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HIV and AIDS Control: Suggestions and Policy Prescriptions

(Project Report)

Submitted to

Dr. Avinash Samal

Faculty Member in Political Science

By

Jyotsana Gupta

B.A. LL.B (Hons.) Student

Semester - VI, Section - B, Roll No. 67

15.02.2017

Hidayatullah National Law University

Uparwara Post, Abhanpur, New Raipur - 493661 (C.G.)


Acknowledgments

I, Jyotsana Gupta, feel myself highly elated, as it gives me tremendous pleasure to come out
with work on the topic, HIV and AIDS control: Suggestions and Policy Prescriptions.

I am thankful to my teacher, Dr. Avinash Samal, who gave me this topic. I am highly obliged for
his guidance in doing all sorts of researches, suggestions and discussions regarding my project
topic by devoting his precious time.

I thank to the HNLU for providing Computer, library facility. And last but not the least I thank
my friends and all those persons who have helped me in the completion of this project.

Jyotsana Gupta

Semester VI

Sec. B (Roll No. 67)

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Declaration

I hereby declare that the project work entitled HIV and AIDS control: Suggestions and Policy
Prescriptions submitted to the Hidayatullah National Law University, is a record of an original
work done by me under the guidance of Dr. Avinash Samal, Faculty Member, Hidayatullah
National Law University, and this project work has not performed the basis for the award of any
Degree or diploma/ associate ship/fellowship and similar project if any.

Jyotsana Gupta

Semester VI

Sec. B (Roll No. 67)

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Contents

Acknowledgments

Declaration

Figure

Introduction......................................................................................................................................6

Objectives Of The Study..................................................................................................................7

Scope Of The Study.........................................................................................................................7

Methodology Of Study....................................................................................................................7

I. About Hiv/Aids.............................................................................................................................8

I.A What is HIV?..........................................................................................................................8

I.B Where did HIV come from?...................................................................................................8

I.C What are the stages of HIV?..................................................................................................8

I.D How is HIV passed from one person to another?................................................................10

II. Prevention...........................................................................................................................13

III. Testing.................................................................................................................................18

IV. Facts....................................................................................................................................20

V. Policies Undertaken............................................................................................................22

UNAIDS.....................................................................................................................................22

UNAIDS Goals..........................................................................................................................23

National Aids Control Organisation (NACO)............................................................................24

Naco Prevention Strategies........................................................................................................27

Concluding Observations...............................................................................................................32

References......................................................................................................................................33

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Figure

Figure 1. Estimated Adult HIV Prevalence (%) in India, 19902015 with Uncertainty Bound1

1
http://naco.gov.in/hiv-facts-figures; last accessed on 15/02/2017

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Introduction

HIV stands for human immunodeficiency virus. It weakens a persons immune system by
destroying important cells that fight disease and infection. No effective cure exists for HIV. But
with proper medical care, HIV can be controlled. It is the virus that can lead to acquired
immunodeficiency syndrome or AIDS if not treated. Unlike some other viruses, the human body
cant get rid of HIV completely, even with treatment. So once you get HIV, you have it for life.

HIV disease continues to be a serious health issue for parts of the world. Worldwide, there were
about 2.1 million new cases of HIV in 2015. About 36.7 million people are living with HIV
around the world, and as of June 2016, 17 million people living with HIV were receiving
medicines to treat HIV, called antiretroviral therapy (ART). An estimated 1.1 million people died
from AIDS-related illnesses in 2015. Sub-Saharan Africa, which bears the heaviest burden of
HIV/AIDS worldwide, accounts for 65% of all new HIV infections. Other regions significantly
affected by HIV/AIDS include Asia and the Pacific, Latin America and the Caribbean, and
Eastern Europe and Central Asia.

This paper focuses on the suggestions for HIV/AIDS control and the policies undertaken by the
UN Program for AIDS and Indias National AIDS Control organization.

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Objectives of the Study

Set in the above perspectives, the broad objective of the study is to understand the control
measures for AIDS.

The specific objectives of the study are as follows:

a.) To know about HIV/AIDS;


b.) To understand the preventive measures of AIDS;
c.) To know the policies/goals undertaken by the UN and India;

Scope of the Study

The research paper would first provide the general introduction of the topic i.e. HIV and AIDS
Control: Suggestions and Policy Prescriptions. It will study the concept into four parts.

In part one, the topic will be assessed with reference to its meaning, history and transmission.

The second part of this paper would discuss as to the prevention of HIV.

In its third part, it will examine the tests related to HIV.

Lastly, it studies the policies undertaken by the UNAIDS and Indias NACO and this will be
followed by the concluding paragraph.

Methodology of Study

This project work is descriptive & analytical in approach. It is largely based on secondary &
electronic sources of data. Books & other references are primarily helpful for the completion of
this project.

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I. About HIV/AIDS

I.A What is HIV?

HIV is a virus spread through certain body fluids that attacks the bodys immune system,
specifically the CD4 cells, often called T cells. Over time, HIV can destroy so many of these
cells that the body cant fight off infections and disease. These special cells help the immune
system fight off infections. Untreated, HIV reduces the number of CD4 cells (T cells) in the
body. This damage to the immune system makes it harder and harder for the body to fight off
infections and some other diseases. Opportunistic infections or cancers take advantage of a very
weak immune system and signal that the person has AIDS, the last stage of HIV infection.

The medicine used to treat HIV is called antiretroviral therapy or ART. If taken the right way,
every day, this medicine can dramatically prolong the lives of many people infected with HIV,
keep them healthy, and greatly lower their chance of infecting others. Before the introduction of
ART in the mid-1990s, people with HIV could progress to AIDS in just a few years. Today,
someone diagnosed with HIV and treated before the disease is far advanced can live nearly as
long as someone who does not have HIV.

I.B Where did HIV come from?

