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The Lawyers’ Collective, an Indian legal cell working on AIDS/HIV, has filed a petition on
behalf of the Delhi Network of Positive People (DNP) - an organisation comprising people
In
with AIDS -- to end the discrimination HIV/AIDS patients face at the hands of the medical
community. The court has asked the DNP to provide it with details of the discrimination by LATE
July 23.
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for better visibility of
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Legal and other experts advocating the rights of HIV-positive people stress that hospitals LATE
and healthcare centres in India routinely turn away people seeking medical treatment if
they are suspected of having AIDS.
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"Discrimination in healthcare is a huge problem in India," says Anjali Gopalan, the director of Naz I
based organisation working on HIV and related issues. "Most HIV patients are treated in an abs
she says.
The issue of denying care to HIV-positive people was taken up by the court recently when newspa,
an AIDS-afflicted patient who was forced to move from one Delhi hospital to another because docti
A government employee, the man was being treated for a urinary blockage at a well-known Del
However, the hospital turned him away after blood tests showed he was HIV-positive.
The DNP, with the help of The Lawyers’ Collective, filed a petition which states there are numerou
patients being turned away by medical personnel. The organisation is preparing an exhaustive li
positive people face to be presented in court.
"They are denied treatment for anything from routine tests to surgeries,” says an AIDS worker with
"They are turned (away) even if they need to get their teeth or eyes checked,” she says.
AIDS workers point out that patients are discriminated against both directly and indirectly. Direc
hospitals refusing to admit such patients; indirect bias is when a person is given a bed in a hospit
that.
"A surgery, for instance, may keep getting postponed on some pretext or the other, forcing the
treatment elsewhere,” says the legal AIDS worker. "But they keep going round and round -- for ev
same.”
The government’s National AIDS Control Organisation estimates that 3.97 million people are HIV-p
Experts say that one of the reasons for discrimination at healthcare centres is that Indian mt
equipped with the basic precautionary gear needed to protect themselves against the infect
healthcare workers don’t have disposable gloves or the thicker disposable bags that are needed fo
AIDS worker.
The petitioners hope that once the court intervenes, guidelines will be framed and implementf
personnel treating HIV-positive people.
Groups such as Naz stress that the court can do a lot to help remove the discrimination. “An HIVmedical help is usually suffering from something like tuberculosis. All that we are asking for is tha:
tuberculosis like any other patient,” says Gopalan.
Source: southasia.oneworld.net
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WJr2000;321:402 ( 12 August)
News
Indian agency admits publishing
’’wrong” HIV figures
Ganapati Mudur, New Delhi
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India's top government agency responsible for tracking HIV
infection has admitted it has published inaccurate figures of
new HIV cases detected in the country over the past three
Collections under which this article appears:
HIV Infcction/AIDS
years. The disclosure follows allegations by a non
government association that the agency, the National AIDS
Control Organisation, has played down numbers in several states and that its reports "do not reflect
reality."
Surveillance centres across the country have detected just over 98000 HIV cases on the basis of tests,
but India is believed to have the largest number of HIV infected people worldwide. The National
AIDS Control Organisation has estimated that 3.5 million people are infected, based on a sentinel
screening programme aimed at determining the HIV prevalence rates among high risk communities
and the general population. The organisation's surveillance figures suggest, however, that three Indian
states— Kerala, Punjab, and West Bengal —have detected no new cases of HIV over the past two to
four years.
In Kerala, for example, the number of HIV infected people has been reported as static at 215 since
1996, and in Punjab the number has remained unchanged at 65 for more than two years. The National
AIDS Control Organisation has been "consistently churning out unreliable figures, while claiming that
it reflects the HIV scenario in India," said Purshottaman Mulloli, an official of the Joint Action
Council, the non-governmental association that has been monitoring the government's HIV
programme. Doctors familiar with HIV infection in these states have called the figures "ludicrous."
Senior officials at the National AIDS Control Organisation are blaming the surveillance centres in the
states for inaccurate reporting. ’’We've decided to stop publishing figures that we get from surveillance
centres," said J V Prasada Rao, the organisation's director. "Beginning this year, [our organisation]
will publish only prevalence figures from the sentinel screening programme," he said.
The Joint Action Council has also questioned the widely varying estimates of people infected with
file.7/A:\bmj_news-Mudur 321 (7258) 402b.htm
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Page 2 of 3
bmj.com Mudur 321 (7258): 402b
HIV in India suggested by UN agencies. The estimates range from 4 million to 8 million. The differing
estimates also prompted the Indian government last week to ask United Nations agencies to accept its
own estimate of 3.5 million as authentic and to stop issuing their own figures.
"Conflicting information can affect the credibility of the national effort towards prevention and control
of HIV," Dr Chandreshwar Prasad Thakur, the Indian health minister, said. "[The National AIDS
Control Organisation] is the only organisation collecting field data through sentinel surveys, and it
would be advisable for UN agencies to adopt epidemiological data generated from these sentinel
surveys," Dr Thakur said.
The National AIDS Control Organisation has objected to a suggestion by UNAIDS (the joint UN
programme on HIV/AIDS) at the recent Durban AIDS conference that up to 300000 people may have
died as a result of AIDS in India. The recorded figure in India is less than 12000. "There is no
evidence yet for a spurt in tuberculosis or any other opportunistic infection from anywhere in India,"
said Mr Prasada Rao. Epidemiologists have long suspected that thousands of infected people may be
dying of HIV related illnesses but are being missed by India’s poor death recording system.
C BMJ 2000
Rapid responses:
Read all Rapid responses
HIV Seroprevalence in India: Is it on the Rise?
Raviraj V Acharya, et al.
bmj.com, 11 Aug 2000 [Full text]
Re: Indian agency admits publishing ’’wrong” HIV figures
Anju Singh
bmj.com, 14 Aug 2000 [Full text]
HIV figures for India
J V R PrasadaRao
bmj.com, 15 Aug 2000 [Full text]
Not only Commissions But also omissions
Karri Rama Reddy
bmj.com, 17 Aug 2000 [Full text]
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6/7/03
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AIDS, Malnutrition, Children, Indicators, Poverty, Gender Inequality, Livelihoods and De^Page 1 of 9
- 2-Q.
i si
UN
D P
UNAIDS
YOUANDAIDS
r
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I UNAIDS I UNICEF I UNFPA I UNODC I UNESCO I WHO I UNIFEM I ILO I WORLDBANK I GOVT I BILATERALS I P
ABOUT HIV/AIDS
INDIA AT A GLANCE
What is HIV/AIDS
Transmission
Diagnosis
Symptoms
Treatment
Life after HIV
Prevention
Safe Sex Guide
South and North East Asia at a Glance: [delect Country |
UPDATE
’ Latest Figures
' Events
' Anouncements
ASIA PACIFIC
AT A GLANCE
AFGHANISTAN
BANGLADESH
BHUTAN
CHINA
DPR KOREA
INDIA
IRAN
MALDIVES
MONGOLIA
NEPAL
PAKISTAN
REPUBLIC OF KOREA
SRILANKA
General Information
Indicators
Socio-Economic Background
HIV Situation
Estimates
National Response
UN Support
UN Offices
Support by Others
Currency: Indian Rupee
Blood Safety
Clinical
Management
Condom Programming
Epidemiology
HIV/AIDS at
Workplace
Human Rights,
Law and Ethics
Injecting Drug
Users
Migration
Sexually Transmitted
J
ar
**-^^*« •<
Independence: 15 August 1947 (from UK)
I j *» *«»»»<<«
4
X5
4
<i s r <
Source: Census of India - 2001, Govl
* Disclaimer
Click Here for a Larger Map
General Information
Location: South Asia, bordering the Arabian Sea and the Bay of Bengal, slightly more than one-third the si;
Neighbouring countries are Bangladesh, Bhutan, Myanmar, China, Nepal and Pakistan
THEMES
T
INDb
Capital: New Delhi
THE EPIDEMIC
' Overview
' Perspectives
' Programmes
Documents related t<
India in Library
r> r*
Government: Federal Republic
Languages: English is an important language for national, political, and commercial communication. Hin
language and the mother tongue of 30% of the people. Twenty-four languages are spoken by at least on
people. There are many regional languages like Bengali (official), Telugu (official), Marathi (official), Tan
(official), Gujarati (official), Malayalam (official), Kannada (official), Oriya (official), Punjabi (official), As:
Kashmiri (official), Sindhi (official) and Sanskrit (official). There are many more languages and dialects
Administrative Divisions: 28 states and 7 union territories (UT). Andaman and Nicobar Islands (UT)
Arunachal Pradesh, Assam, Bihar, Chandigarh (UT), Chhatisgarh, Dadra and Nagar Haveli (UT), Daman ar
(UT), Goa, Gujarat, Haryana, Himachal Pradesh, Jammu and Kashmir, Jharkhand, Karnataka, Kerala, La
Madhya Pradesh, Maharashtra, Manipur, Meghalaya, Mizoram, Nagaland, Orissa, Pondicherry (UTX Pi
Sikkim, Tamil Nadu, Tripura, Uttar Pradesh, Uttaranchal, West Bengal
...\HIV-AIDS in India AIDS, Malnutrition, Children, Indicators, Poverty, Gender Inequality, Livel6/7/03
4.
