NATIONAL RESPONSE TO HIV/AIDS

NATIONAL RESPONSE TO HIV/AIDS

Government:Shortly after reporting the first AIDS case in 1986, the Government of India established a National AIDS Control Program (NACP) which was managed by a small unit within the Ministry of Health and Family Welfare. The program’s principal activity was then limited to monitoring HIV infection rates among risk populations in select urban areas.

In 1991, the strategy was revised to focus on blood safety, prevention among high-risk populations, raising awareness in the general population, and improving surveillance. A semi-autonomous body, the National AIDS Control Organization (NACO), was established under the Ministry of Health and Family Welfare to implement this program. This “first phase” of the National AIDS Control Program lasted from 1992 -1999. It focused on initiating a national commitment, increasing awareness and addressing blood safety. It achieved some of its objectives, notably an increased awareness. Professional blood donations were banned by law. Screening of donated blood became almost universal by the end of this phase. However, performance across states remained variable. By 1999, the program had also established a decentralized mechanism to facilitate effective state-level responses, although substantial variation continued to exist in the level of commitment and capacity among states. Whereas states such as Tamil Nadu, Andhra Pradesh, and Manipur demonstrated a strong response and high level of political commitment, many other states, such as Bihar and Uttar Pradesh, have yet to reach these levels.

The second phase of the NACP began in 1999 and will run until March 2006. Under this phase, India continues to expand the program at the state level. Greater emphasis has been placed on targeted interventions for high-risk groups, preventive interventions among the general population, and involvement of NGOs and other sectors and line departments, such as education, transport and police. Capacity and accountability at the state level continues to be a major issue and has required sustained support. Interventions need to be scaled up to cover a higher percentage of the population, and monitoring and evaluation need further strengthening. The Government has done away with the classification of states based on prevalence to avoid inducing complacency among states categorized as low prevalence, and has since focused on the vulnerability of states, hence creating a sense of urgency.

In brief, while the government’s response has scaled up markedly over the last decade, major challenges remain in raising the overall effectiveness of state-level programs, expanding the participation of other sectors, and increasing safe behavior and reducing stigma associated with HIV-positive people among the population.

The Government of India is currently in the early stages of preparing for the third phase of the National AIDS Control Program (NACP 3), for which a multi-disciplinary design team has been constituted to lead the preparation. The design of NACP 3 envisages a complex consultative process including nationwide consultations with various national stakeholders, as well as international development partners.

Non-Governmental Organizations (NGOs): There are numerous NGOs working on HIV/AIDS issues in India at the local, state, and national levels. Projects include targeted interventions with high risk groups; direct care of people living with HIV/AIDS; general awareness campaigns; and care for AIDS orphans. Funding for NGOs comes from a variety of sources: the federal or state governments of India, international donors, and local contributions.

Donors: India receives technical assistance and funding from a variety of UN partners and bilateral donors. Bilateral donors such as USAID, CIDA, and DFID have been involved since the early 1990s at the state level in a number of states. USAID has committed more than US$70 million since 1992, CIDA US$11 million, and DFID close to US$200 million. The number of major financers and the amount of funding available has increased significantly in the last year. Since 2004, the Gates Foundation has pledged US$200 million for the next five years, the Global Fund has approved US$26 million for Prevention of Mother-to-Child Transmission (PMTCT) and about US$7 million for TB/HIV co-infection, and is considering another round of proposals, and USAID is considering the inclusion of India as its 15th priority country. DFID has also increased its financing and is considering the inclusion of additional states. Other more recent donors include DANIDA, SIDA, the Clinton Foundation and the European Union.