HIV/AIDS in India
While the National AIDS Control Organisation estimated that 2.39 million people live with HIV/AIDS in India in 2008-09, a more recent investigation by the Million Death Study Collaborators in the British Medical Journal (2010) estimates the population to be between 1.4-1.6 million people.
The last decade has seen a 50% decline in the number of new HIV infections. According to more recent National AIDS Control Organisation data, India has demonstrated an overall reduction of 57 percent in estimated annual new HIV infections (among adult population) from 0.274 million in 2000 to 0.116 million in 2011, and the estimated number of people living with HIV was 2.08 million in 2011.
Despite being home to the world's third-largest population suffering from HIV/AIDS (with South Africa and Nigeria having more), the AIDS prevalence rate in India is lower than in many other countries. In 2007, India's AIDS prevalence rate stood at approximately 0.30%—the 89th highest in the world. The spread of HIV in India is primarily restricted to the southern and north-eastern regions of the country and India has also been praised for its extensive anti-AIDS campaign. The US$2.5 billion National AIDS Control Plan III was set up by India in 2007 and received support from UNAIDS The main factors which have contributed to India's large HIV-infected population are extensive labor migration and low literacy levels in certain rural areas resulting in lack of awareness and gender disparity. The Government of India has also raised concerns about the role of intravenous drug use and prostitution in spreading AIDS, especially in north-east India and certain urban pockets. A recent study published in the British medical journal "The Lancet" in (2006) reported an approximately 30% decline in HIV infections among young women aged 15 to 24 years attending prenatal clinics in selected southern states of India from 2000 to 2004 where the epidemic is thought to be concentrated. The authors cautiously attribute observed declines to increased condom use by men who visit commercial sex workers and cite several pieces of corroborating evidence. Some efforts have been made to tailor educational literature to those with low literacy levels, mainly through local libraries as this is the most readily accessible locus of information for interested parties. Increased awareness regarding the disease and citizen's related rights is in line with the Universal Declaration on Human Rights.
The estimated adult HIV prevalence was 0.32% in 2008 and 0.31% in 2009. The states with high HIV prevalence rates include Manipur (1.40%), Andhra Pradesh (0.90%), Mizoram (0.81%), Nagaland (0.78%), Karnataka (0.63%) and Maharashtra (0.55%).
The adult HIV prevalence in India is declining from estimated level of 0.41% in 2000 through 0.36% in 2006 to 0.31% in 2009. Adult HIV prevalence at a national level has declined notably in many states, but variations still exist across the states. A decreasing trend is also evident in HIV prevalence among the young population of 15–24 years. The estimated number of new annual HIV infections has declined by more than 50% over the past decade.
According to Michel Sidibé, Executive Director of UNAIDS, India’s success comes from using an evidence-informed and human rights-based approach that is backed by sustained political leadership and civil society engagement. India must now strive to achieve universal access to HIV prevention, treatment, care and support.
HIV statistics, 2011
|State||Antenatal clinic HIV prevalence 2007 (%)||STD clinic HIV prevalence 2007 (%)||IDU HIV prevalence 2007 (%)||MSM HIV prevalence 2007 (%)||Female sex worker HIV prevalence 2007 (%)|
|A & N Islands||0.25||1.33||...||...||...|
|D & N Haveli||0.50||...||...||...||...|
|Daman & Diu||0.13||...||...||...||...|
|Jammu & Kashmir||0.00||0.20||...||...||...|
Some areas report an HIV prevalence rate of zero in antenatal clinics. This does not necessarily mean HIV is absent from the area, as some states report the presence of the virus at STD clinics and amongst injecting drug users. In some states and territories the average antenatal HIV prevalence is based on reports from only a small number of clinics.
In 1986, the first known case of HIV was diagnosed by Dr. Suniti Solmon amongst female sex workers in Chennai. Later that year, sex workers began showing signs of this deadly disease. At that time, foreigners in India were traveling in and out of the country. It is thought that these foreigners were the ones responsible for the first infections. By 1987, about 135 more cases came to light. Among these 14 had already progressed to AIDS. Prevalence in high-risk groups reached above 5% by 1990. As per UNDP's 2010 report, India had 2.395 million people living with HIV at the end of 2009, up from 2.27 million in 2008. Adult prevalence also rose from 0.29% in 2008 to 0.31% in 2009.
In 1986, HIV started its epidemic in India, attacking sex workers in Chennai, Tamil Nadu. Setting up HIV screening centres was the first step taken by the government to screen its citizens and the blood bank.
To control the spread of the virus, the Indian government set up the National AIDS Control Programme in 1987 to co-ordinate national responses such as blood screening and health education.
In 1992, the government set up the National AIDS Control Organisation (NACO) to oversee policies and prevention and control programmes relating to HIV and AIDS and the National AIDS Control Programme (NACP) for HIV prevention. The State AIDS Control Societies (SACS) was set up in 25 societies and 7 union territories to improving blood safety.
In 1999, the second phase of the National AIDS Control Programme (NACP II) was introduced to decrease the reach of HIV by promoting behaviour change. The prevention of mother-to-child transmission programme (PMTCT) and the provision of antiretroviral treatment were materialized.
In 2007, the third phase of the National AIDS Control Programme (NACP III) targeted the high-risk groups, conducted outreach programmes, amongst others. It also decentralised the effort to local levels and non-governmental organisations (NGOs) to provide welfare services to the affected.
Soon after the first cases emerged in 1986, the Government of India established the National AIDS Committee within the Ministry of Health and Family Welfare. This formed the basis for the current apex Government of India body for HIV surveillance, the National AIDS Control Organisation (NACO). The majority of HIV surveillance data collected by the NACO is done through annual unlinked anonymous testing of prenatal clinic (or antenatal clinics) and sexually transmitted infection clinic attendees. Annual reports of HIV surveillance are freely available on NACO's website.