Scientists identified a type of chimpanzee in Central Africa as the source of HIV infection in
humans. They believe that the chimpanzee version of the immunodeficiency virus (called simian
immunodeficiency virus, or SIV) most likely was transmitted to humans and mutated into HIV
when humans hunted these chimpanzees for meat and came into contact with their infected
blood. Studies show that HIV may have jumped from apes to humans as far back as the late
1800s. Over decades, the virus slowly spread across Africa and later into other parts of the world.

I.C What are the stages of HIV?

When people get HIV and dont receive treatment, they will typically progress through three
stages of disease. Medicine to treat HIV, known as antiretroviral therapy (ART), helps people at
all stages of the disease if taken the right way, every day. Treatment can slow or prevent

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progression from one stage to the next. It can also dramatically reduce the chance of transmitting
HIV to someone else.

Stage 1: Acute HIV infection

Within 2 to 4 weeks after infection with HIV, people may experience a flu-like illness, which
may last for a few weeks. This is the bodys natural response to infection. When people have
acute HIV infection, they have a large amount of virus in their blood and are very contagious.
But people with acute infection are often unaware that theyre infected because they may not feel
sick right away or at all. To know whether someone has acute infection, either a fourth-
generation antibody/antigen test or a nucleic acid (NAT) test is necessary. If you think you have
been exposed to HIV through sex or drug use and you have flu-like symptoms, seek medical care
and ask for a test to diagnose acute infection.

Stage 2: Clinical latency (HIV inactivity or dormancy)

This period is sometimes called asymptomatic HIV infection or chronic HIV infection. During
this phase, HIV is still active but reproduces at very low levels. People may not have any
symptoms or get sick during this time. For people who arent taking medicine to treat HIV, this
period can last a decade or longer, but some may progress through this phase faster. People who
are taking medicine to treat HIV (ART) the right way, every day may be in this stage for several
decades. Its important to remember that people can still transmit HIV to others during this
phase, although people who are on ART and stay virally suppressed (having a very low level of
virus in their blood) are much less likely to transmit HIV than those who are not virally
suppressed. At the end of this phase, a persons viral load starts to go up and the CD4 cell count
begins to go down. As this happens, the person may begin to have symptoms as the virus levels
increase in the body, and the person moves into Stage 3.

Stage 3: Acquired immunodeficiency syndrome (AIDS)

AIDS is the most severe phase of HIV infection. People with AIDS have such badly damaged
immune systems that they get an increasing number of severe illnesses, called opportunistic
illnesses.

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Without treatment, people with AIDS typically survive about 3 years. Common symptoms of
AIDS include chills, fever, sweats, swollen lymph glands, weakness, and weight loss. People are
diagnosed with AIDS when their CD4 cell count drops below 200 cells/mm or if they develop
certain opportunistic illnesses. People with AIDS can have a high viral load and be very
infectious.

The only way to know for sure whether you have HIV is to get tested. Knowing your status is
important because it helps you make healthy decisions to prevent getting or transmitting HIV. No
effective cure currently exists for HIV. But with proper medical care, HIV can be controlled.
Treatment for HIV is called antiretroviral therapy or ART. If taken the right way, every day, ART
can dramatically prolong the lives of many people infected with HIV, keep them healthy, and
greatly lower their chance of infecting others. Before the introduction of ART in the mid-1990s,
people with HIV could progress to AIDS (the last stage of HIV infection) in a few years. Today,
someone diagnosed with HIV and treated before the disease is far advanced can live nearly as
long as someone who does not have HIV.

I.D How is HIV passed from one person to another?

You can get or transmit HIV only through specific activities. Most commonly, people get or
transmit HIV through sexual behaviors and needle or syringe use.

Only certain body fluidsblood, semen (cum), pre-seminal fluid (pre-cum), rectal fluids,
vaginal fluids, and breast milkfrom a person who has HIV can transmit HIV. These fluids must
come in contact with a mucous membrane or damaged tissue or be directly injected into the
bloodstream (from a needle or syringe) for transmission to occur. Mucous membranes are found
inside the rectum, vagina, penis, and mouth.

Less commonly, HIV may be spread

From mother to child during pregnancy, birth, or breastfeeding. Although the risk can be high
if a mother is living with HIV and not taking medicine, recommendations to test all pregnant
women for HIV and start HIV treatment immediately have lowered the number of babies
who are born with HIV.

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By being stuck with an HIV-contaminated needle or other sharp object. This is a risk mainly
for health care workers.

In extremely rare cases, HIV has been transmitted by

Oral sexputting the mouth on the penis (fellatio), vagina (cunnilingus), or anus (rimming).
In general, theres little to no risk of getting HIV from oral sex. But transmission of HIV,
though extremely rare, is theoretically possible if an HIV-positive man ejaculates in his
partners mouth during oral sex.
Receiving blood transfusions, blood products, or organ/tissue transplants that are
contaminated with HIV. This was more common in the early years of HIV, but now the risk is
extremely small because of rigorous testing of the US blood supply and donated organs and
tissues.
Eating food that has been pre-chewed by an HIV-infected person. The contamination occurs
when infected blood from a caregivers mouth mixes with food while chewing. The only
known cases are among infants.
Being bitten by a person with HIV. Each of the very small number of documented cases has
involved severe trauma with extensive tissue damage and the presence of blood. There is no
risk of transmission if the skin is not broken.
Contact between broken skin, wounds, or mucous membranes and HIV-infected blood or
blood-contaminated body fluids.
Deep, open-mouth kissing if both partners have sores or bleeding gums and blood from the
HIV-positive partner gets into the bloodstream of the HIV-negative partner. HIV is not spread
through saliva.

HIV does not survive long outside the human body (such as on surfaces), and it cannot reproduce
outside a human host. It is not spread by

Mosquitoes, ticks, or other insects.


Saliva, tears, or sweat that is not mixed with the blood of an HIV-positive person.
Hugging, shaking hands, sharing toilets, sharing dishes, or closed-mouth or social
kissing with someone who is HIV-positive.

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Other sexual activities that dont involve the exchange of body fluids (for example,
touching).