AIDS, Malnutrition, Children, Indicators, Poverty, Gender Inequality, Livelihoods and De Page 2 of 9
11 II CU.LIVI IO
" Targetted
Intervention
' Trafficking
" Voluntary Counselling
and Testing
SERVICES
Blood Banks
Care/Support (Home
Based)
Care/Support
(Hospital Based)
Counselling
Counselling Hotlines
Hospitals
Laboratories
NGOs
Physicians
PLWHA Support
Groups
Research Centres
State AIDS Control
Societies (India)
STD Clinic
Testing Centres
EXECUTIVE
Head of State
Head of Government
Cabinet
LEGISLATURE
President Kicheril Raman Narayanan (since 25 July 1997); Vice President Krisl
21 August 1997)
Prime Minister Atal Behari Vajpayee (since 19 March 1998)
Council of Ministers appointed by the president on the recommendation of the ph
Bicameral Parliament or Sansad consists of the Council of States or Rajya
consisting of not more than 250 members, up to 12 of which are appointed by tl
remainder are chosen by the elected members of the state and territorial asser
serve six-year terms) and the People's Assembly or Lok Sabha (545 seats;
popular vote, 2 appointed by the president; members serve five-year terms)
JUDICIARY
Supreme Court and lower courts. Judges are appointed by the president and rerr
they reach the age of 65
SPECIAL FACTORS
- India is marked by a vast (one billion) and ethnically heterogeneous population,
recognized regional languages and many hundreds of ethnic and linguistic grou
the country.
- Liberalisation of economic policies in the recent past has led to a significant
investment (from the West as well as the East), which in turn has st
developments in the industrial and infrastructural sectors of the country.
- Due to the lack of balanced economic development throughout the counti
population migrations - especially of young men in search of income - are commi
LIBRARY
-Extensive cross-border trade with neighboring countries (especially Nep
Myanmar, Sri Lanka and Pakistan) for commercial and other purposes is ata
Reportedly there are some well established sex work traffic routes between Nep
Bangladesh and India. Refugee populations from Tibet, Sri Lanka and Afghanisl
concentrated in certain areas of the country.
Advocacy
Audio/Video
Best Practices
Books
Journals
Magazine
Newsletters
Policies
Project Plans
Publications
Research Papers
- Social Sector Development (especially Health, Education and Social Welfar
jurisdiction of the respective States and Union Territories. As a consequence,
sector issues is seen as a matter for State Government, rather than Central Gove
- Issues of human sexuality are extremely sensitive, and attempts to broaden ■
human sexuality matters are categorized by some as attempts to debase the k
traditions.
Back to Top
Indicators
Indicators
Estimate
Population ( millions)
1027
Population growth (1991-2001)
21.34
Annual Population Growth (percent)
1.6
Population Density (per sq.km)
324
Sex Ratio (females per 1,000 males)
933
Crude Birth Rate (per 1000 population)
25
Crude Death Rate
9
Year
2001
2001
2000
2001
2001
1999
1999
Total Fertility Rate
3.3
1995-2000 Human Development
Infant Mortality (per 1000)
69
2000
Maternal Mortality Rate
540
1999
Human Development
Human Development Index Ranking
124
2002
Human Development
Literacy (Total)
Source
Census of India, 2001
Census of India, 2001
U.S. Census Bureau
Census of India, 2001
Census of India, 2001
UNPOP
UNPOP
Human Development
65.38
2001
Census of India, 2001
- Males
75.85
2001
Census of India, 2001
- Females
54.16
2001
Census of India, 2001
13.75
1991 - 2001 Census of India, 2001
Increase in literacy
...\HIV-AIDS in India AIDS, Malnutrition, Children, Indicators, Poverty, Gender Inequality, Livel6/7/03
AIDS, Malnutrition, Children, Indicators, Poverty, Gender Inequality, Livelihoods and De Page 3 of 9
People below poverty line (%)
35
2000
Human Development
Urban Population (%)
27.7
2000
Human Development
Growth of Urban population (annual)
2.2
1990- 1998 World Bank
Life expectancy
63.3
Per capita GNP (US $)
440
Population with access to proper sanitation (%)
31
Population with access to improved water sources (%)
88
2000
1999
2000
2000
Health Expenditure - Private (% of GDP)
4.2
1998
Physicians per 100,000 population
48
1990- 1999 Human Development
Population with Access to Essential Drugs (%)
0-49
1999
Human Development
UNPOP
Human Development
Human Development
Health Expenditure-Public (% of GDP)
Human Development
Human Development
Back to Top
Socio-Economic Background
With more than a billion people, one of the fastest economic growth rates in the world since the 1980s and <
Information Technology industry that is projected to earn about US $ 50 billion by 2008, India is a country ol
contrasts.
It has the highest concentration of poverty anywhere in the world with about 350 million people (1999 figure;
the poverty line. The country accounts for 40 per cent of the world's poor and its social indicators are still po
measures of human development. At 9.6 per cent of GDP, its fiscal deficit is one of the highest in the world.
• More than half of all children under the age of four are malnourished and 30 percent of newborns ai
underweight.
• India adds 16 million people every year to its population, just two million less than the entire popula
• Every day, it adds 42434 to the country's population.
• 60 per cent of the women are anaemic• More women than men die before the age of 35
• Maternal deaths in India account for almost 25 percent of the world's childbirth-related deaths.
• More than half of Indian women are illiterate though it has the second largest education system in tl
China.
• Maternal mortality rate in India is 100 times more than in the developed world.
• India has the largest remaining pool of polio transmission in the world.
But the poor indicators do not articulate India's achievements.
The general condition of India's population has improved since the 1970s. Average life expectancy at birth t
from 50 years to 63 today, the infant mortality rate has fallen by half to about 70 per 1,000 live births, and th
fallen by half to about thee children per woman.
India's national family welfare program has helped move the country about two-thirds of the way toward its c
replacement- level fertility (2.1 births per woman.). However, population growth and the impending strain on
environment, natural resources, and social services still pose a threat to India's development.
Malnutrition poses a continuing constraint to India's development. Despite improvements in health and well
malnutrition remains a silent emergency in India. The World Bank estimates that malnutrition costs India at
billion annually in terms of lost productivity, illness, and death and is seriously retarding improvements in hu
development.
Despite some improvement, India's women remain significantly more malnourished than men. Bias against
is reflected in the demographic ratio of 933 females for every 1,000 males. The country's maternal mortality
high, particularly in rural areas, ranging from 440 to 580 deaths per 100,000 live births.
Although declining, largely preventable diseases such as leprosy, tuberculosis, cataract blindness, and mal;
account for 50 percent of reported illness, and around 470 deaths per 100,000. Despite a decade of polio in
India s immunization program, India accounted for more than two-thirds of polio cases reported worldwide ir
India made modest increases in primary education enrollment rates in the 1990s. Today, it has 108 n
aged 6-10 attending primary school.
The rise in literacy rates over the last decade indicates India's oroaress in education. From 1991- 99. the ov
...\HIV-AIDS in India AIDS, Malnutrition, Children, Indicators, Poverty, Gender Inequality, Livel6/7/03
AIDS, Malnutrition, Children, Indicators, Poverty, Gender Inequality, Livelihoods and De Page 4 of 9
increased from 52 percent to 64 percent. Yet more than half of Indian women are still illiterate; about 40 mill
school-age children are not in school (mostly girls and those from the poorest and socially-excluded househ
about one-third of an age group completes the constitutionally prescribed eight years of education.
Back to Top
HIV Situation
India's socio-economic status, traditional social ills, cultural myths on sex and sexuality and a huge populate
marginalized people make it extremely vulnerable to the HIV/AIDS epidemic. In fact, the epidemic has beco
serious public health problem faced by the country since Independence.
Since the first case was reported in Chennai, the capital of the South Indian State of Tamil Nadu, HIV has s
from urban to rural areas and from high-risk groups to the general population. At the end of 1999, an estima
people are living with HIV/AIDS in the country.
HIV/AIDS has been reported from almost all the states and union territories of the country. Currently the inft
estimated to be 0.7 per cent in adult population (between 15 and 49 years of age).
The second decade of the epidemic is marked by visible heterogeneity. In fact, India's epidemic is made up
epidemics and at some places, they occur within the same state.
The epidemic has become a major developmental challenge that goes beyond the realm of public health. Tl
complexity of the epidemic has made it an issue that touches all aspects of human life. And the perspective
medical, human rights, ethical, legal, religious, cultural and political. The need to prevent the epidemic and |
support to those infected and affected calls for an unprecedented response from all sections of society.
In the most affected state of Maharashtra, HIV has reached 60 per cent of Mumbai's sex workers, 14-16 pei
STD clinics and over 2 per cent among women attending antenatal clinics (ANCs). The prevalence in wome
antenatal clinics, an indicator for the prevalence in general population, has reached 6.5 in Namakkal in Tam
per cent in Churachandpur in Manipur.
