even tackles indigenous systems of medicine. It says that there is an "urgent need" to look for cost-effective alternatives to antiretroviral drugs in indigenous systems of medicine such as Ayurveda, Unani and Siddha — ancient Indian medicinal systems using plants and herbs. It also supports homoeopathy, an alternative medical system that is popular in India.

The document claims that government research in the homoeopathic and the Siddha systems has been "encouraging... Some of the medicines in these systems have the potential of reducing the viral load in the body of the patient thus ensuring a healthier and longer life with the infection".

The government, however, also voices a note of caution against "unscrupulous persons" claiming a cure for HIV/AIDS by "magic remedies". All claims would be checked out by institutions such as the government- run Ayurveda Council and the Homoeopathic Council. "A massive awareness campaign has also been launched to make people aware of the dangers of such medication by unqualified persons indulging in quackery", it says.

The policy welcomes the role played by NGOs in dealing with HIV/AIDS and promises to involve them in decision-making through regular interactions. NGOs, for their part, have cautiously welcomed the policy, though most of them stress that they are still studying it. "We believe that a policy that combines prevention and cure is the best way of controlling HIV," says Irfan Khan non-committally.

Another activist working for an HIV/AIDS NGO says that while the policy deals with health care, it primarily focuses on prevention. "It is still very much a prevention policy," he said, preferring to remain anonymous till his NGO publicly reacts to the policy. He is also wary of the policy's resolve to reinforce "traditional Indian moral values" among the country's youth. "Since there is no one tradition in India, it would have been better if the policy had upheld pluralism in Indian society instead," this activist says.

Giving moral overtones to HIV/ AIDS, he says, is counterproductive. "Showing up someone as immoral often stops a person with HIV/AIDS from coming out in the open for treatment or care," he says. He thinks that once NGOs and health workers have honed their arguments, they will be able to pressure the government into making changes in the policy. "Policies change all the time," he says. n

Bishakha de Sarkar, New Delhi

World Health Organization Genebra - Genebra - Switzerland