Anal sex is the riskiest type of sex for getting or transmitting HIV. HIV can be found in certain
body fluidsblood, semen (cum), pre-seminal fluid (pre-cum), or rectal fluidsof a person who
has HIV. Although receptive anal sex (bottoming) is much riskier for getting HIV than insertive
anal sex (topping), its possible for either partnerthe top or the bottomto get HIV. The
bottoms risk is very high because the lining of the rectum is thin and may allow HIV to enter the
body during anal sex. The top is also at risk because HIV can enter the body through the opening
at the tip of the penis (or urethra); the foreskin if the penis isnt circumcised; or small cuts,
scratches, or open sores anywhere on the penis.

Either partner can get HIV through vaginal sex, though it is less risky for getting HIV than
receptive anal sex. When a woman has vaginal sex with a partner whos HIV-positive, HIV can
enter her body through the mucous membranes that line the vagina and cervix. Most women who
get HIV get it from vaginal sex. Men can also get HIV from having vaginal sex with a woman
whos HIV-positive. This is because vaginal fluid and blood can carry HIV. Men get HIV through
the opening at the tip of the penis (or urethra); the foreskin if theyre not circumcised; or small
cuts, scratches, or open sores anywhere on the penis.

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II. Prevention

Abstinence means not having oral, vaginal, or anal sex. An abstinent person is someone who's
never had sex or someone who's had sex but has decided not to continue having sex for some
period of time. Abstinence is the only 100% effective way to prevent HIV, other sexually
transmitted diseases (STDs), and pregnancy. The longer you wait to start having oral, vaginal, or
anal sex, the fewer sexual partners you are likely to have in your lifetime. Having fewer partners
lowers your chances of having sex with someone who has HIV or another STD.

Use condoms the right way every time you have sex, take medicines to prevent or treat HIV if
appropriate, choose less risky sexual behaviors, get tested for other sexually transmitted diseases
(STDs), and limit your number of sex partners. The more of these actions you take, the safer you
can be.

Use condoms the right way every time you have sex.
Reduce your number of sexual partners. This can lower your chances of having a sex
partner who will transmit HIV to you. The more partners you have, the more likely you are to
have a partner with HIV whose viral load is not suppressed or to have a sex partner with a
sexually transmitted disease. Both of these factors can increase the risk of HIV transmission.
Talk to your doctor about pre-exposure prophylaxis (PrEP), taking HIV medicines daily
to prevent HIV infection, if you are at very high risk for HIV. PrEP should be considered if
you are HIV-negative and in an ongoing sexual relationship with an HIV-positive partner. PrEP
also should be considered if you arent in a mutually monogamous relationship with a partner
who recently tested HIV-negative, and you are a:
o gay or bisexual man who has had anal sex without a condom or been diagnosed
with an STD in the past 6 months;
o man who has sex with both men and women; or
o heterosexual man or woman who does not regularly use condoms during sex with
partners of unknown HIV status who are at very high risk of HIV infection (for
example, people who inject drugs or women who have bisexual male partners).
Post-exposure prophylaxis (PEP) means taking HIV medicines after being potentially
exposed to HIV to prevent becoming infected. If youre HIV-negative or dont know your HIV

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status and think you have recently been exposed to HIV during sex (for example, if the
condom breaks), talk to your health care provider or an emergency room doctor about PEP
right away (within 3 days). The sooner you start PEP, the better; every hour counts. If youre
prescribed PEP, youll need to take it once or twice daily for 28 days. Keep in mind that your
chance of getting HIV is lower if your HIV-positive partner is taking medicine to treat HIV
infection (called antiretroviral therapy, or ART) the right way, every day and his or her viral
load remains suppressed.
Get tested and treated for other STDs and encourage your partners to do the same. If you
are sexually active, get tested at least once a year. Having other STDs increases your risk for
getting or transmitting HIV. STDs can also have long-term health consequences.
If youre HIV-negative and your partner is HIV-positive, encourage your partner to get
and stay on treatment. If taken the right way, every day, the medicine to treat HIV (ART)
reduces the amount of HIV (called viral load) in the blood and elsewhere in the body to very
low levels. This is called viral suppression. Being virally suppressed is good for an HIV-
positive persons overall health and greatly reduces the chance of transmitting the virus to a
partner.
Choose less risky sexual behaviors. HIV is mainly spread by having anal or vaginal sex
without a condom or without taking medicines to prevent or treat HIV.

Receptive anal sex is the riskiest type of sex for getting HIV. Its possible for either partnerthe
partner inserting the penis in the anus (the top) or the partner receiving the penis (the bottom)
to get HIV, but it is much riskier for an HIV-negative partner to be the receptive partner. Thats
because the lining of the rectum is thin and may allow HIV to enter the body during anal sex.

Vaginal sex also carries a risk for getting HIV, though it is less risky than receptive anal sex.
Most women who get HIV get it from vaginal sex, but men can also get HIV from vaginal sex.

In general, there is little to no risk of getting or transmitting HIV from oral sex. Theoretically,
transmission of HIV is possible if an HIV-positive man ejaculates in his partners mouth during
oral sex. However, the risk is still very low, and much lower than with anal or vaginal sex.
Factors that may increase the risk of transmitting HIV through oral sex are oral ulcers, bleeding
gums, genital sores, and the presence of other STDs, which may or may not be visible.

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Sexual activities that dont involve contact with body fluids (semen, vaginal fluid, or blood)
carry no risk of HIV transmission but may pose a risk for other STDs.

In general, there is little to no risk of getting or transmitting HIV from oral sex. Theoretically,
transmission of HIV is possible if an HIV-positive man ejaculates in his partners mouth during
oral sex. However, the risk is still very low, and much lower than with anal or vaginal sex.

Water-based and silicon-based lubricants are safe to use with all condoms. Oil-based lubricants
and products containing oil, such as hand lotion, Vaseline, or Crisco, should not be used with
latex condoms because they can weaken the condom and cause it to break. It is safe to use any
kind of lubricant with nitrile female condoms. But lubricants containing nonoxynol-9 should not
be used because nonoxynol-9 irritates the lining of the vagina and anus and increases the risk of
getting HIV.

