HIV in India: An Analysis

Context

A new report from the Joint United Nations Programme on HIV/AIDS (UNAIDS) says India has brought down HIV incidence

Fast Facts

• Total HIV patients in India: 2.1million
• Among 15-49 years of affected people: 83%
• Among children below 15 years: 3.3%
• Among women: 39%
• HIV is highly prevalent in states of South, West and North East
• Four Southern states account for 55% of HIV infections
• North Eastern States like Manipur, Nagaland and Mizoram account for highest adult (15-49 years) HIV prevalence in the country
• In India, vulnerable population is at high risk of HIV
• Sex workers HIV prevalence is of 2.2%.
• Gay man have an HIV prevalence of 4.3% and transgender have an HIV prevalence of 7.2%
• India is now able to treat over 90% of notified TB patients for HIV
• India achieved MDG goal 6. Between 2010 and 2017, new HIV infections have decreased by 27% and AIDS-related deaths have decreased by 56%

Reason for HIV in India

• Unsafe sex and low condom use
• Migration and mobility
• Injecting drug use with contaminated injecting equipment
  • They an HIV prevalence of 9.9%.
• Gay men and other men who have sex with men
• Low status of women
  • This increase their vulnerability to protect themselves and negotiate safer sex
• Widespread stigma
  • Stigma towards people living with HIV is widespread. The most affected groups are often marginalized, have little or no access to legal protection of their basic human rights.

Steps taken by Government

1. National AIDS Control Program (NACP)

Shortly after reporting the first AIDS case in 1986, the Government of India established a National AIDS Control Program (NACP) which has now become the Department of AIDS under Ministry of Health and Family Welfare

i) Phase 1 (1992 ‐1999): It focused on initiating a national commitment, increasing awareness and addressing blood safety.

ii) Phase 2 (1999 – 2006): Targeted interventions for the most at risk populations, preventive interventions among the general population, and involvement of NGOs and other sectors and departments, such as education, transport and police

iii) Phase 3 (2007 – 2012): The goal was of halting and reversing the epidemic by the end of project period

iv) Phase 4 (2012 -2017): The goal was to reduce new infections by 50 percent and to provide comprehensive care and support to all persons living with HIV/AIDS

2. India receives technical assistance and funding from a variety of UN partners and bilateral donors.

3. National Helpline was launched to facilitate easy dissemination of information related to HIV/AIDS to general public, People Living with HIV/AIDS (PLHIV), High Risk Groups (HRG) and vulnerable population

4. Indian Medical Council Act, 1956 (Professional Conduct, & Ethics) Regulations, 2002– It lays down certain duties on the part of doctors towards the HIV/AIDS patients.

5. Immoral Trafficking Prevention Act, 1986- It provides for conducting compulsory medical examination for detection of HIV/AIDS among the victims of trafficking.

6. HIV and AIDS (Prevention and Control) Bill, 2017

• The Bill seeks to prevent and control the spread of HIV and AIDS
• Prohibits discrimination against persons with HIV and AIDS
• Provides for informed consent and confidentiality with regard to their treatment
• Places obligations on establishments to safeguard their rights
• Createsmechanisms for redressing their complaints

7. National strategic plan (2017-24) and Mission SAMPARK

• The Union Ministry of Health and Family Welfare launched the plan with aim to eradicating HIV/AIDS by 2030. In 2016, India commit at the UNs’ High-Level Meeting on AIDS towards the goal of ‘ending the AIDS epidemic as a public health threat by 2030
• National Strategic Plan (2017-24) aims towards fast track strategy of ending the AIDS epidemic by 2030 and is expected to pave a roadmap for achieving the target of 90:90:90.
• Mission SAMPARK aim is to trace those who are Left to Follow Up and are to be brought under Antiretroviral Therapy (ART) services.
• “Community Based Testing” will be taken up for fast-tracking the identification of all who are HIV positive.

90:90:90 Strategy

It is a new HIV treatment narrative of UNAIDS programme which has set targets of

• 90% of all people living with HIV will know their HIV status (90% diagnosed),
• 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy (90% on HIV treatment) and
• 90% of all people receiving antiretroviral therapy will have viral suppression (90% suppressed)

8. Project Sunrise: It aims for prevention of AIDS specially among people injecting drugs in the 8 North-Eastern states

Issues/challenges

• Inability to reduce stigma and discrimination. The UNAIDS report points out that certain colonial laws legitimize stigma and give license to the harassment of groups at the highest risk of HIV.
• Inability to integrate HIV/AIDS into the mainstream of public health activities
• Inadequate focus on vulnerability factors, especially poverty, illiteracy and empowerment of women
• Inadequate geographic and population coverage in terms of targeted interventions
• Inadequate attention paid to the issues around antiretroviral treatment
• Changes in the pattern of migration and improving use of Information and Communication Technology has raised the risk

Way Ahead

• Emphasis on both prevention & control as well as care and support
• There is a need to invest in research to find cure for this epidemic
• Focus on areas that have received little attention so far from government and other NGOs
• Government must remove colonial laws like IPC section 377 to reach to transgender and sex workers
• Targeted intervention should be adopted. As in Karnataka sensitizing police personnel and educating female sex workershelp to reduce HIV infection
• More awareness should be generated to reduce stigma attached with the HIV infected people.