This year marks the 20th anniversary of India’s national response to HIV/Aids and the establishment of the National Aids Control Organisation (Naco) for its prevention and control. The threat of getting branded as the Aids capital of the world was successfully converted into an opportunity to end Aids in India. In 20 years the country could turn the epidemic on its head. The latest data shows that the yearly rate of new infections has dropped by 56% of the 2001 level, giving India a rare chance of achieving the Millennium Development Goal of halting and reversing the epidemic by 2015.
It is also a good time to introspect whether we are on the right track and can dream of an ‘Aids-free India’ in the next decade. While globally it is still a daunting task, it may be achievable in India. The complete eradication of HIV depends on the availability of preventive vaccines, but eliminating new infections is possible in India.
It is debatable whether the first half of a race is tougher than the second or the opposite. In India’s Aids response, one can argue, mounting a final and intensive campaign is easier than it was to launch a determined response 20 years ago. This is not to underplay the challenges that the programme faces today. Fortunately, the biggest challenge the world faces today — sustainable financing of the Aids programmes — doesn’t affect India. The country has been able to commit 90% of resources from the domestic budget. The government’s policy of stepping up resources for the national Aids control efforts is a mature and far-sighted one.
Despite these strong and positive factors, India’s efforts fall short in three important areas of Aids response.
First, the coverage levels of prevention services for people who inject drugs are not to scale. There’s evidence to show that the emergence of injecting drug use in new areas of Punjab and adjacent states is not matched by increasing the levels of coverage by Oral Substitution Therapy and Needle Syringe Programmes. The governments of these states should ensure rapid expansion of ‘harm reduction’ programmes.
The second area is the treatment of HIV positive adults with anti-retroviral therapy (Art) and pregnant women and newborn children with prevention of parent to child treatment programmes (PPTCT). While the rapid scale up of Art in India is praiseworthy, it hasn’t yet reached the level of coverage where treatment as a prevention tool becomes effective. The coverage of PPTCT services is unacceptably low at around 30%. The target of an Aids-free new generation by 2015 will be daunting if the present levels of coverage are not rapidly increased in the coming three years.
The third determinant is the legal environment surrounding the vulnerable populations in India. The landmark judgement of the Delhi High Court on same sex relationships is under judicial review in the Supreme Court. The Immoral Traffic Prevention Act has been kept on the backburner in the face of strong opposition from civil society and sex worker organisations. But the threat of it getting resuscitated looms large. India’s laws continue to conflate drug trafficking with drug use. Marginal amendments in recent times have made no impact on the ground level situation where youngsters are regularly subjected to police harassment, arrest and prosecution for possessing small quantities of drugs for personal use.
Most importantly, the HIV Bill, which was drafted about seven years ago with strong participation from civil society organisations, is yet to become a law. If passed, it can provide a strong legal framework to protect HIV patients and vulnerable populations who are criminalised.
The Global Commission on HIV and Law in its recent report states that new infections can be cut by twice the present rate if law and its enforcement are softened to benefit the vulnerable populations. This holds true for India too. Twenty years into a determined national effort to prevent HIV/Aids, India has a unique opportunity to beat down the epidemic and reach elimination levels of infection and disease. It is up to the leadership in India to seize the opportunity and make the country Aids-free in the near future.
JVR Prasada Rao is former Secretary of Health, Government of India
The views expressed by the author are personal