HIV/AIDS in India

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According to National AIDS Control Organization of India, the prevalence of AIDS in India in 2013 was 0.27, which is down from 0.41 in 2002. 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.

Video HIV/AIDS in India

Epidemiology

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 2014, India's AIDS prevalence rate stood at approximately 0.26% -- the 90th 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 2006 study published in the British medical journal "The Lancet" 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. Recent studies suggest that many married women in India, despite practicing monogamy and having no other risk behaviors, acquire HIV from their husbands and HIV testing of married males can be an effective HIV prevention strategy for general population.

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.

Maps HIV/AIDS in India

HIV statistics, 2011

According to NACO, In 2009, the average HIV prevalence among adults was 0.31. According to Avert, the statistics for special populations are as follows:

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.

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History

In 1986, the first known case of HIV was diagnosed by Dr. Suniti Solomon and her student Dr. Sellappan Nirmala amongst female sex workers in Chennai, Tamil Nadu. 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 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. 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.

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Government policies

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. The AIDS Bhedbhav Virodhi Andolan (AIDS Anti-Discrimination Movement) had prepared many citizens reports challenging discriminatory policies, and filed a petition in the Delhi High Court regarding the proposed segregation of gay men in prisons. A play titled 'High Fidelity Transmission' has focused on discrimination.the importance of the condom as compared with abstinence and illegal testing of vaccines. 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.

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Treatment

Funding

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.

However the government has drastically reduced the social spending on health affecting the NACO programmes. Low procurement of condoms and laying off health workers have concerned the authorities working in the field that it will have a very negative effect on programme

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

NACO centers providing ART as of September 2006

The National AIDS Control Organisation (NACO) has increased the number of centres providing free Anti Retroviral Treatment (ART) from 54 to 91 centres with another 9 more centres also getting operational soon. At these 91 centres medicines for treating 8,5000 patients have been made available. All the 91 centres have specially appointed and trained doctors, counsellors and laboratory technicians to help initiate patients on ART and follow them up regularly. The ART is a combination of three potent drugs, which is being given to the persons with advanced stage of AIDS. Although these drugs do not cure HIV infection, they suppress multiplication of the virus and reduce the number of opportunistic infections thereby improving the quality of life and prolonging the life span. Apart from providing free treatment, all the ART centres are providing counselling to the infected persons so that they maintain regularity of their medication. Continuity is the most important factor for the long term effectiveness of the ART drugs as disruption can lead to drug resistance. At present 40,000 are on ART, which are expected to go up to 85,000 by March end. All these centres have a plan to ensure that patients take their medicines regularly and are followed up, in case of default, while maintaining their confidentiality.

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List of ART Centres

Complete list can be found in the web link http://naco.gov.in/sites/default/files/List%20of%20ARTC.pdf

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List of ART centers running without the fund from The Global Fund to Fight AIDS, Tuberculosis and Malaria

Community Care Centres

These centers provide treatment for minor Opportunistic Infections & psychosocial support through sustained counseling, acting to function as a bridge between hospital & home care. Make referral to PPTCTC for care of HIV positive pregnant women, pediatric HIV services, ART centers for CD4 or other tests and DOTS for treatment of TB.

• Aidsroko, Non-profit Based In Chennai
• ASHRAYA /Action India
• Aradhya
• BPS-Care Home Deepati Foundation
• CHELSEA- Community Care Home
• Child Survival India /Sneh Sadan
• India HIV/AIDS Alliance, Delhi
• Love Faith Society
• Michael Sahara
• Naz Foundation (India) Trust, New Delhi (Selected Directly by NACO)
• Suraksha Clinic

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

Prenatal HIV treatment

Though despite of large no. ART centers present in India a large no. pregnant mothers in India are not diagnosed of HIV infection due to shame factor or fear of coming out for getting tested and mistreated by family members and rejection by society as a stigma.

Prenatal care that includes HIV counseling, testing, and treatment for infected mothers and their children saves lives and resources. Current recommendations are for HIV-positive women to take specific medications during pregnancy and during labor. Blood tests are also performed to check the amount of virus. HIV-positive women should see a specialist during pregnancy.

Newborn babies of HIV-positive mothers may also receive medication. Studies have found that giving a mother antiretroviral medications during pregnancy, labor, and delivery can reduce the chance of transmission of HIV to the baby to less than 2 percent.

Cesarean delivery may be recommended for HIV-positive women. This also helps reduce the risk of transmission of the virus to the baby, especially when the mother receives medications. HIV may also be transmitted through breast milk. Because breast milk contains the virus, HIV-positive mothers should not breastfeed their babies. HIV is not that much dangerous culprit to deal.

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Conferences

HIV Congress was held in Mumbai from 21 to 23 March 2014 in order to encourage the ongoing research in HIV and its treatment. This was organised and supported by API (Association of Physicians of India), Centre for the AIDS Program of Research in South Africa (CAPRISA) and University Hospital Bazel, Switzerland. These type of conferences help in exchanging techniques for better treatment of this epidemic.

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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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Legislation

HIV / AIDS (Prevention and Control) Bill 2014

A long-awaited legislation that seeks to end stigma and discrimination against HIV positive persons in workplace, hospitals and society, while also ensuring their privacy was introduced in the Rajya Sabha on 11-2-2014. The HIV and AIDS Bill, 2014 was finally passed by the Rajya Sabha on 21 March 2017.

Concessions for HIV AIDS patients

As per rules of Indian Railways "AIDS" is replaced by "Immuno Compromised". The Indian Railway gives 50% concession admissible in basic Mail/Express fares of second class only and not sleeper or any other class while traveling for treatment at nominated ART Centers. Concessions are granted directly by Station Masters on production of certificates in prescribed forms issued by Officer in charge of concerned ART center.

See also

• Indian states ranking by HIV awareness
• Operation Lighthouse- HIV/AIDS prevention programme by Indian Government

General:

• AIDS pandemic
• Health in India

References

External links

• National AIDS Control Organisation
• Avert, 'HIV and AIDS in India'
• Aidsroko, Non-profit based in Chennai
• Ekstrand Maria, Garbus Lisa and Marseille Elliot (2003) 'HIV/AIDS in India', AIDS Research Institute: AIy Research Center, University of California, San Francisco, August. http://ari.ucsf.edu/ari/policy/countries.htm
• National AIDS Control Organization NACO (2003) 'HIV/AIDS Surveillance in India'
• UNAIDS 2004 Report on the Global AIDS Epidemic
• UNPAN (2003) National AIDS Prevention and Control Policy (India) www.unpan.org
• India 'cuts HIV infection rate' a new link to BBC site
• India 'overestimates' HIV/Aids
• aarogya AIDS support group
• [1]
• Indian support forum for HIV/AIDS run by 'Indian Network for People Living with HIV/AIDS'
• HIV/AIDS Prevention and Control Bill 2014
• We are at a Turning Point

Source of article : Wikipedia