HIV/AIDS in India

HIV prevalence among women attending prenatal clinics, commercial sex workers, and injecting drug users, in India in 2001

The main factors which have contributed to India's large HIV-infected population are extensive labour migration and low literacy levels in certain rural areas resulting in a lack of awareness and in gender disparities.[4] The Government of India has also raised concerns about the role of intravenous drug use and prostitution in spreading AIDS.[4][5]

According to Avert,[6] the statistics for special populations in 2007 are as follows:

Note: Some areas in the above table 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 among intravenous drug users. In some states and union territories, the average antenatal HIV prevalence is based on reports from only a small number of clinics.

In India, populations which are at a higher risk of HIV are female sex workers, men who have sex with men, injecting drug users, and transgenders/hijras.[8]

People, especially women, visiting the Red Ribbon Express on a tour of India promoting AIDS awareness when it arrived in Chennai in 2012

"Know AIDS - No AIDS" sign on a road in India

India has been praised for its extensive anti-AIDS campaigning.[9] According to Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (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.[10]

A 2012 UNAIDS report lauded India for doing "particularly well" in halving the number of adults newly infected between 2000 and 2009 in contrast to some smaller countries in Asia. In India, the number of deaths due to AIDS stood at 170,000 in 2009. It also points out that India provided substantial support to neighbouring countries and other Asian countries – in 2011, it allocated USD 430 million to 68 projects in Bhutan across key socioeconomic 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.

The National AIDS Control Organisation (NACO) has increased the number of centres providing free Antiretroviral Treatment (ART) from 54 to 91 centres, with 9 more centres to be operational soon. Medicines for treating 8,500 patients have been made available at these centres. All the 91 centres have trained doctors, counsellors and laboratory technicians to help initiate patients on ART and provide follow up care while protecting confidentiality. Apart from providing free treatment, all the ART centres provide counselling to the infected persons so that they regularly take 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 is expected to go up to 85,000 by March.

Responding to a petition made by NGO's, in 2010, the Supreme Court of India directed the Indian government to provide second-line Antiretroviral Therapy (ART) to all AIDS patients in the country, and warned the government against abdicating its constitutional duty of providing treatment to HIV positive patients on grounds of financial constraint, as it was an issue of the right to life guaranteed under Article 21 of the Indian Constitution. Previously, in an affidavit before the Supreme Court, NACO said second-line ART treatment for HIV patients, costing Rs 28,500 each, could not be extended to those who had received "irrational treatment" by private medical practitioners for the first round, which costs around Rs 6,500. The court rejected both the arguments of financial constraints and that only 10 viral load testing centres were needed for testing patients for migrating from the first line of treatment to the second line, as stated by the Solicitor General representing the government. The court further asked the government to give a clear-cut and "workable" solution within a week's time.[11][12]

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. 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.[6]

Apart from government funding, there are various international foundations like the UNDP, World Bank, Elton John AIDS Foundation, USAID and others who are funding HIV/AIDS treatment in India.[13][14][15]

In 1986, the first known cases of HIV in India were diagnosed by Dr. Suniti Solomon and her student Dr. Sellappan Nirmala amongst six female sex workers in Chennai, Tamil Nadu.[16][17] In the same year, the Government of India established the National AIDS Committee within the Ministry of Health and Family Welfare.[18]

In 1992, on the basis of National AIDS Committee, 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.[19][20] Subsequently, the State AIDS Control Societies (SACS) were set up in states and union territories. SACS implement the NACO programme at a state level, but have functional independence to upscale and innovate.[21] The first phase was implemented from 1992 to 1999 and focused on monitoring HIV infection rates among high-risk populations in selected urban areas.[18]

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 developed.[22] A National Council on AIDS was formed during this phase, consisting of 31 ministries and chaired by the Prime Minister.[18] The second phase ran between 1999 and 2006.[18]

A 2006 study published in the British medical journal The Lancet reported an approximately 30% decline in HIV infections from 2000 to 2004 among women aged 15 to 24 attending prenatal clinics in selected southern states of India, where the epidemic is thought to be concentrated. Recent studies suggest that many married women in India, despite practicing monogamy and having no risk behaviours, acquire HIV from their husbands and HIV testing of married males can be an effective HIV prevention strategy for the general population.[23]

In 2007, the third phase of the National AIDS Control Programme (NACP III) targeted high-risk groups and conducted outreach programmes. It also decentralised the effort to local levels and non-governmental organisations (NGOs) to provide welfare services to the affected.[6] The US$2.5 billion plan received support from UNAIDS.[24] The third stage dramatically increased targeted interventions, aiming to halt and reverse the epidemic by integrating programmes for prevention, care, support and treatment.[18] By the end of 2008, targeted interventions covered almost 932,000 of those most at risk, or 52% of the target groups (49% of female sex workers, 65% of injection drug users and 66% of men who have sex with men).[18]

Some efforts have been made to tailor educational literature to those with low literacy levels, mainly through readily accessible local libraries.[25] Increased awareness regarding the disease and citizen's related rights is in line with the Universal Declaration on Human Rights.

In 2009, India established a National HIV and AIDS Policy and the World of Work, which sought to end discrimination against workers on the basis of their real or perceived HIV status.[18] Under this policy, all enterprises are encouraged to establish workplace policies and programmes based on the principles of non-discrimination, gender equity, healthy work environment, non-screening for the purpose of employment, confidentiality, prevention and care and support.[18] Researchers at the Overseas Development Institute have called for greater attention to migrant workers, whose concerns about their immigration status may leave them particularly vulnerable.[18]

No agency is tasked with enforcing the non-discrimination policy; instead, a multisectoral approach has been developed involving awareness campaigns in the private sector. The AIDS Bhedbhav Virodhi Andolan (AIDS Anti-Discrimination Movement) has prepared many citizen 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 by Rajesh Talwar[26] focused on discrimination, the importance of using a condom and illegal testing of vaccines.[27] HIV/AIDS-related television shows and movies have appeared in the past few years, mostly in an effort to appeal to the middle class.[28] An important component of these programs has been the depiction of HIV/AIDS affected persons interacting with non-infected persons in everyday life.[29]

As per the 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.[30] Setting up HIV screening centres was the first step taken by the government to screen its citizens and the blood bank.

Adult HIV prevalence in India declined from an estimated 0.41% in 2000 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 people aged 15–24.

A 2012 report described a need for youth HIV counseling.[31]

According to NACO data, India has had a 57% reduction in estimated annual new adult HIV infections, from 274,000 in 2000 to 116,000 in 2011, and the estimated number of people living with HIV was 2.08 million in 2011.[32][33]

According to NACO, the prevalence of AIDS in India in 2015 was 0.26%, down from 0.41% in 2002;[34] in 2016, it had risen to 0.30%.[3]

Wikimedia Commons has media related to AIDS in India.

• Avert, 'HIV and AIDS in India'
• HIV/AIDS Prevention and Control Bill 2014