The epidemic is slowly moving beyond its initial focus among sex workers. Sub-epidemics are evolving with
explosive spread among groups of injecting drug users (IDUs) and among Men having Sex with Men (MSM)
The last four years have seen a broadening of the epidemic across the southern and western states of Indic
continued concentration of HIV among IDUs in the North Eastern states. The sharp increases in Andhra Pre
Karnataka reveal that these two states have overtaken Tamil Nadu as states with the highest prevalence rat
In other parts of the country, the overall levels of HIV are still low with some areas reporting no cases at all.
Sexually Transmitted Diseases (STDs), the presence of sexual networks and phenomena like migration anc
point to a significant vulnerability.
The epidemic continues to shift towards women and young people with about 25 percent of all HIV infection
women. This also adds to the Mother To Child Transmission (MTCT) and paediatric HIV. Adverse gender bi
biological vulnerability of women.
The burden of AIDS cases is beginning to be felt in states affected early. Mumbai in Maharashtra and Manif
East have recorded 20-40 per cent bed occupancy by HIV positive persons in certain referral hospitals.
Back to Top
Estimates
HIV in India - A fast spreading Epidemic
• 1986: First case of HIV detected in Chennai
• 1990: HIV levels among High Risk Groups like Sex workers and STD clinic attendants in Maharash
Injecting Drug Users in Manipur reaches over 5%.
• 1994: HIV no longer restricted to high risk groups in Maharashtra, but spreading into the general pc
also spreading to the states of Gujarat and Tamil Nadu where high risk groups have over 5% HIV p
• 1998: Rapid HIV spread in the four large southern states, not only in highrisk groups but also in the
population where it has reached over 1%. Infection rate among antenatal women reaches 3.3 in Na
Nadu and 5.3 in Churachandpur in Manipur. Among IDUs in Churachandpur it crosses 76 percent e
64.4 per cent.
• 1999: The infection rate in antenatal women in Namakkal rises to 6.5. About 60 per cent of the sex
Mumbai sites are infected. Infection rates among STD patients reaches 30 per cent in Andhra Prad
...\HIV-AIDS in India AIDS, Malnutrition, Children, Indicators, Poverty, Gender Inequality, Livel6/7/03
AIDS, Malnutrition, Children, Indicators, Poverty, Gender Inequality, Livelihoods and De Page 5 of 9
per cent in Manarasntra. adout 04.4 per cent iuus at one or tne sites in Mumoai ana ba.4 per cent
Chruachandpur are infected.
• 2001: Infection crosses one per cent in six states. These states account for 75 per cent of the coun
HIV cases. The Prime Minister addresses the Chief Ministers of high prevalence states and urges t
prevention activities
HIV/AIDS Estimates
Estimated Number of People Living With HIV/AIDS : 3.97 million - 2001
Previous Years
Year
1998
1999
No. of cases
3.5 million
3.7 million
2000
3.86 million
Estimated Number of New Infections in 2001 : 0.16 Million
Previous Years
Year
1999
2000
No. of cases
0.2 million
0.16 million
Source : National Aids Control Orgai
Figures
Va,ue
Estimated Number of HIV cases (Adults and children)
Adults (15-49 years)
Women (15-49)
Children
Esimated number of deaths due to AIDS
Estimated Number of AIDS orphans
3,970,000
3,800,000
1,500,000
170,000
Year
2001
2001
2001
2001
Source
UNAIDS Global HIV/AII
UNAIDS Global HIV/AII
UNAIDS Global HIV/AII
UNAIDS Global HIV/AII
Estimation of HIV/AIDS in India - 2001
Back to Top
The National Response
India responded to the AIDS epidemic immediately after the first ever HIV/AIDS case was reported in the cc
The country's National response encompassed the efforts of both the Government and civil society.
Recognising the seriousness of the situation, the Government constituted a high-power committee in 1986 i
Ministry of Health and Family Welfare. Subsequently, a National AIDS Control Programme was launched in
then, the National HIV Programme has moved through three phases.
1986-1992, Denial of the Threat of HIV: This was a period that saw the beginning of a largely research-ba;
Surveillance activities were launched in 55 cities in three states. The programme activities were left to the si
strong central guidance.
1992-97, First Acceleration of the Programme: Backed by World Bank funding and strong WHO GPA (Gl
on AIDS) support, this phase saw the creation of the National AIDS Control Organisation (NACO). Acheiver
higher levels of awareness creation, establishment of state level structures for programme implmentation ar
in blood safety. The launch of successful individual projects such as the innovative intervention in Sonagact
commercial sex workers and breakthroughs in reaching out to college youth through "University Talks AIDS
amongst its achievements. The scope of these efforts remained however on a limited scale. Political accept
and ownership of the programme by the states proved difficult to establish. Involvment of NGOs too was difl
emphasis on blood-safety and strengthening of infrastructure yielded some gains, approach remained prim?
HIV seen largely as a health issue.
1998-2001, Focus on Targetted Intervention: Building on the experience of the first phase, there was a tw
on coverage amongst high risk groups like sex workers, truck drivers and injecting drug users and to make 1
multisectoral.. It has resulted in a strongly decentralized programme with the responsibility of implementatio
states. Flexible State AIDS Socieites were formed with stronger mechanisms for state level programme mai
innovative approach for providing technical support to state programmes was launched by establishing a ne
...\HIV-AIDS in India AIDS, Malnutrition, Children, Indicators, Poverty, Gender Inequality, Livel6/7/03
AIDS, Malnutrition, Children, Indicators, Poverty, Gender Inequality, Livelihoods and De Page 6 of 9
i ecnmcai txesource uroups (i kus ), eacn covering airrerent tnemauc areas or me epioemic. tacn or mem i
provide technical support to states. Surveillance has been expanded and strengthened and a new national F
been submitted to the Central Government. With a new round of resources mobilized from Government of li
major bilateral donors and the UN system, the programme is moving into an important phase of implements
The preparation of the new programme has given a fresh impetus to the national response. However, sever
need to be addressed. These include building capacities to implement the strategies of prevention and builc
multi-sectoral response that is sustainable. It also involves mobilizing and coordinating a considerable rangt
including the private sector.
National Programme Manager: Mr. J.V.R.Prasada Rao, Special Secretary and Project Director, New Delh
National AIDS Control Organisation (NACO):
In India, the National AIDS Control Organisation (NACO) carries out the country's National AIDS Programm
formulation of policy and implmentation of prevention and control programmes. It was established in 1993 a
running the second phase of the National AIDS Control Project (NACP-II). The first phase (NACP-I) ended i
The duration of NACP-II is from December 1999 to March 2004.
In 1989, with the support of WHO, a medium term plan for HIV/AIDS control was developed. With a US $10
was implemented in five most affected states. The actual prevention activities gained momentum by 1992 a
programme became more formalised with the establishment of NACO in 1993.
Besides NACO, the country also has a National AIDS Control Board, which is chaired by the Union Health $
Board reviews NACO policies, expedites sanctions, approve procurement and undertake and award contrac
agencies. The other major functions of the Board are approval of annual operational plan budget, reallocatic
between programme components, formation of the programme managerial teams and appointment of senic
staff.
Project Director, Mr.J.V.R.Prasada Rao, who is a Special Secretary to the Government of India, heads NAC
Objectives:
NACO has two key objectives
• To reduce the spread of HIV infection in India and
• To strengthen India's capacity to respond to HIV/AIDS on a long-term basis.
The overall vision of NACO is
• To lead and catalyse an expanded response to the HIV/AIDS epidemic in order to contain the spre?
• Reduce people's vulnerability to HIV.
• Promote community and family based care to HIV/AIDS cases within an enabling environment with
stigmatisation and discrimination and,
• To alleviate the epidemic's devastating social and economic impact
State AIDS Control Societies:
For the implementation and management of HIV/AIDS programmes in states, State AIDS Cells were create
and UTs of the country. However over a period of time, it was realised that due to many cumbersome admir
financial procedures, there was delay in release of funds sanctioned by the Government of India. This delay
implementation of programmes at different levels. To remove the bottlenecks at the State level, Ministry of I
Family Welfare advised the State Governments/Union Territories to constitute a registered society under th(
of the Secretary Health. The society is broad-based with members representing various ministries like Sock
Education, Industry, Transport and Finance and NGOs. On an experimental basis, the Tamil Nadu State All
Society was created followed by a similar society in Pondicherry. Successful functioning of these societies l<
Government of India advising other states to follow this pattern for implementation of the National AIDS Cor
Findings of Behaviour Sentinel Surveillance-2001
National AIDS Prevention and Control Policy
National Blood Policy
Source : National Aids Control Orgar
Back to Top
I IM
...\HIV-AIDS in India AIDS, Malnutrition, Children, Indicators, Poverty, Gender Inequality, Livel6/7/03
AIDS, Malnutrition, Children, Indicators, Poverty, Gender Inequality, Livelihoods and De Page 7 of 9
Uli uuppui I
• The UN system, through UNAIDS and its cosponsors, is committed to strengthening its support 1
coordination and technical collaboration. Each UN agency - cosponsors as well as UNIFEM and I
lead in its specific strategic focus area. UNAIDS, besides facilitating and coordinating the UN
(through the UN Theme Group(TG) and National Programme officers in several UN agencies),
providing or brokering the provision of technical support to the National Programme.