The first National AIDS Control Programme (NACP) was implemented over seven years (1992-1999), focused on monitoring HIV infection rates among risk populations in selected urban areas. The second phase ran between 1999 and 2006 and the original program was expanded at state level, focusing on targeted interventions for high-risk groups and preventive interventions among the general population. A National Council on AIDS was formed during this phase, consisting of 31 ministries and chaired by the Prime Minister. HIV/Aids was understood not purely as a health issues, but also a development issue and as such it was mainstreamed into all ministries and departments. The third stage dramatically increased targeted interventions, aiming to halt and reverse the epidemic by integrating programmes for prevention, care, support and treatment. By the end of 2008, targeted interventions covered almost 932,000 of those most at risk, or 52% of the target groups (49% of FSWs, 65% of IDUs and 66% of MSM). In 2009 India established a "National HIV and AIDS Policy and the World of Work", which sough to end discrimination against workers on the basis of their real or perceived HIV status. Under this policy all enterprises in the public, private, formal and informal sectors are encouraged to establish workplace policies and programmes based on the principles of non-discrimination, gender equity, health work environment, non-screening for the purpose of employment, confidentiality, prevention and care and support. Researchers at the Overseas Development Institute have called for greater attention to migrant workers, whose concerns about their immigration status may exclude them from these policies and leave them particularly vulnerable.
No agency is tasked with enforcing non-discrimination policy, instead multi-sectoral approach has been developed involving awareness campaigns in the private sector. HIV/AIDS-related television shows and movies have appeared in the past few years, mostly in an effort to appeal to the middle class. An important component of these programs has been the depiction of HIV/AIDS affected persons interacting with non-infected persons in everyday life. Vilification of infected persons has occurred, as the disease has become more popularly associated with sex workers These efforts have focused on increasing tolerance and awareness among the middle class in an effort to diminish the portion of the population affected by HIV/AIDS by developing public concern and calls for greater governmental action. In control measures, a large number of stakeholders can play an important role. The following paragraphs are excerpts on how the Supreme Court of India gave exhaustive recommendations to such stakeholders.
In 2010, NACO approved the TeachAIDS educational materials marking the first time HIV/AIDS education could be provided decoupled from sex education. Later that year, the Government of Karnataka approved the materials for their state of 50 million and committed to distributing them in 5,500 government schools.
HIV spending increased in India from 2003 to 2007, and fell by 15% in 2008 to 2009. Currently, India spends about 5% of its health budget on HIV/AIDS. Spending on HIV/AIDS may create a burden in the health sector which faces a variety of other challenges like malaria, diabetes, heart disease and cancer. Thus, it is crucial for India to step up on its prevention efforts to decrease its spending of the health budget on HIV/AIDS in future.
Second-line treatment issue
Responding to a petition made by NGO's, in December 2010, the Supreme Court of India directed Indian government to provide second-line Antiretroviral Therapy (ART) to all AIDS patients in the country, by warning the government against abdicating its constitutional duty of providing treatment to HIV positive patients on grounds of financial constraint, as it was issue of the right to life guaranteed under Article 21 of the Indian Constitution. Previously in an affidavit before the Supreme Court, NACO had said second-line ART treatment for HIV patients, costing Rs28,500 each, could not be extended to those who had received "irrational treatment" by private medical practitioners for the first round, which costs around Rs6,500. The court rejected both the arguments of financial constraints and only 10 viral load testing centres needed for test patients for migrating from first line of treatment to the second line being are available, raised by the Solicitor General representing the government. The court further asked the government to give a clear-cut and "workable" solution response within a week's time.
Number of ART centres and patients alive and on ART by state, January 2010
|State||No. of ART Centres||Total (Adult)||Total (Paediatric)||Total|
Litigation for access to treatment
- Voluntary Health Association of Punjab v. Union of India
- Love Life Society v. Union of India & Others
- Wahengbam Joykumar v. Union of India & Others
- Delhi Network of Positive People & Another v. Union of India & Others
2012 UN Report
New HIV cases among adults have declined by half in India since 2000, according to a new UN report which praised India's contribution to AIDS response through manufacture of generic antiretroviral drugs.
Though rate of HIV transmission in Asia is slowing down, at least 1,000 new infections among adults continue to be reported in the continent every day in 2011.
An estimated 360,000 adults were newly infected with HIV in Asia in 2011, considerably fewer than 440,000 estimated for 2001, a new UNAIDS report has said.
"This reflects slowing HIV incidence in the larger epidemics, with seven countries accounting for more than 90 per cent of people (in Asia) living with HIV - China, India, Indonesia, Malaysia, Myanmar, Thailand and Vietnam," the report 'Together We Will End AIDS' said.
The UNAIDS lauded India for doing "particularly well" in halving the number of adults newly infected between 2000 and 2009 and said some smaller countries in Asia like Afghanistan and Philippines are experiencing increases in the number of people acquiring HIV infection.
It said a total 1.7 million people had died across the world due to AIDS related illness. In India, the figure for such deaths stood at 170,000 in 2009. The report says India has contributed enormously to the AIDS response.
"With 80 per cent of these drugs being generics purchased in India, several billion dollars have been saved over the past five years. The country is also committed to new forms of partnership with low-income countries through innovative support mechanisms and South?South cooperation," the UNAIDS report says.
It also points out that India already provides substantial support to neighbouring countries and other Asian countries - in 2011, it allocated USD 430 million to 68 projects in Bhutan across key socio-economic sectors, including health, education and capacity-building. In 2011 at Addis Ababa, the Government of India further committed to accelerating technology transfer between its pharmaceutical sector and African manufacturers.
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