ISSUES AND CHALLENGES: PRIORITY AREAS

ISSUES AND CHALLENGES: PRIORITY AREAS

Limited Overall Capacity: There are severe institutional capacity constraints, including managerial, at the national and state levels. These are critical factors to address as the program attempts to scale-up the national response. NACO will require a change in its role and responsibilities to provide the necessary leadership and steering role for a stronger multisector response for the next phase in India’s fight against HIV/AIDS.

Variable Ability to Implement Responses Across States: The capacity to mount a strong program is weakest in some of the poorest and most populated states with significant vulnerability to the epidemic. There is a need for tailored capacity-building activities and the introduction of some performance-based financing approaches.

Institutional arrangements and personnel turnover: There is a high turnover of state level project directors, resulting in limited continuity and variability in performance across states. This puts program growth at risk.

Donor Coordination: At present there are over 32 donor agencies working with NACO in different states and on different programs. Each donor comes with its own mandate and requirements, as well as areas of focus. The transaction cost to the government as a result of attending to the various demands of the donors is huge. There is a need for better coordinating mechanisms among the donors and clear leadership by the Government to reduce the transaction costs.

Use of Data for Decision Making: There remains a need for greater use of data for decision making, including program data and epidemiological data. A lot of data that is being generated is not adequately used for managing the program or inform policies and priorities. Results-based management and linking incentives to the use of data should be explored.

Stigma and Discrimination: Stigma and discrimination against people living with HIV/AIDS and those considered to be at high risk remain entrenched. A lot of this is a result of inadequate knowledge. For instance, more than 75 percent of Indians mistakenly believed they could contract HIV from sharing a meal with a person who has the disease, according to a recent study. Stigma and denial undermine efforts to increase the coverage of effective interventions among high risk groups such as men having sex with men, commercial sex workers and injecting drug users. Harassment by police and ostracism by family and community drives the epidemic underground and decreases the reach and effectiveness of prevention efforts. Though there is significant increase in awareness, due to efforts by the government, there is much room for improvement.

Low Awareness in Rural Areas: Sentinel site behavioral surveillance, completed in 2001, showed high HIV/AIDS basic awareness levels (82.4 percent in males and 70 percent in females). However, rural women demonstrated very low rates of awareness in Bihar (21.5 percent), Gujarat (25 percent), and Uttar Pradesh (27.6 percent). New approaches need to be tried to reach rural communities with information about HIV/AIDS, safe sex and how to prevent and treat HIV/AIDS.