AIDS in India

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HIV-AIDS in India
According to a recent study in the British Medical Journal,
India has an HIV-AIDS population of approximately 1.4-1.6 million
people. According to the United Nations 2011 AIDS report, there
has been a 50% decline in the number of new HIV infections in the
last 10 years in India. "According to the data released by National
AIDS Control Organisation NACO, India has demonstrated an
overall reduction of 57 percent in estimated annual new Human
immunodeficiency virus (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. "
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The prevalence estimates reported above are suspect. NACO's

sentinel survey data indicates over 5.7 million HIV cases in 2001. In
1987 New Delhi announced a National AIDS control Program but
that organization spent a substantial amount of time arguing that
the AIDS problem in India was overstated
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Epidemiology
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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 2007, India's AIDS prevalence rate stood at
approximately 0.30% the 89th highest in the world. The spread of
HIV in India is primarily restricted to the southern and northeastern 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 recent study published in the
British medical journal "The Lancet" in (2006) reported an
approximately 30% decline in HIV infections among young women
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Page 1
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. 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.
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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%).
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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 1524 years. The estimated number of new annual
HIV infections has declined by more than 50% over the past decade.
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According to Michel Sidib, Executive Director of UNAIDS,

Indias 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
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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:
Page 2
State
A&N
Islands
Andhra
pradesh
Antenatal
clinic HIV
prevalence
2007 (%)
STD clinic
HIV
prevalence
2007 (%)
IDU HIV
prevalence
2007 (%)
MSM HIV
prevalence
2007 (%)
Female sex
worker HIV
prevalence
2007 (%)
0.25
1.33
...
...
...
1.00
17.20
3.71
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17.04
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9.74
Arunachal
Pradesh
0.00
0.00
0.00
Assam
0.00
0.50
2.41
2.78
0.44
Bihar
0.25
0.40
0.60
0.00
3.40
Chandigarh
0.25
0.42
8.64
3.60
0.40
3.33
...
...
1.43
...
...
...
...
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Chhattisgarh 0.25
p
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t
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D & N Haveli 0.50
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...
...
Daman &
Diu
0.13
...
...
...
...
Delhi
0.25
5.20
10.10
11.73
3.15
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Antenatal
clinic HIV
prevalence
2007 (%)
STD clinic
HIV
prevalence
2007 (%)
IDU HIV
prevalence
2007 (%)
MSM HIV
prevalence
2007 (%)
Female sex
worker HIV
prevalence
2007 (%)
Goa
0.18
5.60
...
7.93
...
Gujarat
0.25
2.40
...
8.40
6.53
Haryana
0.13
0.00
0.80
5.39
Himachal
Pradesh
0.00
0.00
...
Jammu &
Kashmir
0.00
State
Jharkhand
0.00
Karnataka
0.50
n
o
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t
0.20
s
e
...
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p
a
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0.91
5.39
0.87
...
...
0.40
...
...
1.09
8.40
2.00
17.60
5.30
0.38
1.60
7.85
0.96
0.87
Lakshadweep 0.00
0.00
...
...
0.00
1.72
...
...
0.67
11.62
24.40
11.80
17.91
Kerala
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Madhya
Pradesh
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0.00
Maharashtra 0.50
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Antenatal
clinic HIV
prevalence
2007 (%)
STD clinic
HIV
prevalence
2007 (%)
IDU HIV
prevalence
2007 (%)
MSM HIV
prevalence
2007 (%)
Female sex
worker HIV
prevalence
2007 (%)
Manipur
0.75
4.08
17.90
16.4
13.07
Meghalya-
0.00
2.21
4.17
...
...
Mizoram
0.75
7.13
7.53
...
Nagaland
0.60
3.42
1.91
Orissa
0.00
1.60
7.33
State
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...
7.20
8.91
7.37
0.80
...
2.00
1.30
1.60
13.79
1.22
0.65
Pondicherry
0.00
Punjab
0.00
Rajasthan
0.13
2.00
...
...
4.16
0.09
0.00
0.47
...
0.00
w
w
0.25
8.00
16.80
6.60
4.68
Tripura
0.25
0.40
0.00
...
...
Uttar
0.00
0.48
1.29
0.40
0.78
Tamil Nadu
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Sikkim
3.22
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State
Antenatal
clinic HIV
prevalence
2007 (%)
STD clinic
HIV
prevalence
2007 (%)
IDU HIV
prevalence
2007 (%)
Female sex
worker HIV
prevalence
2007 (%)
MSM HIV
prevalence
2007 (%)
Pradesh
Uttaranchal
0.00
0.00
...
...
West Bengal 0.00
0.80
7.76
5.61
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...
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5.92
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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
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In 1986, the first known case of HIV was diagnosed by Dr.

