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Wednesday, October 24, 2007
Mira Nair's AIDS Jaago presented by AIF - SAHAYA
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Friday, September 28, 2007
HIV/AIDS CHILDREN - Their Secret Status and A Risky Schooling
HIV/AIDS CHILDREN
Their secret status and a risky schooling
HIV-positive children are being thrown out of school in Uttar Pradesh by insensitive teachers and parents alike. Many parents are afraid to let schools know that their children are positive, and the state's machinery has failed to raise any awareness, as a major study has shown. Puja Awasthi sounds the warning bells.
28 September 2007 - Dhirendra Varma is 14, but looks just eight.
In Lucknow, under the watchful eyes of his father, he takes his tuitions in an air less back room of his father's hardware store. From school, to store, it is a closely watched routine, which the boy follows with his younger brother Pankaj, seven. The motherless boys have six other siblings and shrug off the need for peers as playmates. Their father has also warned them of the "dangers" that lurk in their middle class neighbourhood to keep them from mingling with the other kids.
Dhirendra and Pankaj are HIV positive, like 70,000 other children in the country. The National Aids Control Organization (NACO) puts the number of full blown AIDS cases in the 0-14 age group at 5,596 as on August 31, 2006.
A march by the Indian Network for People Living with HIV/AIDS (INP+) demanding the introduction of HIV/AIDS Bill in Parliament. The event took place in Lucknow earlier this month. Pic: U.P. network of Positive People.
According to statistics from the Union Ministry of Health and Family Welfare at the current rates, 21,000 children will be added to this number every year. But this disturbing figure might be misleading as UNICEF India pegs the number of infected children at 220,000. This also could be a deceptive figure as the current HIV/AIDS programmes reach only 15% of India's young people.
Like most other infected children their age, the Varma brothers are ignorant of their status. Their father Ramesh Varma reasons that he is only "protecting" his children, both from the burden of knowing and the jibes of peers and teachers. Hence their status remains a secret from even his other children.
This secrecy means the children must take the morning dose of their medicine before they leave home at 7 a.m., often on empty stomachs. The elder siblings, like the boys' teachers are not expected to care for them.
This secrecy also means the boys must often report sick at school, lose out on class hours and then be pulled up by teachers for lagging. Hence, the tutor and the long hours of tuition.
With a sad drop of the jaw Dhirendra says he does not get high marks in class. "I am poor in English", he attempts to explain in surprisingly good language.
The boys are not alone in their predicament.
According to Future Forsaken: Abuses Against Children Affected by HIV/AIDS in India, 2004, a report published by the Human Rights Watch, USA, most positive children manage to attend school only by hiding their status. While this might enable them to gain admission and remain in school, it keeps them from receiving special measures that will prevent them from dropping out or better protect their own health.
Anil Kumar Singh, president of Savera, a Kushinagar-based organisation that works with people living with HIV/AIDS (PLHAs) says that children cannot be looked upon in isolation because of their dependent status. Kushinagar is a district in eastern U.P., best known as the place where Gautam Buddha preached his last sermon in 543 B.C.
"Most children begin to face stigma and deprivation even before the death of a parent or before their own status is revealed. Sick parents mean loss of income and children, especially girls are pulled out of schools to play the role of care givers and in many cases wage earners. Orphans of infected parents are often abandoned by the extended family and end up on the streets, open to further exploitation," explains Singh.
In the Indian case, the last problem has been compounded by the lack of community based and institutional care systems. The joint/extended family network which had, for centuries taken in the old and ailing within its folds has reacted with horror to the AIDS epidemic.
A society sans awareness and emphathy
Take the case of Baby Gond, a 32 year old illiterate woman from Kushinagar's Harka village. In January 2005, Gond lost her husband. The in-laws promptly turned Gond and her two children (who are not infected) out of the house, forcing them to stay in the cowshed. With help from a local NGO and the district administration she managed to re-gain entry into the home but was forced to set up a separate kitchen.
Gond's case was further twisted by a property angle as the in-laws were demanding that she and her children give up all rights on the deceased's wealth.
This August, Harka witnessed another case of discrimination when Nirmala Devi a low caste widow cooking the mid day meals in a primary school was ousted from her job when her positive status became known. Her children, an 8-year-old positive son and a 10-year-old daughter, were also hounded out of school.
The district magistrate intervened and reasoned with the school headmaster, the village headman and village elders. While they relented other villagers remained adamant that they would not allow their children to eat the food cooked by Nirmala. They were also scared of their children catching the infection if Nirmala touched the school handpump.
While the children are back in school, government intervention has not been able to get Nirmala her job back. This lack of awareness can be attributed to the dismal performance of the UP State Aids Control Society (UPSACS). UPSACS was set up in 1999, during phase II of the National AIDS Control Programme. It works on counseling, surveillance, testing and clinical management, preventive strategies, capacity building, innovative interventions and developing culturally appropriate messages. In addition it runs school and family awareness programmes.
An Action Aid supported study on the Scenario of HIV Vulnerability and Prevalence in Uttar Pradesh, 2006 found that in a sample size of 17,516 government school students 30 per cent felt that HIV-positive people should be kept in isolation while 78 per cent were of the view that such persons should not be allowed to enter schools.
Perceptions such as these have forced a partial disclosure of five-year-old Avtar and his three year old sister Tanuja Singh's status. The orphaned siblings live at Shanti Niketan, a short stay home and care centre for PLHAs, run by the Medical Sisters of St.Joseph on Lucknow's outskirts. A year ago, they were left at the centre by grandparents who live in Chandigarh.
When Sister Lalita, administrator, Shanti Niketan took the two for admission to a nearby missionary school, she was convinced that the school management had to know of the siblings' status to ensure their physical well being. "Last week Avtar fell off from a swing and scrapped his knees. We have given the school medical gloves for use when providing first aid to the children in such cases," she says.
On the principal's advice however, the children's status has not been revealed to the teachers. Next month the centre will organize an awareness workshop at the school to better acquaint teachers with the issue, but not necessarily divulge the siblings' status.
Teachers are part of the problem, not the solution
This caution is hardly surprising given that teachers have been the strongest opponents of education that will create HIV/AIDS awareness. Earlier this year government schoolteachers across the state made bonfires of social studies textbooks meant for classes 9 and 11. They were protesting a single 10-page lesson on "adolescent awareness" that anyway painted the HIV/AIDS issue in bold moralistic strokes.
In Lucknow, government schoolteachers burn books and flip charts to protest sex education. Pic: Puja Awasthi.
Their chant was one that has been repeated in many other states (Gujarat, Madhya Pradesh, Maharashtra Karnataka, Kerala and Chhattisgarh) that such education would "corrupt" the minds of children and cause "sankritik pradushan" (cultural pollution). The government hastily withdrew the texts and ordered a re-evaluation of the books. The teachers chose to stay away.
College principal Prem Kumar Yadav, nodal officer for the now defunct adolescent education programme expresses alarm at this opposition. "Dealing with adolescent curiosities that come with physical changes cannot be obscene. We are dealing with a population that initiates sexual intercourse at a much younger age. If we don't provide them with information, they will turn to questionable sources, which distort issues. But in this state, so great is the stigma attached to HIV/AIDS that even teachers who conducted the adolescent awareness programme were branded ‘AIDS wali teacher' (literally the AIDS teacher)".
In September, the state's High Court pronounced that sex education could not be promoted "under the guise" of AIDS awareness and instead compulsory moral science education would do just as well.
