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Despite being a country with low HIV prevalence, India has the third largest number of people living with HIV/AIDS in the world. The Acquired Immune Deficiency Syndrome (AIDS) is caused by the Human Immunodeficiency Virus (HIV) which weakens the immune system of an individual.HIV attacks the immune system and leaves the body vulnerable to a variety of life-threatening infections and cancers. Thus, the epidemic of AIDSconstitutes one of the most formidable challenges to the development and social progress of the nation.
HIV has been found in saliva, tears, nervous system tissue and spinal fluid, blood, semen (including pre-seminal fluid, which is the liquid that comes out before ejaculation), vaginal fluid, and breast milk. However, only blood, semen, vaginal secretions, and breast milk has been shown to transmit infection to others.
The HIV Estimates 2008-09 put the figure of people infected with HIV/AIDS at an estimated 23.9 lakh with an adult prevalence of 0.31 per cent. Most infections occur through heterosexual transmission. However, in certain regions, injecting drug use, men who have sex with men and single male migrants are contributing for the spread of HIV epidemic. The heterogeneous spread of the HIV epidemic is evident from the fact some pockets show high prevalence than the others.
- Issues and Challenges
- Indian Scenario
- AIDS & National AIDS Control Organization (NACO)
- National AIDS Control Programme
- State AIDS Prevention and Control Societies
- AIDS and Civil Society
- Declining Trends of Adult HIV Prevalence
- People Living with HIV/AIDS (PLHA)
- AIDS Policies & Guidelines: India & World
- International Organizations
| ISSUES AND CHALLENGES | ||
 | There are severe institutional capacity constraints, including managerial, at the national and state levels. These are critical factors to address as the programme attempts to scale-up the national response. National AIDS Control Organization (NACO) has been instrumental in providing the necessary leadership and steering role for a stronger multi-sector response for India's fight against HIV/AIDS.
The capacity to mount a strong programme is weakest in some of the poorest and most populated states with significant vulnerability to the epidemic. There is a need for tailored capacity-building activities and the introduction of some performance-based financing approaches.
Stigma and discrimination against people living with HIV/AIDS and those considered to be at high risk remain entrenched. A lot of this is a result of inadequate knowledge. Stigma and denial undermine efforts to increase the coverage of effective interventions among high risk groups such as men having sex with men, commercial sex workers and injecting drug users. Harassment by police and ostracism by family and community drives the epidemic underground and decreases the reach and effectiveness of prevention efforts. Though there is significant increase in awareness, due to efforts by the government, there is much room for improvement.
Sentinel site behavioral surveillance, completed in 2001, showed high HIV/AIDS basic awareness levels (82.4 per cent in males and 70 per cent in females). However, rural women demonstrated very low rates of awareness in Bihar (21.5 per cent), Gujarat (25 per cent), and Uttar Pradesh (27.6 per cent). New approaches need to be tried to reach rural communities with information about HIV/AIDS, safe sex and how to prevent and treat HIV/AIDS.
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INDIAN SCENARIO
HIV epidemic in India is concentrated in nature. The HIV prevalence among the High Risk Groups, i.e., Female Sex Workers, Injecting Drug Users, Men who have Sex with Men and Trans-genders is about 20 times higher than the general population. Based on HIV Sentinel Surveillance 2008-09, it is estimated that India has an adult prevalence of 0.31 per cent with 23.9 lakh people infected with HIV, of which, 39 per cent are female and 3.5 per cent are children. The estimates highlight an overall reduction in adult HIV prevalence, HIV incidence (new infections) as well as AIDS related mortality in India.
Analysis of epidemic projections revealed that the number of new annual HIV infections has declined by more than 50 per cent during the last decade. It is estimated that India had approximately 1.2 lakh new HIV infections in 2009, as against 2.7 lakh in 2000. This is one of the most important evidence on the impact of the various interventions under NACP and scaled-up prevention strategies.
Of the 1.2 lakh estimated new infections in 2009, the six high prevalence states account for 39 per cent of the cases, while the states of Odisha, Bihar, West Bengal, Uttar Pradesh, Rajasthan, Madhya Pradesh and Gujarat account for 41 per cent of new infections.
The estimated adult HIV prevalence in India was 0.32 per cent (0.26% - 0.41%) in 2008 and 0.31 per cent (0.25% - 0.39%) in 2009. The adult prevalence is 0.26 per cent among women and 0.38 per cent among men in 2008, and 0.25 per cent among women and 0.36 per cent among men in 2009.