Circumcised men are less likely than uncircumcised men to get HIV from HIV-positive female
partners, but circumcision doesnt decrease their risk as much as other prevention options. There
is no evidence that male circumcision decreases a womans risk of getting HIV, and the evidence
about the benefits of circumcision among gay and bisexual men is inconclusive.

Circumcised men should take other actions, like using condoms the right way every time they
have sex or taking medicine to prevent or treat HIV, to further reduce their risk of getting HIV or
to protect their partners.

If you are at very high risk for HIV from sex or injecting drugs, taking HIV medicines daily,
called pre-exposure prophylaxis (or PrEP), can greatly reduce your risk of HIV infection. You
can combine additional strategies with PrEP to reduce your risk even further.

PrEP is also recommended for people whove injected drugs in the past 6 months and have
shared needles or works or been in drug treatment in the past 6 months.

If you have a partner who is HIV-positive and are considering getting pregnant, talk to your
doctor about PrEP. It may be an option to help protect you and your baby.

PrEP involves daily medication and regular visits to a health care provider.

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Taking medicine after being potentially exposed to HIV, called post-exposure prophylaxis (or
PEP), can keep you from becoming infected. But PEP must be started within 72 hours after a
possible exposure.

If you think youve recently been exposed to HIV during sex (for example, if the condom breaks)
or through sharing needles and works to prepare drugs (for example, cotton, cookers, water), talk
to your health care provider or an emergency room doctor about PEP right away. The sooner you
start PEP, the better; every hour counts. If youre prescribed PEP, youll need to take it once or
twice daily for 28 days.

Someone who is on PEP should continue to use condoms with sex partners and safe injection
practices while taking PEP.

There is currently no vaccine that will prevent HIV infection or treat those who have it.

Microbicides are gels, films, or suppositories that can kill or neutralize viruses and bacteria.
Researchers are studying both vaginal and rectal microbicides to see if they can prevent sexual
transmission of HIV, but none are currently available for use.

There are many actions you can take to lower your risk of transmitting HIV to a partner:

The most important thing you can do is to take medicines to treat HIV infection (called
antiretroviral therapy, or ART) the right way, every day. These medicines reduce the amount of
virus (viral load) in your blood and body fluids. They can keep you healthy for many years and
greatly reduce your chance of transmitting HIV to your partners if you have a very low or
undetectable viral load.
If youre taking medicines to treat HIV (ART), follow your health care providers advice.
Visit your health care provider regularly and always take your medicines as directed.
Use condoms the right way every time you have sex.
Choose less risky sexual behaviors. Anal sex is the highest-risk sexual activity for HIV
transmission. If your partner is HIV-negative, its less risky if theyre the insertive partner
(top) and youre the receptive partner (bottom) during anal sex. Oral sex is much less risky
than anal or vaginal sex. Sexual activities that dont involve contact with body fluids (semen,
vaginal fluid, or blood) carry no risk of HIV transmission.

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If you inject drugs, never share your needles or works with anyone.
Talk to your partners about pre-exposure prophylaxis (PrEP), taking HIV medicines the
right way, every day to prevent HIV infection.
Talk to your partners about post-exposure prophylaxis (PEP) if you think theyve recently
had a possible exposure to HIV (for example, if they had anal or vaginal sex without a condom
or if the condom broke during sex). Your partners should talk to a health care provider right
away (within 72 hours) after a possible exposure. Starting PEP immediately and taking it daily
for 28 days will reduce their chance of getting HIV.
Get tested and treated for other STDs and encourage your partners to do the same. If you
are sexually active, get tested at least once a year. STDs can have long-term health
consequences. They can also increase the risk of getting or transmitting HIV.

If youre pregnant, talk to your health care provider about getting tested for HIV and other ways
to keep you and your child from getting HIV. Women in their third trimester should be tested
again if they engage in behaviors that put them at risk for HIV. If you are HIV-negative but you
have an HIV-positive partner and are considering getting pregnant, talk to your doctor about
taking pre-exposure prophylaxis (PrEP) to help keep you from getting HIV. Encourage your
partner to take medicines to treat HIV (ART), which greatly reduces the chance that he will
transmit HIV to you. If you have HIV, take medicines to treat HIV (ART) the right way, every
day. If you are treated for HIV early in your pregnancy, your risk of transmitting HIV to your
baby can be 1% or less. After delivery, you can prevent transmitting HIV to your baby by
avoiding breastfeeding, since breast milk contains HIV.

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III. Testing

Everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health
care. About 1 in 8 people in the United States who have HIV dont know they have it.

The only way to know for sure whether you have HIV is to get tested.

Knowing your HIV status gives you powerful information to help you take steps to keep you and
your partner healthy.

If you test positive, you can take medicine to treat HIV to stay healthy for many years
and greatly reduce the chance of transmitting HIV to your sex partner.
If you test negative, you have more prevention tools available today to prevent HIV than
ever before.

If you are pregnant, you should be tested for HIV so that you can begin treatment if
youre HIV-positive. If an HIV-positive woman is treated for HIV early in her pregnancy, the
risk of transmitting HIV to her baby can be very low.

There are three broad types of tests available: antibody tests, combination or fourth-generation
tests, and nucleic acid tests (NAT). HIV tests may be performed on blood, oral fluid, or urine:

1. Most HIV tests, including most rapid tests and home tests, are antibody tests. Antibodies
are produced by your immune system when youre exposed to viruses like HIV or bacteria.
HIV antibody tests look for these antibodies to HIV in your blood or oral fluid. In general,
antibody tests that use blood can detect HIV slightly sooner after infection than tests done with
oral fluid. It can take 3 to 12 weeks (21-84 days) for an HIV-positive persons body to make
enough antibodies for an antibody test to detect HIV infection. This is called the window
period. Approximately 97% of people will develop detectable antibodies during this window
period. If you get a negative HIV antibody test result during the window period, you should be
re-tested 3 months after your possible exposure to HIV.
2. A combination, or fourth-generation, test looks for both HIV antibodies and antigens.
Antigens are foreign substances that cause your immune system to activate. The antigen is part
of the virus itself and is present during acute HIV infection (the phase of infection right after

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people are infected but before they develop antibodies to HIV). If youre infected with HIV, an
antigen called p24 is produced even before antibodies develop. Combination screening tests
are now recommended for testing done in labs and are becoming more common in the United
States. There is now a rapid combination test available.