Fallouts of such pronouncements have compounded problems for the state's PLHAs most of who have declared their status under the umbrella of the UP Network for Positive People (UPNP+).
Among them, Kamlesh Kumari, 33, who lives in a rural fringe of India's leather capital, Kanpur with her 9-year-old daughter Pinki.
Both are HIV positive.
Kumari, forsaken by her in laws, found the courage to acknowledge her status only after coming in touch with the UPNP+. However while she travels across the district to counsel others, she has not come out in her own neighbourhood.
Till two years ago, Pinki attended an English medium school. Then some parents got wind of her status and children refused to play with her or share tiffins. "I changed her school and told the teachers that she was being treated for some weakness. That way her bouts of illness, and her absence from school don't draw much attention", says Kumari.
Like Dhirendra, Pankaj, Avtar and Tanuja, Pinki who dreams of becoming a doctor, studies in a Hindi medium school, as such schooling is assumed to be less taxing than the demands of an English medium education.
Poor progress in child health, UPSACS not doing much
All these might appear to be isolated incidents as UP is still considered a low prevalence state which has reported only 1.47 per cent of the full blown AIDS cases counted in the country. Government figures claim that of the state's 70 districts many are yet to report even a single HIV infection, while others have only single digit cases. But when these figures are pegged against a larger backdrop, the picture becomes gloomier.
UP is vulnerable for a variety of reasons. Among them: one fourth of all inter state migrants in the country are from the state, voluntary testing and the presence of testing centres in big hospitals and medical colleges that are often inaccessible and a generally unresponsive health system.
While there is a dearth of data on the condition of HIV+ children in the state, some calculations can be made from other health indicators. According to the National Family Health Survey-3 (2005-06) the infant mortality rate in the state is 73 per thousand. That is a small improvement over the 89 per thousand reported in the NFHS 2 (1998-99). The figures for vaccination coverage for children between the ages of 12 to 23 months are 23 and 20 per cent, while the numbers of stunted and underweight children at 46 and 47 percent are only slightly better than the 56 and 52 per cent reported earlier.
A general state of poor progress in child health can be further examined against the allocation and expenditure of funds by UPSACS, which as noted earlier, has fared poorly in raising awareness.
For the financial year 2007-08, of the allocated Rs.29.9 crores, the society had till July 2007, spent only Rs 8.7 crores. In 2004, a report of the Comptroller and Auditor General of India rapped UPSACS for poor utilisation of funds. Between 1999-2004 (the period of the National Aids Control programme-II), the society was allocated Rs.146.76 crores, of which only Rs.54.81 crore were spent.
The only thing going UP's way may be that discrimination against children with HIV/AIDs is widespread throughout the country. UP may be yet to report the levels of discrimination that have been witnessed in the South such as the 2003 case of Bency and Benson, positive orphans from Kerala or the more recent case of five HIV positive orphans who were turned out of their school in Kottayam, Kerala. However, there are no special efforts to be seen in U.P. such as one recently reported from Bangalore, where a city-based NGO plans to open, by 2008, a school where HIV+ children will be equally welcome.
Will a law help?
K K Abraham, President of the Indian Network for People Living with HIV/AIDS (INP+), Chennai, points to the proposed HIV/AIDS bill as another important step to counter discrimination.
The HIV/AIDS bill is an effort that dates back to 2002 to bring a separate law to protect the rights of PLHAs and has been drafted by the Lawyers Collective HIV/AIDS Unit. The collective, formed in 1981 consists of professional lawyers, law students and human rights activists, provides legal assistance to the underprivileged and undertakes public interest work. The draft has been prepared after thorough research of HIV/AIDS law in other countries and discussions with various stakeholders. In 2005, the draft HIV/AIDS Bill was submitted to the government. It is yet to be tabled in Parliament.
For Dhirendra and thousands of others like him who need a supportive environment today for a better tomorrow, that hope might be too distant to make a difference. ⊕
Puja Awasthi
28 Sep 2007
Puja Awasthi reports on development issues, and is based in Lucknow. This article is part of a series on education sponsored by Aide-et-Action India, a not-for-profit organisation dedicated to making education the lever for development.
URL for this article:
http://www.indiatogether.org/2007/sep/chi-aidskids.htm
--------------------------------------------------------------------------------
Their secret status and a risky schooling
HIV-positive children are being thrown out of school in Uttar Pradesh by insensitive teachers and parents alike. Many parents are afraid to let schools know that their children are positive, and the state's machinery has failed to raise any awareness, as a major study has shown. Puja Awasthi sounds the warning bells.
28 September 2007 - Dhirendra Varma is 14, but looks just eight.
In Lucknow, under the watchful eyes of his father, he takes his tuitions in an air less back room of his father's hardware store. From school, to store, it is a closely watched routine, which the boy follows with his younger brother Pankaj, seven. The motherless boys have six other siblings and shrug off the need for peers as playmates. Their father has also warned them of the "dangers" that lurk in their middle class neighbourhood to keep them from mingling with the other kids.
Dhirendra and Pankaj are HIV positive, like 70,000 other children in the country. The National Aids Control Organization (NACO) puts the number of full blown AIDS cases in the 0-14 age group at 5,596 as on August 31, 2006.
A march by the Indian Network for People Living with HIV/AIDS (INP+) demanding the introduction of HIV/AIDS Bill in Parliament. The event took place in Lucknow earlier this month. Pic: U.P. network of Positive People.
According to statistics from the Union Ministry of Health and Family Welfare at the current rates, 21,000 children will be added to this number every year. But this disturbing figure might be misleading as UNICEF India pegs the number of infected children at 220,000. This also could be a deceptive figure as the current HIV/AIDS programmes reach only 15% of India's young people.
Like most other infected children their age, the Varma brothers are ignorant of their status. Their father Ramesh Varma reasons that he is only "protecting" his children, both from the burden of knowing and the jibes of peers and teachers. Hence their status remains a secret from even his other children.
This secrecy means the children must take the morning dose of their medicine before they leave home at 7 a.m., often on empty stomachs. The elder siblings, like the boys' teachers are not expected to care for them.
This secrecy also means the boys must often report sick at school, lose out on class hours and then be pulled up by teachers for lagging. Hence, the tutor and the long hours of tuition.
With a sad drop of the jaw Dhirendra says he does not get high marks in class. "I am poor in English", he attempts to explain in surprisingly good language.
The boys are not alone in their predicament.
According to Future Forsaken: Abuses Against Children Affected by HIV/AIDS in India, 2004, a report published by the Human Rights Watch, USA, most positive children manage to attend school only by hiding their status. While this might enable them to gain admission and remain in school, it keeps them from receiving special measures that will prevent them from dropping out or better protect their own health.
Anil Kumar Singh, president of Savera, a Kushinagar-based organisation that works with people living with HIV/AIDS (PLHAs) says that children cannot be looked upon in isolation because of their dependent status. Kushinagar is a district in eastern U.P., best known as the place where Gautam Buddha preached his last sermon in 543 B.C.
"Most children begin to face stigma and deprivation even before the death of a parent or before their own status is revealed. Sick parents mean loss of income and children, especially girls are pulled out of schools to play the role of care givers and in many cases wage earners. Orphans of infected parents are often abandoned by the extended family and end up on the streets, open to further exploitation," explains Singh.
In the Indian case, the last problem has been compounded by the lack of community based and institutional care systems. The joint/extended family network which had, for centuries taken in the old and ailing within its folds has reacted with horror to the AIDS epidemic.
