Spotlight

National AIDS Control Programme

If we have to win this fight against HIV/AIDS we have to create a more tolerant social environment. One need not condone socially unacceptable or medically inadvisable sexual practices in seeking a more tolerant approach to the problem. It is in the interests of the entire society that everyone afflicted by AIDS wins the battle against it. They deserve and have the right to live lives of dignity.

- Prime Minister Dr. Manmohan Singh remarks on the release of the
Report of the Commission on AIDS in Asia

In India, after the first case of HIV was detected in Chennai in 1986, the virus spread rapidly across the nation in both urban and rural areas. Since then, the HIV epidemic has travelled a long way, establishing itself with the greatest speed in the six high prevalence states of Andhra Pradesh, Maharashtra, Manipur, Nagaland, Karnataka and Tamil Nadu. The natural history of the HIV epidemic has played out in various forms - from the injecting drug use-driven epidemic of the North East seen in Manipur and Nagaland, to the sex work-driven epidemic of the south of India.

Since, every country and every government needs to have a solution to deal with such an issue; the government formulated the National AIDS Control Programme. Here are more details about this programme.

Phases of National AIDS Control Programme:

Phase-I (1992 - 1999) was implemented across the country with objective to slow the spread of HIV to reduce future morbidity, mortality, and the impact of AIDS by initiating a major effort in the prevention of HIV transmission.

Phase-II (1999 - 2006) was aimed at reducing spread of HIV infection in India and strengthen India's capacity to respond to HIV epidemic on long term basis.

Some of the significant achievements of NACP-I & II are:

  • Scaling up PMTCT and VCCTC services especially in the high prevalence states.
  • Increasing access to free ARV is one of the major achievements of NACP-II. The national program for ARV provision has motivated other State Governments (Kerala and Delhi) to announce provision of free ARV from the State Exchequer which is also a good sign.
  • Recognizing the need of care and support for people living with HIV and AIDS and scaling up of Community Care Centers.
  • The effectiveness of the condoms as one of the safest methods to prevent and control the spread of HIV and other STIs has been well established.
  • Initiating the process for developing draft legislation on HIV and AIDS.
National AIDS Control Programme

With the growing complexity of the epidemic, there have been changes in policy frameworks and approaches of the NACP. Focus has shifted from raising awareness to behaviour change, from a national response to a decentralized response and an increasing engagement of NGOs and networks of people living with HIV/AIDS. The National AIDS Prevention and Control Policy and the National Council on AIDS (NCA), chaired by the Prime Minister, provide policy guidelines and political leadership to the response.

Phase-III (2007-2012)is based on the experiences and lessons drawn from NACP-I and II, and is built upon their strengths. Its priorities and thrust areas are drawn up accordingly and include the following:

  • Considering that more than 99 percent of the population in the country is free from infection, NACP-III places the highest priority on preventive efforts while, at the same time, seeks to integrate prevention with care, support and treatment.
  • Sub-populations that have the highest risk of exposure to HIV will receive the highest priority in the intervention programmes. These would include sex workers, men-who-have-sex-with-men and injecting drug users. Second high priority in the intervention programmes is accorded to long-distance truckers, prisoners, migrants (including refugees) and street children.
  • In the general population those who have the greater need for accessing prevention services, such as treatment of STIs, voluntary counselling and testing and condoms, will be next in the line of priority.
  • NACP-III ensures that all persons who need treatment would have access to prophylaxis and management of opportunistic infections. People who need access to ART will also be assured first line ARV drugs.
  • Prevention needs of children are addressed through universal provision of PPTCT services. Children who are infected are assured access to paediatric ART.
  • NACP-III is committed to address the needs of persons infected and affected by HIV, especially children. This will be done through the sectors and agencies involved in child protection and welfare. In mitigating the impact of HIV, support is also drawn from welfare agencies providing nutritional support, opportunities for income generation and other welfare services.
  • NACP-III also plans to invest in community care centres to provide psycho-social support, outreach services, referrals and palliative care.
  • Socio-economic determinants that make a person vulnerable also increase the risk of exposure to HIV. NACP-III will work with other agencies involved in vulnerability reduction such as women's groups, youth groups, trade unions etc. to integrate HIV prevention into their activities.

