AIDS in India

Acquired Immune Deficiency Syndrome
1. Caused By: human immunodeficiency virus (HIV).

Human immunodeficiency virus (HIV) is retrovirus. It is also known as human T-lymphotropic virus-III (HTLV-III), lymphadenopathy-associated virus (LAV), and AIDS-associated retrovirus (ARV)
2. Transmission: Transmission involves anal, vaginal or oral sex, blood transfusion, contaminated hypodermic needles, exchange between mother and baby during pregnancy, childbirth, breastfeeding or other exposure to one of the above bodily fluids.
3. Effects of AIDS:

1. Due to weakened immune system the person is attacked by infections caused by bacteria, viruses, fungi and parasites that are normally controlled by the elements of the immune system that HIV damages.
2. Opportunistic infections are common in people with AIDS. HIV affects nearly every organ system.
3. People with AIDS may develop various cancers such as Kaposi’s sarcoma, cervical cancer and cancers of the immune system known as lymphomas.
4. Besides the people infected with AIDS often have systemic symptoms of infection like fevers, sweats (particularly at night), swollen glands, chills, weakness, and weight loss.

4. Stats: AIDS is now a pandemic.

1. In 2007 approximately 33.2 million people lived with the disease worldwide, and that AIDS had killed an estimated 2.1 million people, including 330,000 children.
2. 75% deaths in sub-Saharan Africa.
3. AIDS has killed more than 25 million people between 1981 and 2007.

AIDS in India :

1. First cases of HIV were diagnosed among sex workers in Chennai in 1986.
2. Following the detection of the first AIDS case in the country, the National AIDS Committee was constituted in the Ministry of Health and Family Welfare.
3. By the end of 1980s a spread of HIV was observed among injecting drug users (IDUs) in Manipur, Mizoram and Nagaland.
4. As the epidemic spread, need was felt for a nationwide programme and an organisation to steer the programme.
5. In 1992 India’s first National AIDS Control Programme (1992-1999) was launched, and National AIDS Control Organization (NACO) was constituted to implement the programme.
6. National AIDS Control Organization is a division of the Ministry of Health and Family Welfare that provides leadership to HIV/AIDS control programme in India through 35 HIV/AIDS Prevention and Control Societies.
7. In 1992 Govt. set up State AIDS bodies in 25 states and 7 union territories.
8. In 1992 India’s first National AIDS Control Programme NACP-I (1992-1999) was launched, and National AIDS Control Organisation (NACO) was to implement the programme.
9. The objective of NACP-I (1992-1999) was to control the spread of HIV infection. During this period 685 blood banks & 504 STD clinics were established. HIV sentinel surveillance system was also initiated. NGOs were involved in the prevention interventions with the focus on awareness generation. The programme led to capacity development at the state level with the creation of State AIDS Cells in the Directorate of Health Services in states and union territories.
10. NACP-II (1999-2006) was launched during which a number of new initiatives were undertaken and the programme expanded in new areas.

• Targeted Interventions were started through NGOs, with a focus on High Risk Groups (HRGs) viz. commercial sex workers (CSWs), men who have sex with men (MSM), injecting drug users (IDUs), and bridge populations (truckers and migrants).
• Behaviour Change Communication, management of STDs and condom promotion were included.
• The School AIDS Education Programme was conceptualized.
• Voluntary counselling and testing facilities were established.
• Free antiretroviral therapy was initiated in selected hospitals in the country.
• Development of indigenous vaccine and research on microbicides are some initiatives in HIV research.
• National AIDS Prevention and Control Policy & National Blood Policy, a strategy for Greater Involvement of People with HIV/AIDS and National Rural Health Mission.
• AIDS control societies were granted funding for youth campaigns, blood safety checks, and HIV testing, among other things.
• Various public platforms were used to raise awareness of the epidemic – concerts, radio dramas, a voluntary blood donation day and TV spots with a popular Indian film-star.
• Messages were also conveyed to young people through schools. Teachers and peer educators were trained to teach about the subject, and students were educated through active learning sessions, including debates and role-play.
• This program finished in March 2006.