• The latter include support for the Technical Resource Groups (TRGs), to state strategic planning
building of NGOs and other service organizations.
• Through the Theme Group mechanism, UNAIDS is focusing the UN system’s efforts on th'
according to the agencies' respective capacities and mandates.
• A collaborative framework and integrated work plan for 1999-20001 has thus been drawn uj
individual as well as collective UN strategies. Examples: UNFPA, UNICEF and WHO on rej
programmes; WHO on HIV/STD and behavioural surveillance; UNDCP and UNAIDS on drug use;
ILO on interventions among Sex Workers; UNICEF, UNESCO and UNFPA on schools-based educ;
• The World Bank has just pledged $191 million credits to support the response, including support
programming, STI prevention and care and interventions targeting risk behaviours. This follows
million credit to the National Programme.
• Besides the World bank IDA credits, there are several bilateral agreements for HIV/AIDS projects
million AVERT project from USAID targeting Maharashtra, and a further $28 million from DFID whir
projects in 4 selected states (WB, Orissa, Andhra P., Kerala) focusing on institutional capacity I
interventions and BCC programmes.
• Other bilateral partners include CIDA and AusAID who intend to focus on capacity building at th
partnerships with NGOs for targeted interventions and behaviour change programmes. And SIDA s
the North East and elsewhere in the country.
• Extensive non-health sector involvement in National AIDS Committee.
Theme Group Chair: Dr.R.J.Kim Farley, WHO Representative to India, New Delhi.
Interim Country Programme Advisor, UNAIDS: Dr. Olavi Elo, New Delhi.
Back to Top
Support by Other Ministries
• Ministry of Human Resource Development (Dept, of Youth & Sports) involved in implementatioi
Talk AIDS" Programme of the National Service Scheme covering 158 universities, 5000 colleges
secondary schools.
• National Council of Education Research & Training (NCERT) involved in development of school cu
for integration of HIV/AIDS into school education (extra-curricular activities).
• A national consultation on the integration of HIV/AIDS into school education has been organised ur
of UNAIDS by UNESCO, UNFPA, and UNICEF with financial support from NACO and the active ir
Department of Education and five key states where these activities have been implemented. Folio
between NACO and the Department of Education with support from the UN System.
• Nehru Yuvak Kendra (NYK) involved in the implementation of non-formal educational apprc
outreach programmes on HIV/AIDS through its national volunteer network in communities in the co
• The Ministry of Information & Broadcasting has been of assistance through its Directorate of Auc
(DAVP), the Song & Drama Division, All India Radio and Doordarshan (national television service)
and forums for the dissemination of public service programming and messages on HIV/AIDS preve
• Ministry of Railways undertook in 1994 a study of risk behaviors amongst its employees with
UNDP. Survey results encouraged Ministry of Railways to design and approach NACO with
proposal for response to HIV/AIDS in Railways sector; proposal currently under discussion with NA
• Ministry of Defense (Health Services) conducts IEC programmes and HIV screening within defense
assistance from NACO.
World Bank Support
The Bank has provided two IDA credits to support India's National AIDS Control Program in collaboratio
Health Organization, other donors and UNAIDS. Through its general health projects and dialogue with o
countries, the Bank is focusing on HIV/AIDS as a major public health and development issue. In In
supporting the country's ongoing program to reduce the growth of HIV infection and strengthen capacity •
epidemic through information awareness efforts, focused interventions promoting behavior change, volu
counseling, and reducing transmission by blood transfusions and occupational exposure
Support by Industry
Industrial federations (West Bengal Chamber of Commerce & Industry, Confederation of Indian Indust
Indian Chambers of Commerce & Industry) becoming involved in stimulating discussions on needs for
response to HIV/AIDS. "AIDS & the Workplace" advocacy & IEC package developed by Confederation <
//■MIX
-------:_1_
t
iailjj
'mi I KI a irxo/i io a in c—-------------4;—
— tiix//Air>o_________ t:_
...\HIV-AIDS in India AIDS, Malnutrition, Children, Indicators, Poverty, Gender Inequality, Livel6/7/03
AIDS, Malnutrition, Children, Indicators, Poverty, Gender Inequality, Livelihoods and De Page 8 of 9
tvii; wiui dssisianue num wnu/uiNMiuo/uoMiu iui piuiiiuuun ui inuusuy auuuii un niv/Miuo pieveimu
policies. The Trucking Corporation of India (TCI) is actively participating in a national network of NGO
being coordinated with support from ODA for the assurance of HIV/STD interventions for truck drivers.
Legislation and policies
• Goa Public Health Act Amendment of 1985 (Section 53.l.vii) allowed the public health authc
discretion to isolate people with HIV/AIDS;
repealed in 1996.
• Railway Board Administrative Notification of 1989 designating HIV/AIDS as "infectious disease" wh
denial of passage; rescinded in 1996.
• Draft legislation in 1989 Session of National Parliament, which was evaluated as extremely prejudic
PLWH/As withdrawn after intervention of WHO and national authorities.
• 1992 Administrative Notification from Minister of Health & Family Welfare (GOI) to all State Govern
them to ensure non-discriminatory access to treatment and care for PLWH/As in all Central and St<
health care institutions.
• The Government has, by Administrative Order, required the screening for HIV of all units of blood t(
transfusion purposes.
• May 1997 Mumbai High Court Judgment held that employers cannot base employment decisions o
employee
Back to Top
Status
Country Status - 2001 by WHO
Country Profile: HIV/AIDS Surveillance Database, US Census Bureau (Pdf)
UN Offices
UNDP ( United Nations Development Programme )
UNAIDS (Joint United Nations Programme
Dr. Brenda Gael McSweeney
UN Resident Coordinator &
UNDP Resident Representative
55 Lodi Estate
New Delhi - 110003
India
Mail AddressrUNDP India
P.O.Box No.3059
New Delhi 110 003, India
Phone: (91-11) 4628877, (91-11) 462 7601,
(91-11)462 8453
Fax: (91.11)462 7612, (91-11)4628330
E-mail: fo.ind@undp.org,registry.in@undp.org
URL: http.//www.undp.org.in/
Dr. Olavi Elo
Interim Country Programme Advisor,
UNAIDS
C/o UNDP,
40 Lodi Estate, IIC, 2nd Floor
New Delhi 110003
Phone: (91 11)4649892
Fax:(91 11) 4649895
E-mail: mailto:eloo@unaids.org
URL: www.unaids.org.in/
UNICEF ( United Nations Children Fund )
UNFPA ( United Nations Population Fund
Ms. Maria Calivis
73 Lodi Estate
New Delhi 110 003
India
Phone: 91- 11- 469.0401
Fax: 91- 11-462.7521, 91- 11-469.1410
E-mail: lndia@unicef.delhi.org
URL: www.unicef.org/
55, Lodi Estate New delhi-110003
P.O. Box 3059 New Delhi - 110003
Tel: 91-11-4628877
Fax: 91-11-4627612
E-mail: lndia@unfpa.org.in
URL: http://www.unfpa.org.in/
UNDCP ( United Nations Drug Control Program )
UNESCO ( United Nations Educational, Sc
Cultural Organization )
UNDCP Regional Office
Ms. Renate Ehmer, Officer-in-Charge
(Responsible for India, Bangladesh, Bhutan,
Maldives, Nepal and Sri Lanka)
P.O. Box 3059 New Delhi, 110003, India
EP 16/17 Chandragupta Marg
Mr Moshen Tawfik
UNESCO Office New Delhi
B 5/29 Safdarjung Enclave
New Delhi-110 029 India
Phone: 91-11-6713000
Fax: 92-11- 6713001,6713002
Chanakvaniiri Npw Dplhi 110091
India
'I ■
mocr'rx z\r<i
...\HIV-AIDS in India AIDS, Malnutrition, Children, Indicators, Poverty, Gender Inequality, Livel6/7/03
AIDS, Malnutrition, Children, Indicators, Poverty, Gender Inequality, Livelihoods and De Page 9 of 9
U-IIIQII. I
Phone: (91-11)4104970-73
Fax: (91-11) 4104962 & 4104963 (Precursor Fax)
E-mail: undcp@undcp.ernet.in
URL: www.undcp.org.in/
ll\U^UHVOW.VI
URL: unescodelhi.nic.in/
y
WHO ( World Health Organization )
UNIFEM ( United Nations Development Fu
Dr. Robert Kim Farley
WHO Representative
World Health House
Indraprastha Estate Mahatma Gandhi Marg
New Delhi 110002
Phone: 91-11-3370804, 3370809
Fax: 91-11-3370197, 9395/9507
E-mail: registry@whosea.org
URL: www.who.int
223, Jor bagh
C/o, UNDP, 55 Lodi Estate
P.O. Box-3059,
New Delhi 110003
Phone: 4698297, 4604351
Fax: 91-11-4622136, 4627612
E-mail: chandni.joshi@undp.org
URL: www.unifem.org.in/
ILO (International Labour Organization )
WORLD BANK
Theatre Court (3rd floor)
India Habitat Centre
Lodi Road
New Delhi 110 003
Phone: (+91 11)460 21 01
Fax: (+91 11)460 21 11
E-mail:delhi@ilodel.org.in
URL: www.ilo.org/public/english/region/asro/newdelhi
70 Lodi Estate,
New Delhi 110 003
Mail Address: P.O.Box No. 416 New Delhi,
Phone: (91-11) 4617241,4619491
Fax: (91-11)4619393
E-mail: gchopra@worldbank.org
URL: www.worldbank.org/
Sources: UN Agencies, World bank, UNAIDS Epidemiological Fact Sheet - 2000, Census of India - 20
Responds to HIV/AIDS
* The map presented here is sourced from Census of India - 2001, Govt, of India. YouandAIDS is not liable
other countries in the region or elsewhere in the world, organizations or individual might raise.