A society sans awareness and emphathy
Take the case of Baby Gond, a 32 year old illiterate woman from Kushinagar's Harka village. In January 2005, Gond lost her husband. The in-laws promptly turned Gond and her two children (who are not infected) out of the house, forcing them to stay in the cowshed. With help from a local NGO and the district administration she managed to re-gain entry into the home but was forced to set up a separate kitchen.
Gond's case was further twisted by a property angle as the in-laws were demanding that she and her children give up all rights on the deceased's wealth.
This August, Harka witnessed another case of discrimination when Nirmala Devi a low caste widow cooking the mid day meals in a primary school was ousted from her job when her positive status became known. Her children, an 8-year-old positive son and a 10-year-old daughter, were also hounded out of school.
The district magistrate intervened and reasoned with the school headmaster, the village headman and village elders. While they relented other villagers remained adamant that they would not allow their children to eat the food cooked by Nirmala. They were also scared of their children catching the infection if Nirmala touched the school handpump.
While the children are back in school, government intervention has not been able to get Nirmala her job back. This lack of awareness can be attributed to the dismal performance of the UP State Aids Control Society (UPSACS). UPSACS was set up in 1999, during phase II of the National AIDS Control Programme. It works on counseling, surveillance, testing and clinical management, preventive strategies, capacity building, innovative interventions and developing culturally appropriate messages. In addition it runs school and family awareness programmes.
An Action Aid supported study on the Scenario of HIV Vulnerability and Prevalence in Uttar Pradesh, 2006 found that in a sample size of 17,516 government school students 30 per cent felt that HIV-positive people should be kept in isolation while 78 per cent were of the view that such persons should not be allowed to enter schools.
Perceptions such as these have forced a partial disclosure of five-year-old Avtar and his three year old sister Tanuja Singh's status. The orphaned siblings live at Shanti Niketan, a short stay home and care centre for PLHAs, run by the Medical Sisters of St.Joseph on Lucknow's outskirts. A year ago, they were left at the centre by grandparents who live in Chandigarh.
When Sister Lalita, administrator, Shanti Niketan took the two for admission to a nearby missionary school, she was convinced that the school management had to know of the siblings' status to ensure their physical well being. "Last week Avtar fell off from a swing and scrapped his knees. We have given the school medical gloves for use when providing first aid to the children in such cases," she says.
On the principal's advice however, the children's status has not been revealed to the teachers. Next month the centre will organize an awareness workshop at the school to better acquaint teachers with the issue, but not necessarily divulge the siblings' status.
Teachers are part of the problem, not the solution
This caution is hardly surprising given that teachers have been the strongest opponents of education that will create HIV/AIDS awareness. Earlier this year government schoolteachers across the state made bonfires of social studies textbooks meant for classes 9 and 11. They were protesting a single 10-page lesson on "adolescent awareness" that anyway painted the HIV/AIDS issue in bold moralistic strokes.
In Lucknow, government schoolteachers burn books and flip charts to protest sex education. Pic: Puja Awasthi.
Their chant was one that has been repeated in many other states (Gujarat, Madhya Pradesh, Maharashtra Karnataka, Kerala and Chhattisgarh) that such education would "corrupt" the minds of children and cause "sankritik pradushan" (cultural pollution). The government hastily withdrew the texts and ordered a re-evaluation of the books. The teachers chose to stay away.
College principal Prem Kumar Yadav, nodal officer for the now defunct adolescent education programme expresses alarm at this opposition. "Dealing with adolescent curiosities that come with physical changes cannot be obscene. We are dealing with a population that initiates sexual intercourse at a much younger age. If we don't provide them with information, they will turn to questionable sources, which distort issues. But in this state, so great is the stigma attached to HIV/AIDS that even teachers who conducted the adolescent awareness programme were branded ‘AIDS wali teacher' (literally the AIDS teacher)".
In September, the state's High Court pronounced that sex education could not be promoted "under the guise" of AIDS awareness and instead compulsory moral science education would do just as well.
Fallouts of such pronouncements have compounded problems for the state's PLHAs most of who have declared their status under the umbrella of the UP Network for Positive People (UPNP+).
Among them, Kamlesh Kumari, 33, who lives in a rural fringe of India's leather capital, Kanpur with her 9-year-old daughter Pinki.
Both are HIV positive.
Kumari, forsaken by her in laws, found the courage to acknowledge her status only after coming in touch with the UPNP+. However while she travels across the district to counsel others, she has not come out in her own neighbourhood.
Till two years ago, Pinki attended an English medium school. Then some parents got wind of her status and children refused to play with her or share tiffins. "I changed her school and told the teachers that she was being treated for some weakness. That way her bouts of illness, and her absence from school don't draw much attention", says Kumari.
Like Dhirendra, Pankaj, Avtar and Tanuja, Pinki who dreams of becoming a doctor, studies in a Hindi medium school, as such schooling is assumed to be less taxing than the demands of an English medium education.
Poor progress in child health, UPSACS not doing much
All these might appear to be isolated incidents as UP is still considered a low prevalence state which has reported only 1.47 per cent of the full blown AIDS cases counted in the country. Government figures claim that of the state's 70 districts many are yet to report even a single HIV infection, while others have only single digit cases. But when these figures are pegged against a larger backdrop, the picture becomes gloomier.
UP is vulnerable for a variety of reasons. Among them: one fourth of all inter state migrants in the country are from the state, voluntary testing and the presence of testing centres in big hospitals and medical colleges that are often inaccessible and a generally unresponsive health system.
While there is a dearth of data on the condition of HIV+ children in the state, some calculations can be made from other health indicators. According to the National Family Health Survey-3 (2005-06) the infant mortality rate in the state is 73 per thousand. That is a small improvement over the 89 per thousand reported in the NFHS 2 (1998-99). The figures for vaccination coverage for children between the ages of 12 to 23 months are 23 and 20 per cent, while the numbers of stunted and underweight children at 46 and 47 percent are only slightly better than the 56 and 52 per cent reported earlier.
A general state of poor progress in child health can be further examined against the allocation and expenditure of funds by UPSACS, which as noted earlier, has fared poorly in raising awareness.
For the financial year 2007-08, of the allocated Rs.29.9 crores, the society had till July 2007, spent only Rs 8.7 crores. In 2004, a report of the Comptroller and Auditor General of India rapped UPSACS for poor utilisation of funds. Between 1999-2004 (the period of the National Aids Control programme-II), the society was allocated Rs.146.76 crores, of which only Rs.54.81 crore were spent.
The only thing going UP's way may be that discrimination against children with HIV/AIDs is widespread throughout the country. UP may be yet to report the levels of discrimination that have been witnessed in the South such as the 2003 case of Bency and Benson, positive orphans from Kerala or the more recent case of five HIV positive orphans who were turned out of their school in Kottayam, Kerala. However, there are no special efforts to be seen in U.P. such as one recently reported from Bangalore, where a city-based NGO plans to open, by 2008, a school where HIV+ children will be equally welcome.
Will a law help?
K K Abraham, President of the Indian Network for People Living with HIV/AIDS (INP+), Chennai, points to the proposed HIV/AIDS bill as another important step to counter discrimination.