Suniti Solmon amongst female sex workers in Chennai. 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 these foreigners were the ones
responsible for the first infections. By1987, 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.
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In 1986, HIV started its epidermic in India, attacking sex

workers in Chennai, Tamil Nadu. Setting up HIV screening centres
was the first step taken by the government to screen its citizens and
the blood bank.
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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.
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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.
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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.
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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
Page 7
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 theOverseas 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.
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No agency is tasked with enforcing non-discrimination policy,

instead multi-sectoral approach has been developed involving
awareness campaigns in the private sector. 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.[19] Vilification of infected persons has occurred, as the disease
has become more popularly associated with sex workers These
efforts have focused on increasing tolerance and awareness among
the middle class in an effort to diminish the portion of the
population affected by HIV/AIDS by developing public concern and
calls for greater governmental action. The HIV/AIDS is one of the
greatest killers of human beings on earth. There is no absolute
reliable drug so far available that can cure the diseases. Controlling
HIV/AID is an alternate best solution. In control measures, large
number of stakeholders can play important role. The following
paragraphs are excerpts on how Supreme Court of India gave
exhaustive recommendations to such stakeholders.
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In 2010, NACO approved the Teach AIDS educational
materials marking the first time HIV/AIDS education could be
provided decoupled from sex education. Later that year, the
Government of Karnataka approved the materials for their state of
50 million and committed to distributing them in 5,500 government
schools.
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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.
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Second-line treatment issue
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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
centers 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.
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Number of ART centres and patients alive and on
ART by state, January 2010
No. of ART
Centres
State
Total
(Adult)
Total
(Paediatric)
Andhra
Pradesh
31
60,328
3,304
Karnataka
33
36,220
3,003
Maharashtra
43
65,409
5,102
Tamil Nadu
36
36,947
Gujarat
12,765
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Grand Total
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39,223
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70,511
2,439
39,586
669
13,678
10,039
594
10,633
2,81,453
18,889
300,743
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63,832
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Uttar Pradesh 10
Total
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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
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Litigation for access to treatment
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
Page 10
contribution to AIDS response
generic antiretroviral drugs.
through
manufacture
of
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.
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"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.
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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 likeAfghanistan and Philippines are
experiencing increases in the number of people acquiring HIV
infection.
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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.
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"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 lowincome countries through innovative support mechanisms and
South & South cooperation," the UNAIDS report says.
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It also points out that India already provides substantial support to

neighboring 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 capacitybuilding. 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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Page 11

AIDS in India

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www.tnpscquestionpapers.

The prevalence estimates reported above are suspect. NACO's

Despite being home to the world's third-largest population

The estimated adult HIV prevalence was 0.32% in 2008 and

The adult HIV prevalence in India is declining from estimated

According to Michel Sidib, Executive Director of UNAIDS,

HIV statistics, 2011

According to NACO, In 2009, the average HIV prevalence

D & N Haveli 0.50

West Bengal 0.00

Some areas report an HIV prevalence rate of zero in antenatal

In 1986, the first known case of HIV was diagnosed by Dr.

In 1986, HIV started its epidermic in India, attacking sex

In 1999, the second phase of the National AIDS Control

In 2007, the third phase of the National AIDS Control Programme

The first National AIDS Control Programme (NACP) was

No agency is tasked with enforcing non-discrimination policy,

HIV spending increased in India from 2003 to 2007, and fell

Second-line treatment issue

Responding to a petition made by NGO's, in December 2010,

Voluntary Health Association of Punjab v. Union of India

Litigation for access to treatment

Though rate of HIV transmission in Asia is slowing down, at least

"This reflects slowing HIV incidence in the larger epidemics, with

"With 80 per cent of these drugs being generics purchased in India,

It also points out that India already provides substantial support to

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