It can take 2 to 6 weeks (13 to 42 days) for a persons body to make enough antigens and
antibodies for a combination, or fourth-generation, test to detect HIV. This is called the
window period. If you get a negative combination test result during the window period, you
should be retested 3 months after your possible exposure.

3. A nucleic acid test (NAT) looks for HIV in the blood. It looks for the virus and not the
antibodies to the virus. The test can give either a positive/negative result or an actual amount
of virus present in the blood (known as a viral load test). This test is very expensive and not
routinely used for screening individuals unless they recently had a high-risk exposure or a
possible exposure with early symptoms of HIV infection.

It can take 7 to 28 days for a NAT to detect HIV. Nucleic acid testing is usually considered
accurate during the early stages of infection. However, it is best to get an antibody or
combination test at the same time to help the doctor interpret the negative NAT. This is
because a small number of people naturally decrease the amount of virus in their blood over
time, which can lead to an inaccurate negative NAT result. Taking pre-exposure prophylaxis
(PrEP) or post-exposure prophylaxis (PEP) may also reduce the accuracy of NAT if you have
HIV.

Its important to share your status with your sex partners. Whether you disclose your status to
others is your decision.

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IV. Facts

As per the recently released2, India HIV Estimation 2015 report, National adult (1549 years)
HIV prevalence in India is estimated at 0.26% (0.22% 0.32%) in 2015. In 2015, adult HIV
prevalence is estimated at 0.30% among males and at 0.22% among Females.

Among the States/UTs, in 2015, Manipur has shown the highest estimated adult HIV prevalence
of 1.15%, followed by Mizoram (0.80%), Nagaland (0.78%), Andhra Pradesh & Telangana
(0.66%), Karnataka (0.45%), Gujarat (0.42%) and Goa (0.40%). All other States/UTs have levels
of adult HIV prevalence below 0.20%.

The adult HIV prevalence at national level has continued its steady decline from an estimated
peak of 0.38% in 2001-03 through 0.34% in 2007 and 0.28% in 2012 to 0.26% in 2015(Figure
1). Similar consistent declines are noted both in males and females at the national level.
Figure 1. Estimated Adult HIV Prevalence (%) in India, 19902015 with Uncertainty Bound

As per the recently released, India HIV Estimation 2015 report, National adult (1549 years)
HIV prevalence in India is estimated at 0.26% (0.22% 0.32%) in 2015. In 2015, adult HIV
prevalence is estimated at 0.30% among males and at 0.22% among Females.

Among the States/UTs, in 2015, Manipur has shown the highest estimated adult HIV prevalence
of 1.15%, followed by Mizoram (0.80%), Nagaland (0.78%), Andhra Pradesh & Telangana
(0.66%), Karnataka (0.45%), Gujarat (0.42%) and Goa (0.40%). Besides these States,
Maharashtra, Chandigarh, Tripura and Tamil Nadu have shown estimated adult HIV prevalence
greater than the national prevalence (0.26%), while Odisha, Bihar, Sikkim, Delhi, Rajasthan and
West Bengal have shown an estimated adult HIV prevalence in the range of 0.21 0.25%. All
other States/UTs have levels of adult HIV prevalence below 0.20%.

The adult HIV prevalence at national level has continued its steady decline from an estimated
peak of 0.38% in 2001-03 through 0.34% in 2007 and 0.28% in 2012 to 0.26% in 2015. 3 Similar
consistent declines are noted both in males and females at the national level.

2
http://naco.gov.in/hiv-facts-figures, last accessed on 15/02/2017
3
Figure 1 at pg 5
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V. Policies Undertaken

UNAIDS

United Nations Member States have committed to implementing a bold agenda to end the AIDS
epidemic by 2030 during the United Nations General Assembly High-Level Meeting on
Ending AIDS, held in New York, United States of America, from 8 to 10 June. The
progressive, new and actionable Political Declaration includes a set of specific, time-bound
targets and actions that must be achieved by 2020 if the world is to get on the Fast-Track and
end the AIDS epidemic by 2030 within the framework of the Sustainable Development Goals.

There has been a 60% decline in new HIV infections among children since 2009 in the 21
countries in sub-Saharan Africa that have been most affected by the epidemic. To build on
the enormous progress made in stopping new HIV infections among children, UNAIDS,
PEPFAR and partners released a framework for ending AIDS among children, adolescents
and young womenStart Free, Stay Free, AIDS-Free. The initiative sets ambitious targets to
eliminate new infections among children, ensure access to treatment for all children living with
HIV and prevent new HIV infections among adolescents and young women in order to put the
world on a path to ending the AIDS epidemic among young women, adolescents and children.

Armenia, Belarus and Thailand joined Cuba in receiving official certificates of validation
from the World Health Organization for eliminating new HIV infections among
children. Thailand is the first country with a major HIV epidemic (450 000 people living with
HIV in 2014) to receive such validation.

Events were held on the wider health agenda, including learning the lessons learned
from responding to emerging epidemics, such as AIDS, Ebola and Zika, and on empowering
adolescent girls and young women to access integrated health-care services, which was
organized by the Organisation of African First Ladies against HIV/AIDS.

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UNAIDS Goals

1. Reducing Sexual transmission

On International Condom Day (13 February 2017), UNAIDS is calling for countries to remove
barriers that hinder access to, and the use of, condoms. Condoms are an effective means of
preventing HIV and sexually transmitted infections. With the annual number of new HIV
infections among adults remaining static at 1.9 million for the past five years, and increasing in
some parts of the world, there is an urgent need for improved access to HIV prevention
options, including condoms and lubricants. For example, the gap between availability and need
in sub-Saharan Africathe region most affected by HIVis estimated to be more than 3 billion
condoms.