The HIV/AIDS bill is an effort that dates back to 2002 to bring a separate law to protect the rights of PLHAs and has been drafted by the Lawyers Collective HIV/AIDS Unit. The collective, formed in 1981 consists of professional lawyers, law students and human rights activists, provides legal assistance to the underprivileged and undertakes public interest work. The draft has been prepared after thorough research of HIV/AIDS law in other countries and discussions with various stakeholders. In 2005, the draft HIV/AIDS Bill was submitted to the government. It is yet to be tabled in Parliament.
For Dhirendra and thousands of others like him who need a supportive environment today for a better tomorrow, that hope might be too distant to make a difference. ⊕
Puja Awasthi
28 Sep 2007
Puja Awasthi reports on development issues, and is based in Lucknow. This article is part of a series on education sponsored by Aide-et-Action India, a not-for-profit organisation dedicated to making education the lever for development.
URL for this article:
http://www.indiatogether.org/2007/sep/chi-aidskids.htm
--------------------------------------------------------------------------------
Monday, July 16, 2007
HIV NUMBERS: TRUE LIES: INDIA'S NEW AIDS GOOGLY
Halving the number of infected persons is a statistical trick. the prevalence may not have come down; the new and old estimates cannot be compared.
Mihir Srivastava reports:
Data from endemic, high prevalence states has been extrapolated to states like UP and Bihar to arrive at the figure
THE NEWS that India does not have the world's biggest HIV-positive caseload, and is less affected than South Africa and Nigeria, has produced its share of sighs of relief, but experts and activists are questioning the easy conclusions being drawn from the new data. While launching the third phase of the National AIDS Control Programme on July 6, 2007, the Minister for Health and Family Welfare, Dr Anbumani Ramadoss announced a dramatic fall in the estimated HIV+ population in India: 2 million to 3.1 million people infected with a prevalence level of about 0.36 percent, against the previous estimate of 5.7 million cases with a prevalence rate of 0.9 percent.
The new statistical methodology adopted this time to estimate HIV+ prevalence in India is said to have made all the difference. The new estimate is based on the National Family Health Survey (NFHS), which is a countrywide household survey covering about 2,00,000 people aged between 15 and 54, and was conducted through face-to-face interviews across India between December 2005 and August 2006. Also, the data from sentinel surveillance (prenatal clinics, sexually transmitted infection clinics and public hospitals) has been expanded to 1,122 sites from the earlier 703.
Ramadoss tried to score a point by saying: "We have always been faulted for underestimating the seriousness of the epidemic. That was a disturbing allegation as we were, and continue to be, very committed to containing and reversing the HIV AIDS epidemic." He, however, warned that the two sets of figures cannot be compared to show that there has been a steep decline. "These figures are not comparable. By using the same methodology for the past years that we used this year, there is only a marginal reduction in the prevalence," he clarified.
The implication is clear. There is no significant downfall in the HIV+ population. It is just a new estimate using a new method that is dubbed to be more reliable. "We should look at these figures with a pinch of salt," says Ashok K. Rau of the Freedom Foundation, a self-help group working with HIV+ people. "Different sets of people will arrive at different figures using the same data. It all depends on how it is treated statistically, on what assumptions are made. It is no surprise that the same data can be used to arrive at a higher figure than the last time. I will call it no more than another guesstimate."
Ashok Alexzander , the director of Bill and Melinda Gates Foundation's HIV/AIDS prevention initiative in India, Avahan, agrees that the fresh estimate indicates no trend. "The change in figure does not at all show a fall in the number of HIV+ cases. It's a new estimate with NFHS data, which is supposed to be more reliable. But it gives a clearer picture with southern states showing alarming figures with some hot spots in the northern states."
YOUR GUESS MY GUESS THEIR GUESS
TOTAL AFFECTED 5.7 million (Old estimate) 2.47 million (New estimate)
PREVALENCE RATE 0.9 % (Old estimate) 0.3 % (New estimate)
FUNDING IMPACT
The two figures are not comparable as different methodologies have been followed to arrive at them. The government is still to provide details of the new methodology used this time. For this reason the figures do not represent a decline, they are merely a new estimate that the government claims to be more reliable
NGOs are skeptical about the new estimate. They want more information on the new methodology adopted and demand aggregate data that has always being kept under wraps. They are apprehensive that this sudden fall in estimated numbers of HIV+ people will adversely affect the funding of AIDS mitigation efforts.
Anand Grover of the Lawyers' Collective says there might have been an over estimation of HIV+ population in India in the past, but questions the labelling of the new exercise as a more reliable estimate. "They say the earlier estimates were not so reliable, this one is more reliable. But nobody tells what was wrong with the earlier methodology. What changes have been made to arrive at this new figure? The primary data is never shared with NGOs, it is with agencies like NACO, UNAIDS or Bill and Melinda Gates Foundation," he says.
Rau points to the fact that data collected from endemic, high prevalence states has been extrapolated to other states to arrive at the figure. "It does not take into account states like UP and Bihar, which have huge populations and not much is known about them," he says.
There is still a paucity of reliable data on high-risk groups like sex workers and drug addicts using syringes. Says Vivek Diwan, lawyer and activist on HIV/AIDS issues, "There is little information on what is happening to vulnerable groups. This is crucial. It is important to provide these vulnerable groups with counselling. The level of literacy is shocking in these groups." Agrees Alexzander, "We are carrying out studies on high-risk groups that would provide vital information to design our mitigation response."
THE CHIEF of the National AIDS Control Organisation (NACO), Sujatha Rao, said the figure "has come down" and not merely been "re-estimated to be less", despite her minister Ramadoss saying that the two estimates were not comparable. "Even as the general prevalence is reported to have come down, the trends of HIV infection continue to remain the same. It's more in rural areas and amongst women," Rao said in a speech. Peter Ghys, in-charge of epidemic and impact monitoring at UNAIDS, seconded Sujatha Rao's claim. "We are today a lot more confident that what is being presented to you is closer to the true prevalence as it exists in the population," Ghys said.
There are concerns that the revised estimate increases chances of large pharmaceutical firms securing patents for essential AIDS drugs. "If more than one percent of population was HIV+ an epidemic would have been declared. This was very much on the cards with 0.9 percent of the population estimated to be HIV+. If the figure wasn't revised downwards it would have hampered the granting of patents on AIDS drugs," said a senior functionary in the Ministry of Health and Family Welfare.
NGOs say the new estimate will adversely affect the funding of Aids mitigation projects. "The reduced numbers will definitely mean reduced funding for AIDS-related projects that till now have been a major money spinner for NGOs," says Grover. "More numbers means more money," agrees Chandran. Alexander, however, doesn't see a decline ahead in support from international donor agencies. "I do not think so because the numbers are still very high. In fact, there is a greater need for funding in India. In per capita terms, India is getting less than countries like China and Cambodia," he said. Meanwhile, HIV+ patients remain, at best, confused.
Mihir Srivastava reports:
Data from endemic, high prevalence states has been extrapolated to states like UP and Bihar to arrive at the figure
THE NEWS that India does not have the world's biggest HIV-positive caseload, and is less affected than South Africa and Nigeria, has produced its share of sighs of relief, but experts and activists are questioning the easy conclusions being drawn from the new data. While launching the third phase of the National AIDS Control Programme on July 6, 2007, the Minister for Health and Family Welfare, Dr Anbumani Ramadoss announced a dramatic fall in the estimated HIV+ population in India: 2 million to 3.1 million people infected with a prevalence level of about 0.36 percent, against the previous estimate of 5.7 million cases with a prevalence rate of 0.9 percent.
