Since inception, the National AIDS Control Organisation (NACO) had done a great job in reducing the prevalence of HIV positive cases. But there has been a roadblock recently.
Source — National Strategic Plan for HIV/AIDS and STI, 2017–2024
Do you see that the rate of decline has decreased since 2011? Earlier the reduction was 5.35 %. Now it’s 3.28 % every year. We’re expecting a stagnation if new approaches are not being made.
Why has stagnation happened? It is because new cases are rising and older cases are dying? (since there’s no proven cure for AIDS). Thus, creating an equilibrium. And why are the new cases increasing?
We have managed to limit HIV transmission from the “core group” to the other ‘at risk’ population, but yet we have not been able to treat the core group, which still is the source of HIV transmission in India… Who belongs to the “core group”?
Our new strategy for HIV control not only should stop the outward transmission of HIV from the core group, but should also crack down on the core group and stop HIV transmission between themselves, which will help in realising our goal of HIV elimination. But our new strategy no longer limits itself to healthcare services for HIV, as most of it is well developed in government hospitals in present times (though there are some lacunae and deficits which need to be addressed in an individual basis). It is now more of a sociological battle.
The recent National Strategic Plan for HIV/AIDS and STI, 2017–2024 has said this —
“About 99.74% of the population is HIV negative. Given the concentrated epidemic, NACP IV prioritised a prevention response. The package of prevention services included prevention of parent-to-child transmission (PPTCT). Information Education Communication (IEC), customized and tailored to the needs of different target groups, key population outreach, behaviour change communication (BCC), condom promotion, needle and syringe exchange, opioid substitution therapy (OST), counselling and testing, blood safety, mainstreaming of HIV into other sectors, youth interventions, link-worker scheme, and management of STIs and RTIs.”
However, I would like to see some additions in Indian polity and society which can help a lot in HIV control.
- Legalising sex work — Currently an unorganised sector in India, sex work has been the hidden ground for many at-risk behaviour and sexual crimes. Putting legalities inside it will do the following:
- Bringing commercial sex workers to mainstream society — This will ensure that their income becomes legalised and only legitimate voluntary workers will work. Enabling of income tax (kept at a nominal rate only) will ensure only consenting adults will join it.
- Curtailment of child and women trafficking.
- Regularisation of use of condoms — commercial sex workers being legalised, can be used to promote and encourage condom use during intercourse with them.
- Diminishing promotion of at-risk behaviour in media — Media has recently been one of the worst proponents of at-risk behaviour, like smoking, alcoholism, open flouting of rules to look cool, unsafe sex, etc., in a bid to look realistic. Many of such movies have hidden undertones that shame safe behaviour and call it as old-fashioned. This needs to stop. Media should also encourage and idolize safe behaviour too, if they want to see some change in the society.
Talking about the media reminded me of the moment in Udta Punjab, when Tejinder “Tommy” Singh, played by Shahid Kapoor, realises his mistake of negatively affecting teenagers and adolescents through his songs and actions. I hope the media also realises this and mends its ways.
I expect these reforms in India in the next few years, and I sincerely hope the new government after the 2019 Lok Sabha elections do something about these.
Written as an answer to the question in Quora – “What health care reforms do you wish to see in India seeing the rise in HIV positive people?”