Opinion

It’s still a grim fight against HIV

Anita Victor | Updated on January 16, 2018 Published on October 28, 2016

Long journey: The fight for better access to treatment

The number of new infections has come down, but reduced funds could reverse these gains and put infected people at risk

The revised draft of the HIV and AIDS (Prevention and Control) Bill, 2014, which makes discrimination against a person living with HIV and AIDS a punishable offence, was quietly cleared by the Union Cabinet recently, after languishing more than two years in the Rajya Sabha. This is a major step in ending discrimination and ensuring basic rights of people living with HIV and AIDS.

Reversal of gains?

Effective government interventions have ensured that the number of new infections has been reduced to half. It has been a long arduous journey since 2002 for the Bill to get the attention of the Cabinet.

The Bill promises to bring a rights-based approach to the care and treatment of people living with HIV and AIDS, making it imperative for both the Centre and States governments to provide treatment “as far as possible”.

However, it is these four words that are of deep concern, as it stops short of making treatment for all a legal right. Therefore, a patient who is denied anti-retroviral treatment (ART) and opportunistic infection management cannot ordinarily drag any government to court.

While this Bill has received the Cabinet nod, we are aware of budget cuts to two of India’s key health initiatives — the National AIDS Control Programme (NACP) and the Revised National Tuberculosis Control Programme (RNTCP). A total of 2.1 million people in India are HIV positive and about 1.2 million new cases of tuberculosis are diagnosed every year.

For more than a decade, under the NACP, our government has been dispensing free ART and diagnostic services through a national network of 510 ART clinics. About 869,000 HIV-positive people currently receive first-line and second-line ART.

The central funds allocated for AIDS control in States has been slashed from ₹9.28 billion in 2014-15 to ₹5.40 billion for 2015-16. For the National Strategic Plan (2012-17) of the RNTCP, the allocation until 2014-15 was ₹ 22.63 billion. A shortfall is looming as the projected expenditure for five years is ₹45 billion. (NACO 2015-16 Annual Report)

The Bill does promise to provide ART and infection management for persons with HIV and AIDS and facilitate access to welfare schemes. But the trepidation that budget cuts can reverse the gains of the last decade is not baseless. After all, the virus continues to outsmart us and evade a cure! It is therefore imperative that policymakers and technical experts work closely with civil society organisations to influence funding agencies and corporates.

Along with treatment components, the Bill also mandates Central and State governments to formulate HIV and AIDS education communication programmes that are age-appropriate, gender sensitive, non-stigmatising and non-discriminatory.

Children with HIV

Currently in India, there are an estimated 1,38,456 children living with HIV (NACO Technical report, 2015).

This is the time for State governments to demonstrate conscientious responsibility towards the children living with HIV and AIDS.

The provisions for care and support of these vulnerable children as cited in the Bill will become a reality only if there is commitment to work out district-specific implementation plans with adequate resource allocation.

While the guardianship of children living with HIV and AIDS by an older sibling helps in easing out admission to educational establishments, operating bank accounts, managing property, care and treatment, there is a need to step up counselling services to address mental and sexual health issues.

During the upcoming winter session of the Parliament, we look to the Government to make the HIV Bill an Act. Only then, can the existing major concerns on State-specific budgetary allocations be addressed.

The writer is the director of health projects at World Vision India

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Published on October 28, 2016
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