The new statistical methodology adopted this time to estimate HIV+ prevalence in India is said to have made all the difference. The new estimate is based on the National Family Health Survey (NFHS), which is a countrywide household survey covering about 2,00,000 people aged between 15 and 54, and was conducted through face-to-face interviews across India between December 2005 and August 2006. Also, the data from sentinel surveillance (prenatal clinics, sexually transmitted infection clinics and public hospitals) has been expanded to 1,122 sites from the earlier 703.
Ramadoss tried to score a point by saying: "We have always been faulted for underestimating the seriousness of the epidemic. That was a disturbing allegation as we were, and continue to be, very committed to containing and reversing the HIV AIDS epidemic." He, however, warned that the two sets of figures cannot be compared to show that there has been a steep decline. "These figures are not comparable. By using the same methodology for the past years that we used this year, there is only a marginal reduction in the prevalence," he clarified.
The implication is clear. There is no significant downfall in the HIV+ population. It is just a new estimate using a new method that is dubbed to be more reliable. "We should look at these figures with a pinch of salt," says Ashok K. Rau of the Freedom Foundation, a self-help group working with HIV+ people. "Different sets of people will arrive at different figures using the same data. It all depends on how it is treated statistically, on what assumptions are made. It is no surprise that the same data can be used to arrive at a higher figure than the last time. I will call it no more than another guesstimate."
Ashok Alexzander , the director of Bill and Melinda Gates Foundation's HIV/AIDS prevention initiative in India, Avahan, agrees that the fresh estimate indicates no trend. "The change in figure does not at all show a fall in the number of HIV+ cases. It's a new estimate with NFHS data, which is supposed to be more reliable. But it gives a clearer picture with southern states showing alarming figures with some hot spots in the northern states."
YOUR GUESS MY GUESS THEIR GUESS
TOTAL AFFECTED 5.7 million (Old estimate) 2.47 million (New estimate)
PREVALENCE RATE 0.9 % (Old estimate) 0.3 % (New estimate)
FUNDING IMPACT
The two figures are not comparable as different methodologies have been followed to arrive at them. The government is still to provide details of the new methodology used this time. For this reason the figures do not represent a decline, they are merely a new estimate that the government claims to be more reliable
NGOs are skeptical about the new estimate. They want more information on the new methodology adopted and demand aggregate data that has always being kept under wraps. They are apprehensive that this sudden fall in estimated numbers of HIV+ people will adversely affect the funding of AIDS mitigation efforts.
Anand Grover of the Lawyers' Collective says there might have been an over estimation of HIV+ population in India in the past, but questions the labelling of the new exercise as a more reliable estimate. "They say the earlier estimates were not so reliable, this one is more reliable. But nobody tells what was wrong with the earlier methodology. What changes have been made to arrive at this new figure? The primary data is never shared with NGOs, it is with agencies like NACO, UNAIDS or Bill and Melinda Gates Foundation," he says.
Rau points to the fact that data collected from endemic, high prevalence states has been extrapolated to other states to arrive at the figure. "It does not take into account states like UP and Bihar, which have huge populations and not much is known about them," he says.
There is still a paucity of reliable data on high-risk groups like sex workers and drug addicts using syringes. Says Vivek Diwan, lawyer and activist on HIV/AIDS issues, "There is little information on what is happening to vulnerable groups. This is crucial. It is important to provide these vulnerable groups with counselling. The level of literacy is shocking in these groups." Agrees Alexzander, "We are carrying out studies on high-risk groups that would provide vital information to design our mitigation response."
THE CHIEF of the National AIDS Control Organisation (NACO), Sujatha Rao, said the figure "has come down" and not merely been "re-estimated to be less", despite her minister Ramadoss saying that the two estimates were not comparable. "Even as the general prevalence is reported to have come down, the trends of HIV infection continue to remain the same. It's more in rural areas and amongst women," Rao said in a speech. Peter Ghys, in-charge of epidemic and impact monitoring at UNAIDS, seconded Sujatha Rao's claim. "We are today a lot more confident that what is being presented to you is closer to the true prevalence as it exists in the population," Ghys said.
There are concerns that the revised estimate increases chances of large pharmaceutical firms securing patents for essential AIDS drugs. "If more than one percent of population was HIV+ an epidemic would have been declared. This was very much on the cards with 0.9 percent of the population estimated to be HIV+. If the figure wasn't revised downwards it would have hampered the granting of patents on AIDS drugs," said a senior functionary in the Ministry of Health and Family Welfare.
NGOs say the new estimate will adversely affect the funding of Aids mitigation projects. "The reduced numbers will definitely mean reduced funding for AIDS-related projects that till now have been a major money spinner for NGOs," says Grover. "More numbers means more money," agrees Chandran. Alexander, however, doesn't see a decline ahead in support from international donor agencies. "I do not think so because the numbers are still very high. In fact, there is a greater need for funding in India. In per capita terms, India is getting less than countries like China and Cambodia," he said. Meanwhile, HIV+ patients remain, at best, confused.
Monday, July 9, 2007
HEALTH MINISTER LAUNCHES THIRD PHASE OF NACP
Friday, July 06, 2007
Ministry of Health and Family Welfare
HEALTH MINISTER LAUNCHES THIRD PHASE OF NACP
18:15 IST
Minister for Health & Family Welfare, Dr. Anbumani Ramadoss launched the third Phase of the National AIDS Control Programme (NACP), here today. *Speaking on the occasion, he said that there are an estimated 2 million to 3.1 million people infected with HIV/AIDS with a prevalence level of about 0.36%. He was optimistic of the country’s ability to win the battle against AIDS.
*
Smt. Panabaka Lakshmi, Minister of State for Health & Family Welfare, Shri Naresh Dayal, Secretary, H&FW, Ms. K. Sujatha Rao, AS&DG (NACO) and Representatives of the UN Group, World Bank, DFID, GFATM, USAID and Private Foundations also attended the function.
The following is the text of the Minister’s speech:
“I am indeed very happy to be here today with you all to launch the Third Phase of the National AIDS Control Programme. Today is a momentous day for all of us present here as it brings us to the end of one critical phase in the evolution of our battle against HIV AIDS. The strategies and approaches outlined in the NACP III indicate the maturity of the epidemic and the vast improvement in our knowledge of this disease which continues to challenge our ability to find a cure. I am also happy to note that the NACP III is founded on the important principle of equality and inclusion, demonstrated by giving primary focus to prevention and behaviour change among the high risk groups through a process of empowerment.
There is one other reason to be happy today. Many of you know how we have always been found fault with for underestimating the seriousness of the epidemic. That was a disturbing allegation as we were and continue to be very committed to containing and reversing the HIV AIDS epidemic. Today we have with us a far more reliable estimate of the burden of HIV disease in India. These estimates are based mainly on two important sources of data. First, we continue to have the data from our sentinel surveillance, now expanded to 1122 sites from the earlier 703 sentinel sites. This year we have the additional inputs from the National Family Health Survey, which is a country wide community based household survey.
Experts from India and round the world were consulted and after a lot of hard work and outstanding support from the WHO, UNAIDS, CDC and other partners, we have been able to arrive at robust figure that all our experts feel is as correct an estimate as we can get. The results show that there are an estimated 2 million to 3.1 million people infected with HIV/AIDS with a prevalence level of about 0.36%. While the prevalence appears to be less than the previous estimate of 0.9%, these figures are not comparable. By using the same methodology for the past years that we used this year, there is only a marginal reduction in the prevalence. Moreover, in terms of human lives affected, the numbers are still large and worrying. There is no doubt in my mind that we cannot let down our vigil but continue to work hard to ensure that the HIV/AIDS are under total control.