Among the states, Manipur has shown the highest estimated adult HIV prevalence (1.40%), followed by Andhra Pradesh (0.90%), Mizoram (0.81%), Nagaland (0.78%), Karnataka (0.63%) and Maharashtra (0.55%). Besides these states, Goa, Chandigarh, Gujarat, Punjab and Tamil Nadu have shown estimated adult HIV prevalence greater than national prevalence (0.31%), while Delhi, Odisha, West Bengal, Chhattisgarh and Puducherry have shown estimated adult HIV prevalence of 0.28-0.30 per cent. All other states/UTs have lower levels of HIV prevalence.
| AIDS & NATIONAL AIDS CONTROL ORGANIZATION (NACO) | ||
 | National AIDS Control Organisation (NACO) is a Government of India organisation under the Ministry of Health & Family Welfare with the primary objective to control the epidemic in India. NACO also aims at facilitating and improving access to treatment for HIV+ people and also to promote and protect their human rights.
Ever since its establishment, NACO has been working to create awareness about HIV/AIDS, giving accurate and reliable information on the menace, clearing existing myths and misconceptions and providing practical skills that can be implemented at the individual's level so as to lead to behaviour changes that minimise the risk of HIV infection.
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NATIONAL AIDS CONTROL PROGRAMME
With its first two phases already successfully over, NACP is currently in its IIIrd phase and the overall goals of this phase is to halt and reverse the epidemic in India over the next five years by integrating programmes for prevention, care and support and treatment.
NACP III has the following four-pronged strategy:
- Prevent infections through saturation of coverage of high-risk groups with targeted interventions (TIs) and scaled up interventions in the general population.
- Provide greater care, support and treatment to larger number of PLHA.
- Strengthen the infrastructure, systems and human resources in prevention, care, support and treatment programmes at district, state and national levels.
- Strengthen the nationwide Strategic Information Management System.
The specific objective is to reduce the rate of incidence by 60 per cent in the first year of the programme in high prevalence states to obtain the reversal of the epidemic, and by 40 per cent in the vulnerable states to stabilise the epidemic.
Achievements of NACP
- Promotion of voluntary blood donation has enabled reducing transmission of HIV infection through contaminated blood from about 6.07% (1999), 4.61% (2003), 2.07% (2005), 1.96% (2006) to 1.87% (2007).
- The number of integrated counseling and testing centres increased from 982 in 2004, 1476 in 2005, 4027 in 2006, 4567 in 2007 and 4817 in 2008 (till September, 2008). The number of persons tested in these centres has increased from 17.5 lakh in 2004 to 37.9 lakhs in 2008-09 (August, 2008).
- In the year 2007, a total of 3.2 million pregnant women accessed PPTCT services at ICTCs across the country of which 18449 pregnant women were diagnosed to be HIV +ve. Of these 11460 (62%) pregnant women and the infants born to them received prophylactic single dose Nevirapine to prevent parent to child transmission of HIV.
- The number of STI clinics being supported by NACO has increased from 815 in 2005 to 895 in 2008. The reported number of patients treated for STI in 2005 was 16.7 lakh, in 2006, 20.2 lakh and in 2007, it has increased to 25.9 lakh.
- As of September 2008, 5,61,981 patients have been registered at ART centers and 1,77,808 clinically eligible patients are receiving free ART in Govt. & inter-sectoral health sector. This is achieved through 179 ART centers across 31 states. Total 159 Community Care Centers are established across country of providing Care & Support Services to PLHA's.
- The Targeted Intervention (TI) projects aim to interrupt HIV transmission among highly vulnerable populations. Such population groups include - commercial sex workers, injecting drug users, men who have sex with men, truckers and migrant workers. As on date, 1132 Targeted Interventions are operational in various states and UTs in the country.
| STATE AIDS PREVENTION AND CONTROL SOCIETIES | ||
 | National AIDS Control Organisation provides leadership to HIV/AIDS Control Programme in India, implementing one National Plan within one monitoring system. State AIDS Prevention and Control Societies (SACS) implement NACOprogramme at state level, but have functional independence to upscale and innovate.
SACS are autonomous and decentralised. Each State AIDS Prevention and Control Society has a governing body, its highest policy-making structure, headed either by the minister in charge of health or the chief secretary. It has on board representatives from key government departments, the civil society, trade and industry, private health sector and PLHA networks, who meet twice a year. It approves new policy initiatives, annual plan and budget, appoints statutory auditors and accepts the annual audit report. For better financial and operational efficiency, administrative and financial powers are vested in the Executive Committee and the Programme Director.
