Not too long ago, it was widely believed that being infected with HIV in India was nothing short of a death sentence. However, two decades of concerted efforts and investments later, the HIV epidemic has been substantially addressed in many ways. A well-funded, carefully monitored and empathetic programme has delivered over the last 14 years, reducing new infections by 20% and giving lakhs of people treatment. India has fought HIV valiantly, but recently it has started to falter. A mistake that could have the makings of an epidemic.
On the eve of World AIDS Day, which falls on 1 December, a shocking statement from the National AIDS Control Organisation (NACO) said it was not feasible to provide free ART (lifesaving medicines for HIV infected) to all patients as per the new WHO guidelines. These new WHO guidelines suggest starting ART treatment at the earliest to ensure slow progression of the disease and curtail transmission. It's based on extensive evidence and expert opinion. While countries across the world are considering this as an urgent policy change, India's NACO is citing reasons such as finance and operational feasibility among others for its non-implementation. How can this be justified in a country where more than 2 million people are HIV-infected and millions others remain at risk? How does a disease-control programme disregard international guidelines so callously, putting lives at risk and increasing suffering? The government hasn't bothered to answer.
"By reducing funding and deprioritising HIV, the government may be destroying one of India's more successful disease control programmes."
It's unclear whether this reflects a change in political thinking but a growing sense complacency and neglect has been palpable with regard to HIV in India. Last year, the government decided that the programme would no longer be under the independent charge of a secretary but one of the numerous responsibilities of an additional secretary. This has naturally reduced both effort and decision-making capacity at the programme level. The hardest blow however has been a reduction in funding by over 20% -- a blow to any programme activities and expansion.
The impact of the government's neglect of HIV, however, had become apparent much earlier when the fourth phase of NACO began and the government was required to provide the largest funding for the programme. With fewer international partners involved and monitoring reduced, delays have become inevitable. In 2014, for the first time India witnessed widespread stock-outs of an essential first-line drug, Tenofovir, in the public programme. Ironically, the drug is produced by India-based pharmaceutical companies who supply it across the world to HIV patients in need. Thousands who could not afford private sector drugs and were entirely dependent on the government were left helpless and at enormous risk. The program, however, seemed unshaken.
Not long before that, India's HIV program also witnessed a stock-out of critical viral load kits. These kits too were produced in India and the stock outs were a result of delayed procurement. The government officials, quite literally, forgot to procure the kits in time. They probably neither tracked their usage or consumption. By the time they went to the manufacturer the stocks were critically low. This too passed without any explanation.
Apart from criminal negligence the most significant impact of the government's apathy has been in prevention. The funding of prevention activities -- the most critical aspect of HIV control -- has been significantly reduced. Targeted prevention and screening interventions targeted at high-risk populations such as truckers, gay and bisexual men, sex workers, drug users suffer from insufficient funds. In fact with reduced funding, many organisations on the ground have stopped working on HIV. The government's own staff at the state level is often not paid for months due to delayed access to funds within the state treasuries.
By reducing funding and deprioritising HIV, the government may be destroying one of India's more successful disease control programmes. Evidence worldwide shows that without sufficient awareness, education and focus on high-risk populations, the number of new infections is bound to climb up. How does the government plan to address this? There is no doubt that there will be economic implications as well -- both in human and healthcare costs. At what point will we realise that by this criminal neglect, we are recreating an epidemic and putting at risk the gains made over the last decade? Who will take the responsibility for these infections? What economic sense does it make to cut funding at this crucial time in India's fight against HIV? The government has to rise above its apathy and apparent negligence and answer these questions -- because those affected by HIV deserve to know.
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