If I am sounding optimistic of our ability to win this battle, it is because the programme has achieved its aim of keeping the HIV sero-prevalence below 5% in the high prevalence states and below 3% in the moderate prevalence states and below 1-2 % in the other states. A case in point is Tamil Nadu which has shown a consistent decline in HIV prevalence in the last 5 years. The surveillance reports of 2006 reinforce the fact that expected outcomes of NACP were broadly accomplished.
Major policy initiatives were launched in NACP II. Initiatives such as the National AIDS Prevention and Control Policy, National Blood Policy, provision of Antiretroviral Therapy (ART), strategy for Greater Involvement of People with HIV/AIDS (GIPA) were initiated during the NACP II. Programmatically, we achieved good results. 1033 Targeted Interventions were implemented through NGOs among high risk groups and bridge populations. Facilities providing voluntary counseling and testing (VCT) and prevention of parent to child transmission services (PPTCT) were remodeled as ‘Integrated Counseling and Testing Centres’ (ICTC).
NACP II saw a massive scale up of counselling and testing services and today more than 10 million people have been counseled and tested in more than 4000 ICTCs spread throughout the country. The NACP III now envisages expansion of testing sites to 5000 and establishing another 10,000 through a system of franchising by forging partnerships with the private sector. Such expansion is necessary to achieve 42 million tests by the end of NACP-III. Launching the provider initiated testing and counseling for patients referred from clinics treating tuberculosis, STD or pregnant women in high risk areas will also help us identify persons infected by this virus. These measures will not only strengthen the prevention and control of HIV/AIDS but also be beneficial to the health outcomes of people living with HIV/AIDS.
Blood safety was a major area of focus in NACP II and modernization of blood banks and installation of blood component separation centres were taken up. Through these efforts, we have brought down the transmission of HIV infection through contaminated blood to less than 2%. But we have a long way to go in this area. We have yet to satisfactorily address the critical issues of volume, access and quality of blood. There is a lot of private blood collection and also a shortage of blood. This year, we will be initiating action to establish 4 centers of excellence in the four metros that will have a capacity to collect and process one lakh units of blood annually.
To address the various issues related to blood collection, storage, distribution and supply, we are working on a regulatory framework to establish a Blood Transfusion Authority on the lines of the FDA. I am confident that in the next couple of years, we will be able to have a world class system of blood collection and distribution. This will help bringing down blood transmissible diseases such as HIV and Hepatitis B etc.
Condoms, as you know, is the only prophylaxis we have with us to check transmission of sexually transmitted infection. Its promotion is essential in India as it has multiple uses – it can avert an unwanted pregnancies as well as stop the spread of sexually transmitted diseases. Though some work was done to promote the use of condoms, it is inadequate. I am pleased to learn that under NACP III, condom availability and use will be significantly scaled up. I am happy to learn that the Gates Foundation is providing us funding support to establish a professional group to help us expand the market for condoms. Promoting condom use is important. Thailand is now facing the possibility of a resurgence of the HIV epidemic because they gave up prevention and condom promotion and focused only on treatment. So also China. Non-emphasis on condoms is resulting in the gradual increase of HIV due to unsafe sex. This is the same story in Nagaland where we neglected the promotion of the condom and are today facing the spread of HIV on account of unsafe heterosexual behaviour.
With young men and women bearing the brunt of the disease burden, it is essential that we educate our youth on healthy lifestyles. While good work was done under NACP II in training 2 teachers and 2 students in all the 1.4 lakh high schools we need to do more. We are therefore, currently working on coming up with a health education package that will focus on healthy lifestyle which will say no to unsafe sexual behaviour, no to tobacco, no to alcohol and no to drugs. We hope to harness the abundant energies of youth, as has been done in Tamil Nadu, in combating HIV/AIDS.
While, prevention will continue to be the mainstay of the NACP III, strategy and focus on saturating coverage of an estimated 4 million high risk groups, continued attention will also be on providing care, support and treatment to the infected. The ART programme which was launched in 2004 brought hope and expectation in lives of thousands of people living with HIV/AIDS. The ART programme has been rapidly scaled up. Today about 80,000 patients are accessing free treatment in 127 centers. This year another 36 centers are going to be established. Efforts are being made to identify centers closer to the community level to make it easier for patients to get their refill of drugs and save them time and money spent on coming all the way to the ART center. Such decentralization of drug distribution will greatly enhance adherence, reduce loss to follow up and alleviate the economic hardship of the PLHA’s. I do hope these centers attached to the ART centers will come up soon.
India was a global leader in coming out with the treatment protocols for children. Since the launch of the Pediatric AIDS Initiative on 30th November, we have more than 6000 children on treatment and 12,000 diagnosed.
I would also like to reiterate that HIV/AIDS is not just a public health problem. It is a disease that is the result of deeply rooted socio-economic conditions and cultural beliefs, practices, attitudes and vulnerabilities. The virus spread in India mainly through the heterosexual route. Sexual behaviours and choices are an intensely private matter and difficult to change. At one level we have easy access to information though internet, rapidly changing values and attitudes as depicted in modern cinema and the TV, greater mobility etc. and greater impoverishment and unmatched aspirations at another level are factors that contribute to enhancing risk and increasing vulnerability to this infection. We cannot, therefore, let our guard down. _We need to understand the significance of the presence of the virus in some 20 to 30 lakh people in the country against the backdrop that we also have a very high population of young and sexually active persons.
_
Of utmost importance is fighting stigma and discrimination. Even as we are celebrating our successes, we need to also feel a sense of shame that we as a society continue to lack compassion and stigmatize those who have the misfortune of being affected by this disease. Be it the incident of little children in Kerala being denied admission or the one in Meerut being denied medical care, it is indeed unfortunate. I would like on this occasion to appeal to all my fellow colleagues in the medical profession to live upto their oath of treating all those who suffer disease and sickness on equal grounds. I appeal to all faith based organizations and civil society organizations to come forward and help us to fight irrational attitudes of stigma against PLHAs.
I would like to thank all the media, the donor partners, the PLHA networks and the NGO’s for all the support that they have been giving us in our fight against HIV /AIDS. We value their support and understanding that they have extended to us. I do hope that this partnership will continue and the NACP III will be implemented successfully”.
Ministry of Health and Family Welfare
HEALTH MINISTER LAUNCHES THIRD PHASE OF NACP
18:15 IST
Minister for Health & Family Welfare, Dr. Anbumani Ramadoss launched the third Phase of the National AIDS Control Programme (NACP), here today. *Speaking on the occasion, he said that there are an estimated 2 million to 3.1 million people infected with HIV/AIDS with a prevalence level of about 0.36%. He was optimistic of the country’s ability to win the battle against AIDS.
*
Smt. Panabaka Lakshmi, Minister of State for Health & Family Welfare, Shri Naresh Dayal, Secretary, H&FW, Ms. K. Sujatha Rao, AS&DG (NACO) and Representatives of the UN Group, World Bank, DFID, GFATM, USAID and Private Foundations also attended the function.
The following is the text of the Minister’s speech:
“I am indeed very happy to be here today with you all to launch the Third Phase of the National AIDS Control Programme. Today is a momentous day for all of us present here as it brings us to the end of one critical phase in the evolution of our battle against HIV AIDS. The strategies and approaches outlined in the NACP III indicate the maturity of the epidemic and the vast improvement in our knowledge of this disease which continues to challenge our ability to find a cure. I am also happy to note that the NACP III is founded on the important principle of equality and inclusion, demonstrated by giving primary focus to prevention and behaviour change among the high risk groups through a process of empowerment.