The strategic objectives of NACP-III are:

  • Prevent infections through saturation of coverage of high-risk groups with targeted interventions (TIs) and scaled up interventions in the general population.
  • Provide greater care, support and treatment to more people living with HIV/AIDS.
  • Strengthen the infrastructure, systems and human resources in prevention, care, support and treatment programmes at District, State and National levels.
  • Strengthen the nationwide Strategic Information Management System.

The specific goal of this phase is to reverse and stabilize the spread of AIDS by reducing the rate of incidence by 60 per cent in high prevalence States and by 40 per cent in vulnerable States.

Current Scenario:

HIV situation in the country is assessed and monitored through regular annual sentinel surveillance mechanism established since 1992.As per the recent estimates using the internationally comparable Workbook method and using multiple data sources namely expanded sentinel surveillance system, NFHS-III, IBBA and Behavioural Surveillance Survey, there are 1.8 - 2.9 million (2.31 million) people living with HIV/AIDS at the end of 2007. The estimated adult prevalence in the country is 0.34% (0.25% - 0.43%) and it is greater among males (0.44%) than among females (0.23%). The overall HIV prevalence among different population groups in 2007 continues to portray the concentrated epidemic in India, with a very high prevalence among High Risk Groups - IDU (7.2%), MSM (7.4%), FSW (5.1%) & STD (3.6%) and low prevalence among ANC clinic attendees (Age adjusted - 0.48%).

Key Achievements under NACP:

  • Promotion of voluntary blood donation has enabled reducing transmission of HIV infection through contaminated blood from about 6.07% (1999), 4.61% (2003), 2.07% (2005), 1.96% (2006) to 1.87% (2007).
  • The number of integrated counseling and testing centres increased from 982 in 2004, 1476 in 2005, 4027 in 2006, 4567 in 2007 and 4817 in 2008 (till September, 2008). The number of persons tested in these centres has increased from 17.5 lakh in 2004 to 37.9 lakhs in 2008-09 (August, 2008).
  • In the year 2007, a total of 3.2 million pregnant women accessed PPTCT services at ICTCs across the country of which 18449 pregnant women were diagnosed to be HIV +ve. Of these 11460 (62%) pregnant women and the infants born to them received prophylactic single dose Nevirapine to prevent parent to child transmission of HIV.
  • The number of STI clinics being supported by NACO has increased from 815 in 2005 to 895 in 2008. The reported number of patients treated for STI in 2005 was 16.7 lakh, in 2006, 20.2 lakh and in 2007, it has increased to 25.9 lakh.
  • As of September 2008, 5,61,981 patients have been registered at ART centers and 1,77,808 clinically eligible patients are receiving free ART in Govt. & inter-sectoral health sector. This is achieved through 179 ART centers across 31 states. Total 159 Community Care Centers are established across country of providing Care & Support Services to PLHA's.
  • The Targeted Intervention (TI) projects aim to interrupt HIV transmission among highly vulnerable populations. Such population groups include - commercial sex workers, injecting drug users, men who have sex with men, truckers and migrant workers. As on date, 1132 Targeted Interventions are operational in various states and UTs in the country.

Combating HIV

It is easy to fight against HIV/ AIDS if people lead by example. Also, we need to inform others about AIDS and empower them, so that they make safe choices.

People who may be infected with HIV need society's support and protection. They are not a threat to society. They have the right to live their life with dignity and continue with their jobs without losing their earning power. Every Indian needs to uphold the dignity of people living with HIV so that they can live secure harmonious lives.

The countrywide response to the National AIDS Control Programme of the Government has been constructive and yielded positive results. This shows the way forward in controlling the spread of this disease and soon making the country AIDS free.

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