11. On World AIDS Day 2007 India flagged off its largest national campaign to date, in the form of a seven-coach train the Red Ribbon Express (RRE) This train travelled across 24 states during its one year journey, halting at 180 stations, covering a distance of over 27,000 km and reaching around 6.2 million people with HIV/AIDS education and awareness.
12. It was world’s largest social mobilization campaign against HIV/AIDS by the United Nations Children’s Fund (Unicef).
13. The awareness created by the train, which returned to New Delhi on 1 December on World AIDS Day is unprecedented, in part because of an unusually high level of coordination among New Delhi and state governments outside of emergency situations.
14. The government has announced that this campaign will place a strong focus on condom promotion. It has already supported the installation of over 11,000 condom vending machines in colleges, road-side restaurants, stations, gas stations and hospitals.
15. With support from the United States Agency for International Development (USAID), the eovernment has also initiated a campaign called ‘Condom Bindas Bol!’, which involves dvertising, public events and celebrity endorsements. It aims to break the taboo that currently surrounds condom use in India, and to persuade people that they should not be embarrassed to buy them.
16. In one unique scheme, health activists in West Bengal are attempting to promote condom use through kite flying, which is popular before the state’s biggest festival, Durga Puja:
17. In 2001, the government adopted the National AIDS Prevention and Control Policy. The Prime Minister (Atal Bihari Vajpai) also met the chief ministers of the six high-prevalence states to plan the implementation of strategies for HIV/AIDS prevention.
18. In 2006 UNAIDS estimated that there were 5.6 million people living with HIV in India, which indicated that there were more people with HIV in India than in any other country in the world.
19. India’s Third National AIDS Control Programme – Strategy and Implementation Plan –NACP-III( 2007-2012)

• India has now developed the Third National AIDS Programme Implementation Plan (2007-2012).
• The programme has a budget of around $2.6 billion, two thirds of which is for prevention and one sixth for treatment.
• Aside from the government, this money will come from non-governmental organisations, companies, and international agencies, such as the World Bank and the Bill and Melinda Gates Foundation.
• This has evolved through a year-long preparatory process that included wide-ranging consultations through 14 working groups, e-forums, civil society organisations, PLHA networks, NGOs/CBOs, national expert groups, development partners and the World Bank led pre-appraisal team.
• It has also incorporated inputs from various assessments and studies. All this has led to a consensus about the goals, objectives and overall framework of the NACP–III.
• India is committed to achieving Millennium Development Goals (MDGs). Keeping this in view, the primary goal of NACP–III is to halt and reverse the epidemic in India over the next 5 years by integrating programmes for prevention, care, support and treatment.
• In 2008, NACO began to roll out government funded second-line antiretroviral treatment in two centres in Mumbai and Chennai.
• At the beginning of 2009 second-line therapy was available in a total of eight states

Comparison of NACP-I, NACP-II & NACP-III

1. Cumulative no. of AIDS cases reported since 1986
   Before NACP-I : 110
   NACP-II : 46000
   NACP-III : 167000
2. No. of anti-retroviral centres (ART) established to provide free ART services
   NACP-II : 126
   NACP-III : 163
3. No. of patients on ART
   NACP-II : 69329
   NACP-III: 146605
4. No. of patients on HIV/TB co-infection detected:
   NACP-II : 14112
   NACP-III : 26000
5. Community care centres for care and support services set up
   NACP-II : 96
   NACP-III : 122
6. No. of integrated counselling and testing centres (ICTCs) established for counselling and HIV testing
   NACP-II : 4027
   NACP-III : 4817
7. No. of STI clinics for treating sexually transmitted infections (STIs)
   NACP-II : 617
   NACP-III : 845
8. No. of schools covered under school AIDS education programme
   NACP-II : 110685
   NACP-III :114345
9. No. of blood banks supported by Naco under the modernization scheme
   NACP-I : 126
   NACP-II : 865
   NACP-III : 1093
10. No. of condom vending machines installed for accessing condoms
    NACP-I : 150
    NACP-II : 5100
    NACP-III : 10025

source: *National AIDS Control Programme

20. UNAIDS:

The Joint United Nations Programme on HIV and AIDS, or UNAIDS, is the main advocate for accelerated, comprehensive and coordinated global action on the HIV epidemic.
UNAIDS’ mission is to lead, strengthen and support an expanded response to HIV and AIDS that includes :

1. Preventing transmission of HIV, providing care and support to those already living with the virus
2. Reducing the vulnerability of individuals and communities to HIV and alleviating the impact of the epidemic.