There is one other reason to be happy today. Many of you know how we have always been found fault with for underestimating the seriousness of the epidemic. That was a disturbing allegation as we were and continue to be very committed to containing and reversing the HIV AIDS epidemic. Today we have with us a far more reliable estimate of the burden of HIV disease in India. These estimates are based mainly on two important sources of data. First, we continue to have the data from our sentinel surveillance, now expanded to 1122 sites from the earlier 703 sentinel sites. This year we have the additional inputs from the National Family Health Survey, which is a country wide community based household survey.
Experts from India and round the world were consulted and after a lot of hard work and outstanding support from the WHO, UNAIDS, CDC and other partners, we have been able to arrive at robust figure that all our experts feel is as correct an estimate as we can get. The results show that there are an estimated 2 million to 3.1 million people infected with HIV/AIDS with a prevalence level of about 0.36%. While the prevalence appears to be less than the previous estimate of 0.9%, these figures are not comparable. By using the same methodology for the past years that we used this year, there is only a marginal reduction in the prevalence. Moreover, in terms of human lives affected, the numbers are still large and worrying. There is no doubt in my mind that we cannot let down our vigil but continue to work hard to ensure that the HIV/AIDS are under total control.
If I am sounding optimistic of our ability to win this battle, it is because the programme has achieved its aim of keeping the HIV sero-prevalence below 5% in the high prevalence states and below 3% in the moderate prevalence states and below 1-2 % in the other states. A case in point is Tamil Nadu which has shown a consistent decline in HIV prevalence in the last 5 years. The surveillance reports of 2006 reinforce the fact that expected outcomes of NACP were broadly accomplished.
Major policy initiatives were launched in NACP II. Initiatives such as the National AIDS Prevention and Control Policy, National Blood Policy, provision of Antiretroviral Therapy (ART), strategy for Greater Involvement of People with HIV/AIDS (GIPA) were initiated during the NACP II. Programmatically, we achieved good results. 1033 Targeted Interventions were implemented through NGOs among high risk groups and bridge populations. Facilities providing voluntary counseling and testing (VCT) and prevention of parent to child transmission services (PPTCT) were remodeled as ‘Integrated Counseling and Testing Centres’ (ICTC).
NACP II saw a massive scale up of counselling and testing services and today more than 10 million people have been counseled and tested in more than 4000 ICTCs spread throughout the country. The NACP III now envisages expansion of testing sites to 5000 and establishing another 10,000 through a system of franchising by forging partnerships with the private sector. Such expansion is necessary to achieve 42 million tests by the end of NACP-III. Launching the provider initiated testing and counseling for patients referred from clinics treating tuberculosis, STD or pregnant women in high risk areas will also help us identify persons infected by this virus. These measures will not only strengthen the prevention and control of HIV/AIDS but also be beneficial to the health outcomes of people living with HIV/AIDS.
Blood safety was a major area of focus in NACP II and modernization of blood banks and installation of blood component separation centres were taken up. Through these efforts, we have brought down the transmission of HIV infection through contaminated blood to less than 2%. But we have a long way to go in this area. We have yet to satisfactorily address the critical issues of volume, access and quality of blood. There is a lot of private blood collection and also a shortage of blood. This year, we will be initiating action to establish 4 centers of excellence in the four metros that will have a capacity to collect and process one lakh units of blood annually.
To address the various issues related to blood collection, storage, distribution and supply, we are working on a regulatory framework to establish a Blood Transfusion Authority on the lines of the FDA. I am confident that in the next couple of years, we will be able to have a world class system of blood collection and distribution. This will help bringing down blood transmissible diseases such as HIV and Hepatitis B etc.
Condoms, as you know, is the only prophylaxis we have with us to check transmission of sexually transmitted infection. Its promotion is essential in India as it has multiple uses – it can avert an unwanted pregnancies as well as stop the spread of sexually transmitted diseases. Though some work was done to promote the use of condoms, it is inadequate. I am pleased to learn that under NACP III, condom availability and use will be significantly scaled up. I am happy to learn that the Gates Foundation is providing us funding support to establish a professional group to help us expand the market for condoms. Promoting condom use is important. Thailand is now facing the possibility of a resurgence of the HIV epidemic because they gave up prevention and condom promotion and focused only on treatment. So also China. Non-emphasis on condoms is resulting in the gradual increase of HIV due to unsafe sex. This is the same story in Nagaland where we neglected the promotion of the condom and are today facing the spread of HIV on account of unsafe heterosexual behaviour.
With young men and women bearing the brunt of the disease burden, it is essential that we educate our youth on healthy lifestyles. While good work was done under NACP II in training 2 teachers and 2 students in all the 1.4 lakh high schools we need to do more. We are therefore, currently working on coming up with a health education package that will focus on healthy lifestyle which will say no to unsafe sexual behaviour, no to tobacco, no to alcohol and no to drugs. We hope to harness the abundant energies of youth, as has been done in Tamil Nadu, in combating HIV/AIDS.
While, prevention will continue to be the mainstay of the NACP III, strategy and focus on saturating coverage of an estimated 4 million high risk groups, continued attention will also be on providing care, support and treatment to the infected. The ART programme which was launched in 2004 brought hope and expectation in lives of thousands of people living with HIV/AIDS. The ART programme has been rapidly scaled up. Today about 80,000 patients are accessing free treatment in 127 centers. This year another 36 centers are going to be established. Efforts are being made to identify centers closer to the community level to make it easier for patients to get their refill of drugs and save them time and money spent on coming all the way to the ART center. Such decentralization of drug distribution will greatly enhance adherence, reduce loss to follow up and alleviate the economic hardship of the PLHA’s. I do hope these centers attached to the ART centers will come up soon.
India was a global leader in coming out with the treatment protocols for children. Since the launch of the Pediatric AIDS Initiative on 30th November, we have more than 6000 children on treatment and 12,000 diagnosed.
I would also like to reiterate that HIV/AIDS is not just a public health problem. It is a disease that is the result of deeply rooted socio-economic conditions and cultural beliefs, practices, attitudes and vulnerabilities. The virus spread in India mainly through the heterosexual route. Sexual behaviours and choices are an intensely private matter and difficult to change. At one level we have easy access to information though internet, rapidly changing values and attitudes as depicted in modern cinema and the TV, greater mobility etc. and greater impoverishment and unmatched aspirations at another level are factors that contribute to enhancing risk and increasing vulnerability to this infection. We cannot, therefore, let our guard down. _We need to understand the significance of the presence of the virus in some 20 to 30 lakh people in the country against the backdrop that we also have a very high population of young and sexually active persons.
_
Of utmost importance is fighting stigma and discrimination. Even as we are celebrating our successes, we need to also feel a sense of shame that we as a society continue to lack compassion and stigmatize those who have the misfortune of being affected by this disease. Be it the incident of little children in Kerala being denied admission or the one in Meerut being denied medical care, it is indeed unfortunate. I would like on this occasion to appeal to all my fellow colleagues in the medical profession to live upto their oath of treating all those who suffer disease and sickness on equal grounds. I appeal to all faith based organizations and civil society organizations to come forward and help us to fight irrational attitudes of stigma against PLHAs.