2. Eliminating new HIV infections among children

Eliminate new HIV infections among children by 2015 and substantially reduce AIDS-related
maternal deaths.

3. Eliminating Stigma and Discrimination

Eliminate stigma and discrimination against people living with and affected by HIV through
promotion of laws and policies that ensure the full realization of all human rights and
fundamental freedoms.

4. Eliminating Gender Inequalities

Eliminate gender inequalities and gender-based abuse and violence and increase the capacity of
women and girls to protect themselves from HIV. On World Cancer Day, UNAIDS is calling
for all women living with HIV to have access to information about the human papillomavirus
(HPV) and to be offered cervical cancer screening and treatment if necessary.

22
National Aids Control Organization (NACO)

Indias AIDS Control Programme is globally acclaimed as a success story. The National AIDS
Control Programme (NACP), launched in 1992, is being implemented as a comprehensive
programme for prevention and control of HIV/AIDS in India. Over time, the focus has shifted
from raising awareness to behavior change, from a national response to a more decentralized
response and to increasing involvement of NGOs and networks of PLHIV.

In 1992, the Government launched the first National AIDS Control Programme (NACPI) with an
IDA Credit of USD84 million and demonstrated its commitment to combat the disease. NACP I
was implemented with an objective of slowing down the spread of HIV infections so as to
reduce morbidity, mortality and impact of AIDS in the country. National AIDS Control Board
(NACB) was constituted and an autonomous National AIDS Control Organization (NACO) was
set up to implement the project. The first phase focused on awareness generation, setting up
surveillance system for monitoring HIV epidemic, measures to ensure access to safe blood
and preventive services for high risk group populations.

In November 1999, the second National AIDS Control Project (NACP II) was launched with
World Bank credit support of USD 191 million. The policy and strategic shift was reflected in
the two key objectives of NACP II: (i) to reduce the spread of HIV infection in India, and (ii) to
increase Indias capacity to respond to HIV/AIDS on a long-term basis. Key policy initiatives
taken during NACP II included: adoption of National AIDS Prevention and Control Policy
(2002); Scale up of Targeted Interventions for High risk groups in high prevalence states;
Adoption of National Blood Policy; a strategy for Greater Involvement of People with
HIV/AIDS (GIPA); launch of National Adolescent Education Programme (NAEP); introduction
of counseling, testing and PPTCT programmes; Launch of National Anti-Retroviral Treatment
(ART) programme; formation of anointer-ministerial group for mainstreaming; and setting up of
the National Council on AIDS, chaired by the Prime Minister; and setting up of State AIDS
Control Societies in all states.

In response to the evolving epidemic, the third phase of the national programme (NACPIII) was
launched in July 2007 with the goal of Halting and Reversing the Epidemic by the end of project

23
period. NACP was a scientifically well-evolved programme, grounded on a strong structure of
policies, programmes, schemes, operational guidelines, rules and norms. NACP-III aimed at
halting and reversing the HIV epidemic in India over its five-year period by scaling up
prevention efforts among High Risk Groups (HRG) and General Population and integrating them
with Care, Support & Treatment services. Thus, Prevention and Care, Support & Treatment
(CST) form the two key pillars of all the AIDS control efforts in India. Strategic Information
Management and Institutional Strengthening activities provide the required technical, managerial
and administrative support for implementing the core activities under NACP-III at national, state
and district levels.

The capacities of State AIDS Control Societies (SACS) and District AIDS Prevention and
Control Units (DAPCUs) have been strengthened. Technical Support Units (TSUs) were
established at National and State level to assist in the Programme monitoring and technical
areas. A dedicated North-East regional Office has been established for focused attention to the
North Eastern states. State Training Resource Centres (STRC) was set up to help the state level
implementation units and functionaries. Strategic Information Management System (SIMS) has
been established and nation-wide rollout is under way with about 15,000 reporting units across
the country. The next phase of NACP will build on these achievements and it will be ensured that
these gains are consolidated and sustained.

NACP IV, launched in 2012, aims to accelerate the process of reversal and further
strengthen the epidemic response in India through a cautious and well defined integration
process over the next five years.

NACP IV Objectives:

Reduce new infections by 50% (2007 Baseline of NACP III)

Provide comprehensive care and support to all persons living with HIV/AIDS and
treatment services for all those who require it.

24
Naco Prevention Strategies:

1. Targeted Intervention for High Risk Group

Indias HIV program has been recognized globally as a very successful public health model with
specific interventions for key population of Female Sex Workers (FSW), Men who have Sex
with Men (MSM), Transgender (TG)/Hijra and Injecting Drug Users (IDUs) known as the Core
Group and Migrants and Truckers known as the Bridge Population. Over 3 decades of
implementing Targeted Interventions through NGO/CBOs, critical insights into the operational
aspects is gained. Consolidating the success gained, a focused HIV intervention has been
developed to reduce HIV prevalence among the key population.

2. Targeted Intervention (TI) Approach

The prevention of HIV infection among the high risk group (HRGs) is the main thrust area for
the NACP and the TI program has demonstrated that it is the most effective way of controlling
the epidemic among this population. The approach for providing services to this population
began by conducting various mapping exercises that helped in arriving at a specific
denominator for service provision. The latest mapping was conducted for TGs/Hijra in 2013.
One of the primary aims of NACO and the State AIDS Control Society (SACS) is to ensure
saturation of this figure through TI service components of Behaviour Change Communication,
Condom Distribution for Core Group, Condom Social Marketing for Bridge Population,
Outreach Services, Counseling, HIV testing, Linkages/Referrals, STI management,
Needle/Syringe Program (for IDUs), Opioid Substitution Therapy (for IDUs), enabling
environment for all key population and advocacy to reduce stigma and discrimination.