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...\HIV-AIDS in India AIDS, Malnutrition, Children, Indicators, Poverty, Gender Inequality, Livel6/7/03
pis &U
Centres for CD4/CD8 Blood I ests
New Delhi:
1. AIJMS
2. Dr. RML Hospital
3. NICD
4. Safdajjung Hospital
Pune: BJ Medical College
Kolkata:
1. Calcutta Medical College
2. School of Tropical Medicine
Medical College, Kolkata
3. City Counselling Centre (Run by Durbar Mahila
Samanwaya Committee)
8/1 s Bawani Dutta Lane
Kolkata - 700 006
4 Bharuka Public Welfare Trust
\HAmaadcr Bari\H
63. Rafi Ahmed Kidwai Road
kolkata
5. Roy & Trivedi
Parkstreet (Beside Petrolpump near Park Street
Thana)
6. Ranbaxv Speciality, Collection Centre
Divine Nursing Home
Beliaghata.
Indore: Choitram Hospital
Bhopal: Gandhi Medical College
Shimla: Govt; Medical College
Chennai: Institute of Thoracic Medicine, Tambaram
Mumbai: JJ Group of Hospitals, KEM Hospital
Imphal: IN Medical College
Lucknow:
1. KG Medical College
2. Department of Immunilogy, Sanjay Gandhi Post Graduate Institute of Medical
Sciences. Raibareilly Road. Tncknow
Madurai: Madurai Medical College
Guvvahati. Medical College
J'C
^TV
Goa: Medical College, Panjim
Kerala: Tiruvanndapuram Medical College
Bangalore: NIMHANS
Hyderabad: Nizam’s Institute of Medical Sciences
Chandigarh : Post Graduate Institute of Medical Education and Research
Jaipur: SMS Medical College
Aiuncdabad. VJ Medical College
The Global Fund to fight AIDS. TB and Malaria
PITPOSE
What is the Global Fund to bight AIDS, Tuberculosis and Malaria?
The Global Fund is an independent, publie-private partnership
designed to attract, manage, and disburse new resources to fight the
global crises of AIDS, tuberculosis, and malaria. The
Fund's objectives arc to: finance effective programmes, balancmg the
needs for prevention, treatment, care, and support, in order to
alleviate suffering, save lives, and help end these diseases
dramatically increase the global resources dedicated to fighting
these diseases.
Why was the Fund created?
The Fund was created to fight the global HIV/AIDS, TB, and malaria
epidemics by sharing resources and expertise across national
boundaries, and between the private and public sectors.
The concept for an international funding mechanism to fight HIV/AIDS,
TB, and malaria began at the Okinawa G8 Summit in July 2000. At the
urging of UN Secretary (deneral Kofi
Annan and many national leaders, the concept of the Fund was
unanimously endorsed in June 2001 at the first UN General Assembly
Special Session to focus on HIV7AIDS. In July 2001 at its meeting in
Genoa, G8 leaders commihed US SI .3 billion Io lhe Fund.
Why address these three diseases?
The need for more rapid, sustained and concerted action on AIDS, TB,
and malaria is overwhelming. Together, these diseases have a
devastating global impact, killing nearly 6 million people each year
and causing major social and economic upheaval. While effective
interventions now exist to help prevent and treat these diseases,
they remain out of reach for most people in the developing world. A
dramatic increase in resources to fight HIV, TB, and malaria is
urgently needed to help reduce the suffering and death caused by
these diseases.
I low is the Fund different from previous efforts to address HIV/AIDS,
TB, and malaria?
The Fund is a unique global public-private partnership that includes
donor and recipient country 7 governments, multilateral agencies, NGOs,
priva le sector representatives, and representatives from the
communities affected by the three diseases. The full involvement of
all these stakeholders reflects an unprecedented level of shared
commitment to roll back these global health and development
chailenses. The Fund is a novel approach that emphasizes the
achievement of results, independent technical validation of
proposals, and efficient processes for utilizing resources.
Does the Fund replace current funding mechanisms for HIV/AIDS. TB, or
malaria?
The Fund is meant to supplement, not to replace, current funding
mechanisms for H1V/A1DS, TB, and malaria, hi fact, support for
current erions to fight these diseases should also be increased.
How will the Fund ensure that it doesn’t duplicate or compete with
the work of others in the field?
The Fund is not an implementing agency, so it will in no way compete
with development oi international agencies on the giound. Instead,
the Fund is a mechanism to raise new funds to fight HIV/AIDS, TB, and
Malaria and to direct these resources quickly and efficiently where
they are most needed, to piogiams and interventions that are not
adequately funded now. The
Fund is committed to coordinating with and working through existing
international, regional, and national mechanisms wherever possible.
Will the Fund address the root causes of these diseases, including
poverty, gender disparity, lack of education, and poor nutrition and
sanitation?
Eiiectively addressing HIV/AIDS, TB, and malaria in developing
countries will require action from a broad developmental perspective.
The Fund will favour programmes that build on and coordinate with
erions to address factors that can be root causes of these diseases,
including poverty, gender disparities, lack of education, lack of
access to healthcare, and inadequate nutrition and sanitation.
HOW TO SUBMIT PROPOSAL APPLICATIONS
What is a Cooidiualcd Co unUy Proposal (CCP)?
The Coordinated Country Proposal (COP) is the single coordinated
proposal to be submitted to the Global Fund through the Country
Coordinating Mechanism (CCM). A C(3P must address one or more of the
throe diseases (HIV/AIDS. tuberculosis or malaria) and may also
address system-vride,'cross-cutting aspects of these diseases in ways
that will coiitiibute to strengthening health systems, depending on
countrv realities and readiness.
Who can submit a CCP?
The Global Fund accepts proposals from a Country Coordinating
Mechanism (CCM). There should be only one CCM per country, except
where a sub-national CCM exists. In certain circumstances such as the
case of very large countries, a sub-national CCM, based on principles
of inclusiveness and partnership, may be formed to submit a proposal.
Such a proposal should be consistent with nationally formulated
policies, and there should be either evidence of a legal framework
stating the autonomy of the sub-national entity or endorsement by the
national-level CCM (or, if no national CCM exists, through other
relevant national authority) for the application. Non-CCM proposals
can only be accepted under very specific conditions described below
(see question 8).
COUNTRY COORDINATION MECHANISMS (CCM)
WhatisaCCM?
The CCM funutious as a "national consensus group" that coordinates
proposal submission from its national partners. The CCM should
facilitate the proposal development process, including the
tianslation of national strategies into concrete implementation plans
with clear responsibilities, tuning of activities, budgets and
expected outcomes; approve and endorse the final version of a single
coordinated country proposal (CCP); and play a mayor role in
monitoring and follow up on the implementation of proposed
adivilies. The CCM is a body (hal functions as a forum to promote
true partnership development and multi-sectoral programmatic
approaches. At the very least, in-country partners must come together
regularly to discuss plans, share information and communicate on
Global Fund issues. The CCM should engage in substantive discussions
and, therefore, its membership should reflect the ability to maintain
such a dialogue, with a representative number of members and an
active chair.
The CCM is an overall guiding body responsible for the use of Global
Fund resources. The CCM will need to manage relations with the Global
Fund.
The CCM should ensure that all relevant actors are involved in the
process: and that all view s are taken into account. As such, it is
responsible for ensuring that information relating to the Global
Fund, such as the Call for Proposals is disseminated widely to all
interested parties in the country. Interested parties in the country
may include the following: government agencies, NGOs, community /
based organizations, private sector institutions and bilateral and
multilateral agencies, as well as other organizations, such as
country' or regionally based academic institutions or faith based
organizations, that can facilitate and support the programs. The CCM
is expected to be responsive and supportive of NGOs and other civil
society' actors wishing to be included in the Country Coordinated
Proposal.
What is the fecoinmended composition of a CCM?