UNAIDS is a joint venture of the United Nations family, which with all their resources aid to help the world prevent manage old cases of HIV, and prevent new infections. They care for people already living with the virus, and try to curb this epidemic from becoming a severe pandemic.
Five major components make up the role of UNAIDS:
1. Leadership and advocacy for effective action on the epidemic
2. Strategic information and technical support to guide efforts against AIDS worldwide
3. Tracking, monitoring and evaluation of the epidemic and of responses to it
4. Civil society engagement and the development of strategic partnerships
5. Mobilization of resources to support an effective response
6. Headquartered in Geneva, Switzerland, its first executive director was Dr. Peter Piot.

21. AIDS & Business Community:
    According to a 2005 World Economic Forum (WEF) survey of 117 countries, 46% of executives expressed concern over the impact of HIV/AIDS on their operations. Yet only 9% of firms had conducted a quantitative HIV/AIDS risk assessment, only 18% had policies addressing discrimination (in terms of promotion, pay or benefits) based on HIV status. A 2005-06 Global Health Initiative study found only 11% of Indian firms had any written policy on discrimination based on HIV status
22. Indian Business Trust for HIV/ AIDS (IBT) was established in the year 2000 to provide a comprehensive response to the HIV/AIDS threat on behalf of the business sector. It is set up and supported by Confederation of Indian Industry (CII).
23. While some companies are taking up HIV initiatives for their employees and in their workplaces, some of them are going a step further to reach out to a larger community.

• The Confederation of Indian Industries (CII) has teamed up with Godrej Industries and Ballarpur Industries to set up anti retroviral treatment (ART) centres. The Godrej-run ART centre is near its facility in Vikhroli, in suburban Mumbai. (2008)
• Mphasis a BPO firm has installed condom vending machines in the vicinity of its offices, including in parking areas in Bangalore (2008)
• In 2008 , Reliance Industries Limited (RIL) teamed up with United Nations Programme on HIV/AIDS (UNAIDS) to ensure equal access to HIV services for the poor across India. RIL already has successful workplace initiatives on HIV across its plants in Hazira, Jamnagar and Dahej in Gujarat which have been scaled up to reach out to more than a 100,000 people in the surrounding communities.
• Standard Chartered Bank, through the Clinton Global Initiative, has pledged to educate one million people on HIV and AIDS by 2010.

22. World AIDS Day: Observed December 1 each year, is dedicated to raising awareness of the AIDS pandemic caused by the spread of HIV infection. Themes of World AIDS Day :
    · 2000 AIDS: Men Make a Difference
    · 2001 I care. Do you?
    · 2002 Stigma and Discrimination
    · 2003 Stigma and Discrimination
    · 2004 Women, Girls, HIV and AIDS
    · 2005 Stop AIDS. Keep the Promise
    · 2006 Stop AIDS. Keep the Promise – Accountability
    · 2007 Stop AIDS. Keep the Promise – Leadership
    · 2008 Stop AIDS. Keep the Promise – Lead – Empower – Deliver

23. Two French scientists who discovered the AIDS virus and a German who found the virus that causes cervical cancer were awarded the 2008 Nobel Prize for medicine or physiology. Luc Montagnier, director of the World Foundation for AIDS Research and Prevention, and Francoise Barre-Sinoussi of the Institute Pasteur won half the prize of 10 million Swedish crowns ($1.4 million) for discovering the deadly virus that has killed millions of people since it gained notoriety in the 1980s.
24. As a noble gesture towards AIDS patients, Railways provides 50% concession to them in second class passenger fares to nominated ART centres for treatment since April 2008.