I would like to thank all the media, the donor partners, the PLHA networks and the NGO’s for all the support that they have been giving us in our fight against HIV /AIDS. We value their support and understanding that they have extended to us. I do hope that this partnership will continue and the NACP III will be implemented successfully”.
Friday, June 8, 2007
Doubts over India's Aids figures
Current estimates for the number of people in India with the HIV/Aids figures could be greatly exaggerated, a leading Aids worker says.
The UN says 5.7 million people in India have the HIV virus, the highest number in the world.
But Ashok Alexander, of the anti-Aids Avahan organisation says figures due out soon could be "substantially lower", the Associated Press reports.
The BBC has learned that the figure could be as low as three million.
Experts say that the discrepancy between 5.7 million and three million could only be explained by errors in the methods of calculating the numbers of people with the HIV virus.
India is about to embark on a new and expanded phase of its Aids control programme, with increased funding from the government and from international donors.
'Substantially lower'
"The actual number we've come up with in aggregate is likely to be lower, and perhaps substantially lower," Ashok Alexander, director of Avahan, the Indian programme of the Bill and Melinda Gates Foundation, said, the Associated Press news agency reports.
Mr Alexander said the new estimates were likely to be more accurate because they came from pre-natal clinics, high risk groups and from the government's National Family Health Survey.
He said that this was a far more accurate way of collating the figures than previous estimates which only relied on details provided by pre-natal clinics.
Mr Alexander declined to speculate on what the new total would be, pointing out that data is still being assessed and exact details will not be available for a few more weeks.
Backward
Last week, India health officials said they were alarmed by the growing numbers of pregnant women infected with HIV/Aids in the northern states of Uttar Pradesh (UP) and Bihar.
They are among India's most backward, with huge populations but poor literacy and health services.
Officials say workers who migrate to cities in search of work bring the infection back to the states with them.
They said that unless the state governments got serious about tackling the disease, there could be an Aids epidemic.
Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/south_asia/6735155.stm
Published: 2007/06/08 16:17:51 GMT
© BBC MMVII
The UN says 5.7 million people in India have the HIV virus, the highest number in the world.
But Ashok Alexander, of the anti-Aids Avahan organisation says figures due out soon could be "substantially lower", the Associated Press reports.
The BBC has learned that the figure could be as low as three million.
Experts say that the discrepancy between 5.7 million and three million could only be explained by errors in the methods of calculating the numbers of people with the HIV virus.
India is about to embark on a new and expanded phase of its Aids control programme, with increased funding from the government and from international donors.
'Substantially lower'
"The actual number we've come up with in aggregate is likely to be lower, and perhaps substantially lower," Ashok Alexander, director of Avahan, the Indian programme of the Bill and Melinda Gates Foundation, said, the Associated Press news agency reports.
Mr Alexander said the new estimates were likely to be more accurate because they came from pre-natal clinics, high risk groups and from the government's National Family Health Survey.
He said that this was a far more accurate way of collating the figures than previous estimates which only relied on details provided by pre-natal clinics.
Mr Alexander declined to speculate on what the new total would be, pointing out that data is still being assessed and exact details will not be available for a few more weeks.
Backward
Last week, India health officials said they were alarmed by the growing numbers of pregnant women infected with HIV/Aids in the northern states of Uttar Pradesh (UP) and Bihar.
They are among India's most backward, with huge populations but poor literacy and health services.
Officials say workers who migrate to cities in search of work bring the infection back to the states with them.
They said that unless the state governments got serious about tackling the disease, there could be an Aids epidemic.
Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/south_asia/6735155.stm
Published: 2007/06/08 16:17:51 GMT
© BBC MMVII
Thursday, May 31, 2007
BBC - India Alarm over HIV in new area
India alarm over HIV in new areas
By Sunil Raman
BBC News, Delhi
India has more HIV infections than any other country, the UN says
India health officials are alarmed by the growing numbers of pregnant women infected with HIV/Aids in the key states of Uttar Pradesh (UP) and Bihar.
The northern states are among India's most backward, with huge populations but poor literacy and health services.
Officials say workers who migrate to cities in search of work bring the infection back to the states with them.
They say unless the state governments get serious about tackling the disease, there could be an Aids epidemic.
According to UN estimates, India has the highest number of HIV infections with 5.7 million people carrying the virus.
Concerned
The head of India's government-run National Aids Control Organisation (Naco), Sujatha Rao, told the BBC that urgent measures were needed in UP and Bihar to "stem the epidemic".
"There is a shift from urban to rural and from high risk to low risk categories"
RP Mathur,
Uttar Pradesh Aids Control Authority
She was speaking after a countrywide survey to collect India's latest HIV/Aids figures. Full results of the annual Aids survey will be made public in early June.
Ms Rao said the districts of Etawah, Banda and Lalitpur in UP had been found to have more than 1% of pregnant mothers infected with the virus.
A high number of pregnant woman infected with HIV had also been identified in the districts of Lakhiserai and Saharsa of Bihar.
Ms Rao says she is concerned over the slow response of the two state governments in dealing with the problem.
The two state governments have "not realised" the seriousness of the problem but "we remain hopeful", she says.
Ms Rao says the situation in UP and Bihar compares with that in the southern state of Tamil Nadu 10 years ago.
Tamil Nadu is another high prevalence state as far as HIV infections are concerned, but what makes matters far more serious in the two northern states is their poor healthcare system.
To compound matters, Ms Rao says, most cases of HIV/Aids infection in UP and Bihar go unreported because of the social stigma attached to the disease.
Migrant labour
The Naco chief's concern is shared by representatives of Aids control programmes in Uttar Pradesh and Bihar, which together have a population of more than 280 million people.
Officials say the virus is spreading to low-risk groups
Health officials say the main cause of the growing incidence of HIV/Aids is migrant labour.
RP Mathur of the Uttar Pradesh Aids Control Authority says around 60% of HIV cases reported come from the socially and economically backward eastern part of the state.
"There is a shift from the urban to rural and from high-risk to low-risk categories" in the last few years, he says.
Mr Mathur says it is estimated that UP has more than half a million HIV positive cases, but only 20,000 of them have been reported, due to the stigma attached to the disease.
Bihar Aids Control Authority representative Vishal Singh says most of the infections have been detected in people who had migrated to work in places outside the state.
"They get infected in industrial cities like Surat [in Gujarat] and return home to Bihar and have unprotected sex with their wives. This has to be controlled," he says.
Mr Singh says given the poor economic situation in Bihar, it is important that more developed states like Gujarat take steps to educate migrants labourers working there.
'Community problem'
Rashmi Sharma of the Population Foundation of India, a non-government organisation involved in spreading awareness about HIV/Aids, says migrant labourers cannot solely be blamed.
"A local community will have to take the blame for its inability to control the problem," she says.
"The problem lies within the community and they have to be involved in looking for a solution."
UP and Bihar are two of India's states which rank lowest on the human development index - they have high levels of illiteracy, unemployment and poor social infrastructure.
Officials say it is only the wide gap between the estimated and reported cases which has kept the two states off the list of high prevalence states
Andhra Pradesh, Tamil Nadu and Karnataka in the south, Maharashtra in the west and Manipur and Nagaland in the north-east are considered high HIV prevalence states in India.
There has been much debate about whether India does indeed have more people living with HIV than any other country.
A study by British journal BMC Medicine last December suggested that methods used to estimate the number of infections in India were flawed and that the true figure could be about 40% of the estimated numbers.
Thursday, May 10, 2007
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