A CCM should be as inclusive as possible and seek representation of
the highest possible level from various sectors such as:
Government
NGO/ community based organizations
Private Sector
People living with HIV/AIDS, TB and /or Malaria
Rehgious/Taith Based Groups
Academic/Educational Sector
United Nations/Multilaieral/Bilateral Agencies
However, CCMs should remain of a manageable size (between 15 and 30)
in order to work and discharge responsibility effectively.
W’hat kind of proposals will have the best chance of being funded?
Successful proposals must clearly demonstrate the added value and
impact that additional resources would have on the epidemics in
country. Successful proposals will focus on measurable results.
Successful proposals will in general be based on:
Technical soundness of approach
Country partnerships
Feasibility with respect to implementation plan and management
Potential for programmatic and financial suslamability
Recent country’ situation analysis
Monitoring & Evaluation
In addition, successful proposals will include a focus on
institutional and absorptive capacity.
Does the Fund support basic research projects?
No. However, the Fund supports operational research projects as part
of a broader scope.
How will eligibility to receive funding from the Global Fund be
assessed?
In assessing the conditions for support, the following parameters
will be taken into account:
Disease burden for HIV/AIDS. TB and/or malaria - based on accepted
international standards for assessing disease prevalence, incidence
and magnitude.
Potential foi rapid increase of disease - based on accepted
international indicators such as recent disease trends, size of
population at risk, prevalence of risk factors, extent of crossborder and internal migration, conflict or natur al disaster.
Economic and poverty situation - based on relevant indicators such as
GNP per capita, UN Human Development Index (HDI), poverty indices, or
other information on resource availability.
In addition to the above entena based on epidemiological and socioeconomic profile, proposals will also be evaluated on the basis of
the following critical dimensions.
Political commitment by the country^ submitting the proposal at the
highest possible level Indicators of such commitment may include:
government contribution to the financing of programmes covered in the
proposal; per capita health expenditure; existence of supportive
national policies and multiyear strategic plans; appropriate
legislation; and recent political pronouncements.
Complementarity and addiuonaiity to existing programmes by
demonstrating how the resources sought from the Global Fund would
complement, add to and be consistent with country 7 level frameworks
(such as National Plans. Poverty Reduction Strategies and Sector-wide
Approaches, etc.) by building on or scaling up existing efforts and
filling existing gaps in national budgets and funding from
international donors. The funds from the Global Fund should not
replace existing national and international resources.
Absorptive capacity by demonstrating how additional resources from
the Global Fund could be effectively absorbed and used. Particularly
m cases where applicants plan to greatly increase the amount of
financial resources, evidence should be provided to show that
programme and human resource capacity exists to absorb the additional
funding within the given period.
Soundness of approach by explaining the mechanisms and work plan il
will use to achieve its goals. It should clearly explain how the
funds requested will be used, justify the amount requested and
indicate how those funds will supplement resources from other
sources.
The proposal should demonstrate a clear logical structure. In
particular, each component should have an overall goal. The overall
goal should translate into specific objectives. In turn, each
specific objective should translate into a set of main activities to
achieve these objectives. The expected results for each of these
levels of strategy7 should be clearly formulated.
For each level of strategy (overall goal, specific objectives, broad
activities), indicators must be provided to measure expected results
of the proposal and'or broader counuy’ programmes to which the
piopvsal is linked.
For each main activity, the proposal should also identify the
implementation arrangements including roles and responsibilities of
implementing partners.
What are the specific areas of focus of the Fund?
The Global Fund supports comprehensive programmes based on multi
sectoral approaches and widely inclusive partnerships with a
particular emphasis on scaling up proven approaches.
Resources from the Global Fund may be used to support activities
which must include on or more of the following:
Prevention, treatment, care and support of those directly affected
Increased access to health services; recruitment and training of
personnel and community health workers;
Behaviour change and outreach; and community-based programmes,
including care for the sick and orphans;
Provision of critical health products (including drugs) to prevent
and treat the three diseases, and lor the strengthening of
comprehensive commodity management systems ar country level; and
Operational research in the context of programme implementation:
Basic research will notybe covered by the Global Fund grants.
For activities involving the use of essential drugs, there should be
a description of the products and treatment protocols as well as
resources (human and systems, etc.) in place to ensure rational use
and maximizing adherence and monitoring of resistance.
"What are the Fund’s priorities for funding?
The highest priority will be given to proposals from countries and
regions with the greatest need, based on highest burden of disease
and the least ability to bring the required additional financial
resources to address these healfh problems
Does the Fund support the purchase of ARV treatment?
Provision of antiretroviral treatment is currently included in the
Fund’s scope as an example of the types of activities that could be
supported. The Board of the Fund will balance the available resources
against the priorities that countries themselves identify within the
context of comprehensive health system strategies and plans
Global rund to Fight AIDS, Tts and Malaria
’’Centie Casai” - 53 Avenue Louis-Casai
CH -1216 Comtrin,Geneva, Switzerland
T+4122 791 17 00
F-t-41 22 791 17 01
IIIV spread by violence against women
ADVERTISEMENT
Forty-Seventh Session of the
Commission on the Status of Women
Statement by Bertil Lindblad, Deputy Director UNAIDS New York Office
Violence against women fuels the spread of HIV, according to a
sizatemenr by UNAIDS to the 47th session of the Commission on the
Status of Women. "The fear of intimidation prevents the risk of
contracting HIV from being discussed and worse, results in HIV
infection," said UInAIDS. "In a number of countries, HIV-positive
women wore found to bo 10 times more likely to have experienced male
violence than those that are HIV-negative." The elimination of all
forms of violence against women and girls is a main theme of the 47th
session, being held in New York from 3-14 March.
5 Mrirch 2003
Mr. Chairman;
At the heart of the global AIDE epidemic lies gender inequality. At
Lhe end of 2002, women for Lhe first Lime comprised 50 percent of the
42 million cooclo living with AIDS worldwide, In sub-Saharan Africa,
there are 17 million women living with HIV, 58 percent of the total.
Women bear the main burden of care; women are the last in the queue
for treatment; women and girls are denied information and education
and women are denied the power to negotiate their sexual safety
because they do not have control over income and property.
Women and girls often lack information about IIIV/AIDS. A recent
UNICEF survey found that up to 50 percent of young women in high
prevalence countries did not know basic races about AIDS. Girls do
not sleep with older men because they think it is safe. They may do
AO to be able +-O pay thAi r school fees. Sex workers do not agree to
sex without condoms because they do not know their benefits. They do
so because they get paid up to five times as much money. Women do not
breastfeed their babies because they are unaware of the risks. They
do so because they do not know their HIV status and they arc afraid
of condemnaf.i on or they cannon afford t.o use breast, milk subst.it.ut.es
safely. The point is that women need more than advice. They need
resources, education, jobs - real options to live safely and
productively in a world with AIDS.
The interplay between gender inequality and AIDS is therefore central
to the world’s pledges to do better. It is a key component of the
action plans in follow up to the World Conference on Women and the
International Conference on Population and Development. Likewise, A
oervasive theme throughout the 2001 Declaration of Commitment on
H1V/A1DS, adopted at the UN General Assembly Special Session on AIDS
in June 2001, is the importance of gender equality and women’s
empowerment as a core long-term strategy to reduce the vulnerability
of women to HIV/AlDS.
Women’s empowerment - the full realisation of women’s human rights
reduces their vulnerability to HIV/AIDS. This year’s theme of the
Commission — ’women’s human rights and the elimination of all forms of
violence against women and girls - is particularly important in
defeating the epidemic. Strategies to protect women from sexual
aggression and violence are not only important m their own right,
biiL w±ll markedly Increase women’s protection against. Hrv inreci—ton.
The varied forms of violence against women, and the economic
which mak^s violent situations harder to escape from, fuel
the spread of HIV. Between 10 and 50 per cent of women worldwide
report physical abuse by their partners. The fear of intimidation
prevents the risk of contracting HIV from being discussed and worse,
results in HIV infection In a number of countries, HIV-positive women
were found r.o be 10 times more likely to have experienced male
violence than those that are HTV-negative.
AL the same Lime, HIV posiLive women have in many cases noL soughL
care or treatment for the same fears of physical violence, stigma,
discrimination and ostracism. This despite the fact that for millions
of women worldwide, their only ’risk factor’ for IIIV has been sex
with their spouse. Bindings of recent research have shown that in
many cases, the majority of HIV positive women were infected by their
husbands. For example, in a city in ?xsia, more than 90 percent of
women being treated for sexually transmitted diseases admitted to
having only one sex partner in their whole life - their husband, and
14 percent of the women had been infected with HIV.
Mr. Chairman,
Conflict situations greatly increase the vulnerability of women and
girls and the risk of contracting HIV. The breakdown of social
systems, lack of access to care and education services, and increased
levels of sexual violence all contribute to this risk. UNAIDS is
working uloseiy wiun the UN Department of Peacekeeping Operations to
ensure that wherever they arc deployed, UN peacekeepers arc also
warriors against HIV. Similarly, special HIV/AIDS gender advisers
have been attached to peacekeeping operations to work with both
uniformed personnel and affected civilian populations to try to break
the link between connict and HTV transmission.