In order to measure the program efficiency a system of HIV Sentinel Surveillance was
introduced and over the years Indias efficient response to HIV has resulted in reduction of HIV
prevalence among most of the core group with the exception of IDUs and TGs/Hijra. The
HIV prevalence among ANC is 0.29% and Female Sex Worker 2.20%, Men who have Sex with
Men 4.30%, Injecting Drug Users 9.90%, and Transgender/Hijra population 7.20% (IBBS 2015).

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The bridge population consisting of Truckers and Migrants had HIV prevalence of 2.59% and
0.99% respectively. (HSS 2012-13 Technical Brief)

3. Female Sex Workers (FSWs)

The HIV epidemic in India is known to be a concentrated epidemic with FSWs being one of the
core risk groups that are affected. FSWs have many sexual partners concurrently. Generally,
full time FSWs have at least one client per day. Some FSWs have more clients than others. In
addition to the number of clients their nature of work also increases their vulnerability to
HIV. The higher risk of FSWs is reflected in a substantially higher prevalence of HIV among
them than in the general population.

As per the IBBS conducted in 2014-15, HIV prevalence among FSWs found to be 2.2%, which
is eight times more than among pregnant women attending antenatal clinics (0.29%) as per HSS
2014-15. However there has been a steady decline in the HIV prevalence among this
population as a result of effective interventions over the years.

4. Men having Sex with Men (MSM)

Men Having Sex with Men(MSM) are another important group who are highly vulnerable to
HIV and are also a strategically important group for focusing HIV prevention programmes. The
term men who have sex with men (MSM) is used to denote all men who have sex with other
men as a matter of preference or practice, regardless of their sexual identity or sexual orientation
and irrespective of whether they also have sex with women or not.

It is important to know that not all MSM have many sexual partners however, there are MSM
sub-populations which do have high rates of partner change as well as high number of concurrent
sexual partners. These sub-groups of MSM who often engage in anal sex with multiple partners
are at particularly high risk. As per the IBBS conducted in 2014-15, HIV prevalence among
MSMs found to be 4.30%.

5. Transgender/Hijra

NACO has initiated exclusive TG/Hijra intervention under NACP IV based on the
recommendation from the working groups and needs from communities. A separate costing and
26
operational guideline has been developed for uniformity in scaling up of TG/Hijra intervention
in the country based on the mapping.

In order to ensure standardization of program, feedback from stakeholders and communities, the
typology wise Technical Resource Groups (TRG) formed and conducted, periodically.

6. Harm Reduction Program

NACO has adopted the harm reduction policy as a strategy for prevention of HIV/AIDS amongst
IDUs in 2002 during the second phase of the National AIDS Control Program (NACP II).
Counselling, behavior change communication (BCC), Needle Syringe Exchange Program
(NSEP), abscess prevention and management, STI treatment, referral and linkages, etc are
the service components of the strategy. These services are being provided through the NGOs
known as the IDU TI.

In the current NACP IV, the provision of female outreach worker (ORW) was added in all the
IDU TIs for reaching out to the spouses of male IDUs. Female Injecting Drug User (FIDU) is
also an additional typology being included in NACP IV. The key aspects of the strategy to
provide services to FIDUs include:

Comprehensive package of services including services specifically addressing needs of


Female IDUs

Female friendly service delivery mechanisms

Gender responsive and need based services

Community participation in programme planning and implementation

Evidence driven response- Collection and application of strategic information for


program design and improvement in quality implementation

27
The Human Immunodeficiency Virus And Acquired Immune Deficiency Syndrome (Prevention
And Control) Bill, 2014 (Current Status: Pending):
The Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome
(Prevention and Control) Bill, 2014 was introduced in the Rajya Sabha on February
11, 2014 by the Minister for Health and Family Welfare, Mr. Ghulam Nabi Azad.
The Bill seeks to prevent and control the spread of HIV and AIDS, prohibits
discrimination against persons with HIV and AIDS, provides for informed consent and
confidentiality with regard to their treatment, places obligations on establishments to
safeguard their rights, and creates mechanisms for redressing their complaints.

Prohibition of discrimination against HIV positive persons: The Bill lists the various
grounds on which discrimination against HIV positive persons and those living with
them is prohibited. These include the denial, termination, discontinuation or unfair
treatment with regard to: (i) employment, (ii) educational establishments, (iii) health
care services, (iv) residing or renting property, (v) standing for public or private office,
and (vi) provision of insurance (unless based on actuarial studies). The requirement for
HIV testing as a pre-requisite for obtaining employment or accessing health care or
education is also prohibited.

Every HIV infected or affected person below the age of 18 years has the right to
reside in a shared household and enjoy the facilities of the household. The Bill also
prohibits any individual from publishing information or advocating feelings of
hatred against HIV positive persons and those living with them.

Informed consent and disclosure of HIV status: The Bill requires that no HIV test,
medical treatment, or research will be conducted on a person without his informed
consent. No person shall be compelled to disclose his HIV status except with his
informed consent, and if required by a court order.

Informed consent for an HIV test will not be required in case of screening by any
licensed blood bank, a court order, medical research, and epidemiological purposes where
the HIV test is anonymous and not meant to determine the HIV status of a person.

28
Establishments keeping records of information of HIV positive persons shall adopt data
protection measures.

Role of the central and state governments: The central and state governments shall
take measures to: (i) prevent the spread of HIV or AIDS, (ii) provide anti-retroviral
therapy and infection management for persons with HIV or AIDS, (iii) facilitate their
access to welfare schemes especially for women and children, (iv) formulate HIV or
AIDS education communication programmes that are age appropriate, gender sensitive,
and non stigmatizing, and (v) lay guidelines for the care and treatment of children with
HIV or AIDS. Every person in the care and custody of the state shall have right to HIV
prevention, testing, treatment and counselling services.

Role of the Ombudsman: An ombudsman shall be appointed by each state government


to inquire into complaints related to the violation of the Act and the provision of
health care services. The Ombudsman shall submit a report to the state government
every six months stating the number and nature of complaints received, the actions
taken and orders passed.