Functions of SACS are:
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AIDS AND CIVIL SOCIETY
NGOs and civil society organisations have made significant contribution in reaching out HIV prevention and care services to the highly vulnerable population groups. There are numerous NGOs/CSOs working on HIV/AIDS at the local, state and national levels. The National AIDS Control Programme recognises the importance of their participation, particularly in preventive or targeted interventions for high risk groups, care and support of people living with HIV/AIDS and in general awareness campaigns.
Community mobilisation and empowerment are essential for successful transition of a programme to the communities. Civil Society Organisations and NGOs bring with them their experience of community level work in enhancing people's participation. They, therefore, play a crucial role in preparing communities to take ownership of the programme, and thereby enhance the scope of prevention, care and support. Their participation has immensely benefited the HIV/AIDS programme.
These organizations provide comprehensive and integrated approach for HIV prevention among the marginalised and vulnerable populations such as female sex workers (FSW), injecting drug users (IDU), men-having-sex-with-men (MSM) and bridge population such as migrant workers and truckers.NACO, in partnership with CSOs/NGOs, provides HIV prevention services to these groups at a place and time where they can be most effectively accessed.
| DECLINING TRENDS OF ADULT HIV PREVALENCE | ||
 | The adult HIV prevalence at national level has continued its steady decline from estimated level of 0.41 per cent in 2000 through 0.36 per cent in 2006 to 0.31 per cent in 2009. According to UNAIDS World AIDS Day Report, 2011 (604 KB)  in India new HIV infections fell by 56 per cent. All the high prevalence states show a clear declining trend in adult HIVprevalence. HIV has declined notably in Tamil Nadu to reach 0.33 per cent in 2009. However, the low prevalence states of Chandigarh, Odisha, Kerala, Jharkhand, Uttarakhand, Jammu & Kashmir, Arunachal Pradesh and Meghalaya show rising trends in adult HIV prevalence in the last four years.
A clear decline is also evident in HIV prevalence among the young population (15-24 yrs) at national level, both among men and women. Stable to declining trends in HIV prevalence among the young population (15-24 yrs) are also noted in most of the states. However, rising trends are noted in some states including Odisha, Assam, Chandigarh, Kerala, Jharkhand and Meghalaya.
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PEOPLE LIVING WITH HIV/AIDS (PLHA)
The total number of people living with HIV/AIDS (PLHA) in India is estimated at 23.9 lakh (19.3 - 30.4 lakh) in 2009. Children less than 15 yrs account for 3.5 per cent of all infections, while 83 per cent are the in age group 15-49 years. Of all HIV infections, 39 per cent (9.3 lakhs) are among women. The four high prevalence states of South India (Andhra Pradesh-5 lakhs, Maharashtra-4.2 lakhs, Karnataka-2.5 lakhs, Tamil Nadu-1.5 lakhs) account for 55 per cent of all HIV infections in the country. West Bengal, Gujarat, Bihar and Uttar Pradesh are estimated to have more than one lakh PLHA each and together account for another 22 per cent of HIV infections in India. The states of Punjab, Odisha, Rajasthan & Madhya Pradesh have 50,000-1 lakh HIV infections each and together account for another 12 per cent of HIV infections. These states, in spite of low HIV prevalence, have large number of PLHA due to the large population size.
| AIDS POLICIES & GUIDELINES: INDIA & WORLD | ||
 | The broad framework and ideology of the HIV/AIDS Policy of the Government of India in particular and the world in general have been instrumental in declining HIV positive cases. These various national and international policies and guidelines stress that the organized and unorganized sector needs to be mobilized for taking care of the health of the society. Few policies and guidelines are mentioned below:
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INTERNATIONAL ORGANIZATIONS
Global efforts to halt and even reverse the spread of HIV/AIDS are showing welcome results, with the number of people newly infected declining andAIDS-related deaths falling, according to the latest report from the United Nations agency leading the fight against the disease. Few organizations that are working efficiently in the field of AIDS:
- International Council of AIDS Service Organizations
- World Health Organization
- Joint United Nations Programme on HIV/AIDS (UNAIDS)
- United Nations Children's Fund
- International AIDS Society
- International Labour Organization
- United Nations Educational Scientific and Cultural Organization
- International AIDS Economics Network