The UNAIDS partnership comprising the eight Cosponsoring
organizations and the Secretariat is giving particular attention to
the gender dimensions of the epidemic across their full mandate. Sc,
for example, ensuring that the goals of Education for All are met by
ensuring that girls arc not pulled out of school when a crisis
strikes, is a fundamental action to protectagainst HIV. Likewise,
the UNAIDS’ partnership with UNIFEM is raising awareness of the
centrality of the realisation of women’s human rights to the H1V/A1DS
epidemic.
Overcoming the gender ineguality that drives the global AIDb epidemic
therefore requires targeted action on many fronts:
Attacking stigma and discrimination;
Enacting and strengthening legislation to give women economic rights
and access to credit
Expanding access to prevention services, including prevention of
mother to child transmission, as well as access to antenatal care and
real opi Lons available to HIV—infected women in choosing not to
breastfeed;
Training uniformed services and health personnel;
Protecting orphans, particularly girl orphans.
Women’s empowerment, gender equality and reversing the spread of the
HIV/AIDS epidemic are inextricably linked. As the Secretary General’s
Special Envoy for Humanitarian Needs in Southern Axfrica, Mr. James
Morris, concluded in September 2002: "An immediate, strongly led and
broadly implemented joint United Nations drive to take action on
gender and H1V/A1DS -involving all UN partners, actively engaging
governments and subsLantially increasing support to civil society
organizations - must be initiated without delay".
Substantial though the task may be, it is not hopeless. To take one
example of action under way, in Southern Africa, where girls are
infected with HIV at four times the rate of boys, UNAIDS is
supporting a youth AIDS initiative with a special emphasis on
add escent gi rl s . Working wi r.h eight, di fferenr. countries, community
based interventions are expanding reproductive health services,
training peer educators, extending micro-credit and health insurance,
and supporting training and employment.
There e r’e hopeFul signs emerging across the world, and often, it is
young women who have been the harbingers of hope. IIiV rates among
young women have fallen -- in parts of Zambia, among young south
Africans, in Addis Ababa, in Malawi, in Cambodia and elsewhere.
This message of hope needs to be central in the deliberations of the
Commission^ The link between violence against women and the spread of
ken if and when concerted action is taken against nhese
»—* * *
twin evils.
thank you.
India has had a sharp increase in the estimated number of HIV infections, from a
few thousand in the early 1990s to a working estimate of about 3.8 million children
and aduits living with HIV/AIDS in 2001. With a population of one billion, the HIV
epidemics in India will have a major impact on the overall spread of HIV in Asia and
the Pacific and indeed worldwide. Most of the Indian states have a population
areater than a majority of the countries in Africa.
The spread of HIV within the country is as diverse as the societal patterns between
its different regions, states and metropolitan areas. In fact, India’s epidemic is
made up of a number of epidemics, and in some places they occur within the same
state. The epidemics vary from states with mainly heterosexual transmission of
HIV, to some states where injecting drug use is the main route of HIV transmission.
Both tracking the epidemic and implementing effective programs poses a serious
challenge to the authorities and communities in India.
When the first case of HIV was discovered in Chennai in 1986, the Indian
Government responded to the HIV epidemic immediately. Recognising the
seriousness of the situation, the Government constituted a high powered committee
under the Ministry of Health and Welfare. Subsequently, a National AIDS Control
Programme was launched in 1987. The program activities covered surveillance,
screening blood and biood products and health education.
In 1990, HIV ieveis were high amongst high-risk groups such as sex workers and
STD attendants in Maharashtra and injecting drug users in Manipur; infection rates
reached over 5%. This period saw the beginning of a largely research-based
national programme. Surveillance activities were launched in 55 cities in three
states. The programme activities were left to the states and did not have strong
central guidance.
The National AIDS Control Organization (NACO) was established in 1992. NACO
carries out India's National AIDS Programme, which includes the formulation of
ooiicy, prevention and control programmes. The same year that NACO was
established, the Government launched a Five -Year Strategic Plan for HIV/AIDS
prevention under the National AIDS Conti oi Project. The Pioject established the
administrative and technical basis for programme management and also set up
State AIDS bodies in 25 states and 7 union territories. The Project was able to
make a number of important improvements in HIV prevention such as improving
blood safety. To strengthen surveillance the Government established 140 centres
and 180 sentinel sites across the country, to monitor HIV trends and the
geographical spread of HIV among the general population at-risk groups.
When surveillance systems in the Indian state of Tamil Nadu, home to some 60
million people, showed that HIV infection rates among pregnant women were rising,
tripling to 1.25% between 1995 and 1997, the State Government acted decisively.
It set up an AIDS society, which worked closely with non-governmental
organizations (NGOs) arid other partners to develop an active AIDS prevention
campaign. This included hiring a leading international advertising agency to
promote condom use for risky sex in a humorous way, without offending the many
people who do not engage in risky behaviour. The campaign also attacked the
ignorance and stigma associated with HIV infection, encouraging compassion for
those affected. The bold safe-sex campaign was a hit with its target market of
young sexually active men. Regular behaviour surveillance shows that the number
of visits to sex workers and sex with other irregular partners has fallen, and
condom use during risky sexual encounters has rise dramatically.
Although HIV prevalence rate is low (0.7%), the overall number of people with HIV
infection is high accordina to estimates by UNAIDS, i he official Indian figures do
not reveal such a scale of infection, but weaknesses in the serosurveillance system,
bias in targeting groups for testing, and the lack of availability of testing services in
several parts of the country suggest a significant element of underreporting. Given
India's large population, a mere’o.l percent increase in the prevalence rate would
increase the number of aduits living with HIV/AIDS by over half a million people.
HIV infection in India is currently concentrated among poor, marginalized groups,
including commercial sex workers, truck drivers, and migrant labourers, men who
have sex with men and injecting drug users. Transmission of HIV within and from
these groups drives the epidemic, but the infection is spreading rapidly to the
general community. The epidemic continues to shift towards women and young
people with about ?5 % of all HIV infections occurring in women. This also adds to
mother to child HIV transmission and paediatric HIV.
About 90% of the total reported AIDS cases occur in the sexually active and
economically productive 15 to 44 age group. Men account for 79% of HIV infections
in India. Trie predominant mode of HIV transmission is through heterosexual
contact, the second most common mode being injecting drug use. Previously blood
transfusion and blood product transfusion were also major causes, but blood safety
measures are now in place to prevent such transmission.
In 2001, the HIV infection rate went above one per cent in six states, and the Prime
Minister urged the Chief Ministers to intensify prevention activities. Three states,
(Maharashtra, Tamil Nadu and Manipur), account for 75% of the country's
estimated HIV cases. The burden of AIDS cases is beginning to be felt in states
affected early. Mumbai and Manipur have recorded 20 to 49 per cent bed
occunancy by HIV positive people in certain hospitals.
In the most affected state of Maharashtra, HIV has reached 60% in Mumbai's
(Bombay) sex workers, 14-16% in sentinel STD clinics, and over 2% among women
attending anti-natal clinics. The prevalence rate in women attending antenatal
clinics can be treated as an indicator for the prevalence in general^ population, i his
prevalence rate has reached 6.5% in Namakkai in Tamil Nadu and 5.j % in
Churschariupur tn Manipur.
The last four years have seen a broadening of the epidemic across the southern and
western states of India, as well a concentration of HIV among the injecting drug
users in the North Eastern states. The sharp increases in Andhra Pradesh and
Karnataka reveal that these two states have overtaken Tamil Nadu as states with
the highest prevalence rates. In other parts of the country, the overa.l .eve.s are
still low with some areas reporting no cases at all.
The AIDS epidemic in India consists of a number of local epidemics. Around 707o o,
India's population lives in rural areas, once though to be relatively immune to the
epidemic. Some recent studies, however, suggest that HIV has begun to spread in
several rural areas. The epidemic is now moving beyond its initial focus among sex
workers and injecting drug users and is shifting towards the general population:
makino women and young people the most vulnerable for HIV infection.
In India, as elsewhere, AIDS is perceived as a disease of "others' - or people living
on the margins of society, whose lifestyles are considered 'perverted and sinful.
Discrimination, stigmatisation and denial (DSD) are the expected outcomes of such
values, affecting life in families, communities, workplaces, schoo.s and health care
settlnas. Because of HIV/AIDS related DSD, appropriate policies and models of
good practice remain underdeveloped. People living with HIV and AIDb continue to
be burdened by poor care and inadequate services, whilst those with the power to
help do little to make the situation better.
In a recent study by UNAIDS different levels of discrimination and stigmatisation
were found among people living with H1V/A1DS in India. UNAIDS found that there
was uncertainty among health care staff about basic HIV-transmission information
and about the need for and purpose of universal precautions. Also, trie study
revealed a depressing picture of widespread labelling and stereotyping anu a lock o.
care throughout the health sector, with the possible exception of a small number of
hospitals where good practice and policies have been established.
