The general consensus among those fighting AIDS

Testing

The general consensus among those fighting AIDS worldwide is that HIV testing should be carried out voluntarily, with the consent of the individual concerned. This view has been supported by the Indian government and NACO, who have helped to establish hundreds of integrated counselling and testing centres (ICTCs) in India. By the end of 2009 there were 5135 ICTCs in India,⁶¹ compared to just 62 in 1997.⁶² By 2009 these centres tested had tested 13.4 million people for HIV, an increase from 4 million in 2006.⁶³

india-web.jpg

Health Clinic near Sangli, India - 2005

Although voluntary testing is officially supported in India, some states have tried to implement policies that would force people to be tested for HIV against their will. In Goa and Andhra Pradesh the state governments proposed a bill in 2006 to make HIV tests compulsory before marriage, and in Punjab it has been proposed that all people wishing to obtain or retain a driver’s license should be tested for HIV.⁶⁴ Neither of these plans have come to pass, but they have concerned activists, who argue that HIV testing should never be imposed on people against their wishes.

Unfortunately, cases of people being tested without their consent or knowledge are common in Indian hospitals. In one 2002 study, it was suggested that over 95% of patients listed for surgical procedures are tested against their will, often resulting in their surgery being cancelled.⁶⁵ Hospital staff and health professionals, much like the rest of the Indian population, are often unaware of the facts about HIV. This leads to unnecessary fears and, in some cases, causes them to stigmatise HIV positive people and discriminate against them, including testing them without consent.

India has certainly made progress in expanding HIV testing to its large population. However, considering only 50% of those currently infected with HIV are aware of their status there is still significant work to be done in this area. ⁶⁶

Treatment for people living with HIV

Antiretroviral drugs (ARVs), which can significantly delay the progression from HIV to AIDS – have been available in developed countries since 1996. Unfortunately, as in many resource-poor areas, access to this treatment is limited in India; an estimated 285,000 people were receiving free ARVs in 2009.⁶⁷ This, totalled with the number receiving ARVs through the private sector, amounted to 320,000 people receiving ARVs in 2009. According to NACO, this represents just over half of the adults estimated to be in need of antiretroviral treatment in India. However, according to WHO's latest treatment guidelines (2010), which recommend starting treatment earlier, revised estimates may indicate that only around 1 in 4 people in need of ARVs are currently receiving it.⁶⁸

While the coverage of treatment remains unacceptably low, improvements are being made. The government has started to expand access to ARVs in a number of areas; by November 2009 there were 266 reported sites providing antiretroviral therapy.⁶⁹

Increasing access to ARVs also means that an increasing number of people living with HIV in India are developing drug resistance. When HIV becomes resistant to the ARVs the treatment regimen needs to be changed to 'second-line' ARVs. As with many other parts of the world, second-line treatment in India is far more expensive than first-line treatment.

In 2008, NACO began to roll out government funded second-line antiretroviral treatment in two centres in Mumbai and Chennai. However coverage remains limited; of the 3,000 who needed to be on second line treatment, about 970 were receiving it as of January 2010.^{70 71} One reason for this is expense; second line ARV drugs, unlike first line ARVs, are not produced on a large scale in India due to patent issues that control drug pricing. Therefore, they can be more than 10 times more expensive than first line ARVs.

Ironically, India is a major provider of cheap generic copies of ARVs to countries all over the world. However, the large scale of India’s epidemic, the diversity of its spread, and the country’s lack of finances and resources continue to present barriers to India’s antitretroviral treatment programme.

To read about the challenges faced in increasing access to antiretroviral drugs around the world, see our Universal access to AIDS treatment page.