Guardianship: A person between the age of 12 to 18 years who has sufficient maturity
in understanding and managing the affairs of his HIV or AIDS affected family shall be
competent to act as a guardian of another sibling below 18 years of age. The
guardianship will be apply in matters relating to admission to educational
establishments, operating bank accounts, managing property, care and treatment,
amongst others.

Court proceedings: Cases relating to HIV positive persons shall be disposed off by the
court on a priority basis. In any legal proceeding, if an HIV infected or affected
person is a party, the court may pass orders that the proceedings be conducted (a)
by suppressing the identity of the person, (b) in camera, and (c) to restrain any person
from publishing information that discloses the identity of the applicant. When passing
any order with regard to a maintenance application filed by an HIV infected or affected
person, the court shall take into account the medical expenses incurred by the applicant

29
Concluding Observations

In July 2011, it was announced by the WHO and UNAIDS that a once-daily antiretroviral tablet
could significantly reduce the risk of HIV transmission in heterosexual couples. 4 These findings
were based on the results of two trials conducted in Kenya and Uganda, and Botswana.

The HIV-1 virus has proved to be tenacious, inserting its genome permanently into victims'
DNA, forcing patients to take a lifelong drug regimen to control the virus and prevent a
fresh attack. Now, a team of Temple University School of Medicine 5 researchers have
designed a way to "snip out" the integrated HIV-1 genes for good.

This is one important step on the path toward a permanent cure for AIDS. This is the first
successful attempt to eliminate latent HIV-1 virus from human cells.

Since HIV-1 is never cleared by the immune system, removal of the virus is required in order to
cure the disease. The same technique could theoretically be used against a variety of viruses.

There has been a 60% decline in new HIV infections among children since 2009 in the 21
countries in sub-Saharan Africa that have been most affected by the epidemic. To build on the
enormous progress made in stopping new HIV infections among children, UNAIDS, PEPFAR
and partners released a framework for ending AIDS among children, adolescents and young
womenStart Free, Stay Free, AIDS-Free. The initiative sets ambitious targets to eliminate new
infections among children, ensure access to treatment for all children living with HIV and
prevent new HIV infections among adolescents and young women in order to put the world on a
path to ending the AIDS epidemic among young women, adolescents and children.

The prevention of HIV infection among the high risk group (HRGs) is the main thrust area for
the NACP and the TI program has demonstrated that it is the most effective way of controlling
the epidemic among this population. The approach for providing services to this population
began by conducting various mapping exercises that helped in arriving at a specific denominator
for service provision.

4
http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2011/july/20110713psprep/; last
accessed on 15/02/2017
5
http://www.aidsmap.com/The-TDF2-trial/page/2213126/; last accessed on 15/02/2017

30
References

1. UNAIDS, 2009, Monitoring the Declaration of Commitment on HIV/AIDS: Guidelines on


Construction of Core Indicator, Geneva: UNAIDS.

2. Global Health.Gov Website, 2008, National Composite Policy Index Questionnaire,


Washington, D.C.: U.S. Department of Health and Human Services, PEPFAR, 2009,

3. UNAIDS, 2006, Political Declaration on HIV/AIDS, Geneva: UNAIDS.

4. UNGASS, 2001, Declaration of Commitment on HIV/AIDS,

5. http://www/un.org/ga/aids/coverage/FinalDeclarationHIVAIDS.html

6. WHO, 2003, Nutrient requirements for people living with HIV/AIDS: Report of a technical
consultation, May 13-15, Geneva: WHO.

7. Agha S., Karlyn A., Meekers D. The Promotion of Condom Use in Non-Regular Sexual
Partnerships in Urban Mozambique. Health Policy and Planning. 2001;16(2):14451.
8. Alcabes P., Munoz A., Vlahov D., Friedland G. H. Incubation Period of Human
Immunodeficiency Virus. Epidemiologic Reviews. 1993;15(2):30318.
9. Anthony J. C., Vlahov D., Nelson K. E., Cohn S., Astemborski J., Solomon L. New Evidence
on Intravenous Cocaine Use and the Risk of Infection with Human Immunodeficiency Virus
Type 1. American Journal of Epidemiology. 1991;134:117589.
10. Anzala O. A., Nagelkerke N. J., Bwayo J., Holton D., Moses S., Ngugi E. Rapid Progression
to Disease in African Sex Workers with Human Immunodeficiency Virus Type 1
Infection. Journal of Infectious Diseases. 1995;171(3):68689.
11. Askew I., Berer M. The Contribution of Sexual and Reproductive Health Services to the
Fight against HIV/AIDS: A Review. Reproductive Health Matters. 2003;11(22):5173.
12. Auvert B., Buve A., Lagarde E., Kahindo M., Chege J., Rutenberg N. et al. Male
Circumcision and HIV Infection in Four Cities in Sub-Saharan Africa. AIDS.
13. Auvert, B., A. Puren, D. Taljaard, E. Lagarde, R. Sitta, and J. Tambekou. 2005. "Impact of
Male Circumcision on the Female-to-Male Transmission of HIV." Paper presented at the 3rd
IAS Conference on HIV Pathegenosis and Treatment. Rio de Janeiro, July 2427.

31
14. Ayouba A., Tene G., Cunin P., Foupouapouognigni Y., Menu E., Kfutwah A. et al. Low Rate
of Mother-to-Child Transmission of HIV-1 after Nevirapine Intervention in a Pilot Public
Health Program in Yaounde, Cameroon. Journal of Acquired Immune Deficiency Syndrome.
15. Badri M., Wood R. Usefulness of Total Lymphocyte Count in Monitoring Highly Active
Antiretroviral Therapy in Resource-Limited Settings. AIDS.
16. Basu I., Jana S., Rotheram-Borus M. J., Swendeman D., Lee S. J., Newman P., Weiss R. HIV
Prevention among Sex Workers in India. Journal of Acquired Immune Deficiency Syndrome.

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