UNAIDS also found that HIV/AIDS related DSD in India is in some respects a
gendered phenomena. Women are often blamed by their parents and in-laws for
infecting their husbands, or for not controlling their partners urges to have sex with
other women. Children of HIV positive parents, whether positive or negative
themselves, are often denied the right to go to school or are separated from other
children. People in marginalized groups (female sex workers, hijras (transgendered;
and gay men) are often stigmatised in India on the grounds of not only HiV status
but also being members of socially excluded group.
For mdia to respond effectively to Infection trends and limit the costly social and
economic impact of HIV and AIDS, its efforts need to be accelerated, intensified ano
expanded while the country remains at a low prevalence of IIIV and there is still
time to slow the spread of the epidemic. With HIV prevalence doubling every one to
two years in certain groups, there is still a narrow window of opportunity' over tne
next few years in which to prevent the HiV epidemic from becoming generalised
and much harder to control.
India’s socio-economic status, traditional social ills, cultural myths on sex and
sexuality and a huge population of marginalized people maxe it extremely
vulnerable to the HIV/AIDS epidemic. In fact, the epidemic has become tne most
serious public health problem faced by the country since tne Independence.
The Indian Government and individual state Governments have launched
prevention proqrammes to reduce high-risk sex and, there is evidence that in some
states these programmes are resulting in safer behaviour, i here are some success
stories for effective prevention and controi of HIV infection. An intervention
nmnmmmp among commerciai sex workers in Sonagachi, Calcutta has been ab.e to
hicrease condom use from 0% in 1992 to more than 70% in 1992-1994 and
sustained this at over 70% until 1998. If current prevention efforts can be scaled
up and sustained, India may be able to bring down the rates of HIV infection in
particuiariy exposed groups and avert a widespread heterosexual epidemic.-----------India
THE UNAIDS report on the global impact of HIV/AIDS presented al the XI International Confeience on
AIDS stated that there are an estimated 2-5 million people infected with HD/in India today. 50,000 to
100,00 cases of AIDS may have already/ occurred in this counny' with a population or over 900 milhon.
■Hie most rapid and well-documented spread of infection has occurred in Bombay and the State of Tamil
Nadu In Bombay. HIV prevalence has reached 50% in sex workers, 36% in S1D patients, and 2.5% in
women seen in antenatal clinics. The infection affects both urban and rural areas. In Bombay,
seroprevalence rose from 2-3% in patients seen in STD clinics in 1990 to 36% in 1994 and in rural areas
3-4% of some populations have an S I D. Source: ThAWus andTrends ofThe_Olpb^ HLV/AlDS
Pandemic OHwial Satellite Symposium presenled al the XT Tnlemational Conference on AIDS m
.
.
Vancouver, July 5-6, 1996)
IV drug users (IDUs) present a major problem in the State of Manipur whicn composes part ot tne
Golden Triangle, the source of the world's supply of pure grown heroin, $ 5% of the users are HI vinlcctcd. Hr/infcvlion among IDUs jumped Ifom zero to nearly 70% in 1992, according to the U.S.
™
i <.
Census Bureau.
In India, there are an estimated 1-2 million cases of tuberculosis every year. TB is the most prevalent
patients
of the patients
form of POI (opportunistic infection) in over 60% of AIDS cases. In Bombay alone, 10% oi
with I B are HIV-positive.
The Central Administration of the Tibetan government in exile, under the leadership of His Holiness, the
DalaTamsL is locaied in Dharmasala, India. A Department of Health was established in 1981 to serve the
needs of of all Tibetan refugees in India and Nepal and has set up 67 health centers, 8 hospitals and
employs 255 field staff, most of whom arc Community Health workers. Because of the HIV/AIDS
situation in the host countries of India and Nepal, the Department declared 1997 as Tibetan AIDS
Awareness Year. The year began with a public speech bv the health minister and a senes of workshops on
AIDS prevention were held at various refugee settlements. The Department is now in the process of
producing a short video on AIDS in Tibetan to be distributed to all of the health centers, hospital, and
schcois
Kalsang Norbu, the Training and Reproductive Health Ofticer of the Department of Health is the
coordinator of a training program for nurses and health workers which addresses the topics of HIX / AIDS
and STDs. He said that"there are no statistics available on AIDS on the Tibetan refugee population in
India and Nepal and aUribules Ibis Lo a lack of available facilities such as testing materials, counselors,
and lack of a policy concerning PWAs. Mr. Norbu also pointed out that there arc also no statistics
available on the HIV/AIDS situation in Tibet.
India has a population of one billion, around half of whom are adults in the sexually active age group,
with a large number below this age group. The first AIDS case in India was detected in 1986, and since
then, HIV infection has been reported in all States and Union Territories. The spread of HIV in India has
been diverse, vrith much of India having a low rate of infection and the epidemic being most extreme in
the southern States. 96% of the total number of nationally reported AIDS cases were found in 10 of the 28
States and 7 Union Territories, the worst being Maharashtra in the west. Tamil Nadu and Pondicherry m
tb* south and Manipur in the north-east. In Maharashtra and Tamil Nadu the infections are mostly due to
heterosexual contact, while infections
are mainly found amongst injecting drug users (IDU) and their
H.V.-AUK. «d MM
Adute
' 3970000
fca
J500000
170000
Ch.ldrv0.7%
Autdi ril\ H.ciajeiice eMiiiiaxc
These estimates aboveZe bSZ obviously published estimates for 1997 and 1999 and on recent
trends m HIV,'AIDS surveillance in various population Adidts arc defined as mqn and women agvd 1.
to 49. These esumStes m6mde ah mose wnn iiiV Lnfection, whiter or not mejy nave developed
symptoms of AIDS.
•p----------—j
i!SS cases in fiuHa
.f—-jVhuvj
Cumulative
-32161""(
Vrm--.t--<
10786
:—n
(----- Total
s m many sitnaiions a
a j..... guide
v..... io the sevei hyj of ille epidemirTA
The slalislx’s for ATT5^ cases may be ayoor
.
patient will die without HIV having been diagnosed, and the cause of death attributed to an opportunistic
infection, such as tuberculosis or POP.
%
Tnussmissmu Categories
Number of cases
84.29
•• •1 36201
Sexual
2.61
1119
2.99
1282
Blond and bltwd yrednets
z.o/
■;i 1232
intcciiug ui ug usets
7.25
100
.'....•7 'll7
42947
• • •
IWAWWWvWHAXl'.O^WAWM-l......................................... .
Aae'Sfnd^
*3 *%
IS . 79
3G-44
-j Tuuu
Female lota!
------1642“
15438
10427 5011
■18132-.. 4W" -“■226393228
2584 644 ’
—
42947
•32161...10 786
Male
Sraie- i nwn i^rriftHy
Pradesh.
.assatn
A-& N islands
.Baar
(^^tsarhirjT)
r
B AIDS cases
12350
1149
■■ °24
ggl46
S650
IMbi
S720
Dadra &. 'xagar riaveli
10________
r
.....■.'.•.•..A
j
■1
T
i
4>.-A
124
Gujaim
2029
247
iHimaGfKi: Ar. Kashwiir
; 1575
Kshy -T.^ .
P6?"-
‘K^raia ..
fo
{Madiiva rmfesh
’9106
Matvainahua
!Ori<«
ijS2
I
: Z7O
v:~
•vaiziyram
.34
'J' -'■ 2-”"
ron^heTfv
r
: 157
Kot^ian
r<616
|&itdGsa
Tamil Nadi?
i< 18276
r—
:rT’-.vt'-.'»-»_£-^-
F
1
1
1
.... ............. .......
804
936
|Wcsi Bengal
A
•1.---r--i-’
267
• C
iMijmnfii AR
HIV estimates, 2001
atteadm^
The prevalence rates belo^^rfronr^
rhnirc
rates
are
only
prevalence
relevant
sexually
active
women.
these
to
meaninp
that
clinics meaning that these prevalence rates
HIV Prevalence (%) |
1.50 ‘
■
A
i
0
rv ts-Kifids
Giianui^arh fvi r
:0.13 ’
rO---•0.13
I
h.25 1
Gi^
wwituair
$ 0.50 '
Hiitiairnai r liKirsii
X 0.13
10.08 '
i
1
rs.<rym
1.13
0.08
pfiauhyH Pardew
|tn5r-‘
■1.75
---- -
<€jn«sa •
ii.25
4
iir75
(Msninur
N^zaram
• .
i0.33
• 0.25
PvlKaCiivIiv
W
Riiiiisihan
■
'
' ............................. ....
iaisiinacii
>0
F“
i: 1.13
1
“
‘wsr Frades*
|5
•Ct7x^hJ.
0.13
£
V¥«5tfBenfaS ”‘
Some areas ieporipi 111V' pfc<^iivc rale ol 0 m
Uinies. Ihis does noiii^essanly mean that
there is no Hi V in the area, as some of them report the presence ot the virus at SI D clinics and amongst
............... injcetmgdrugu sefS:------ ---------------------:?
’ •
Sources:
//a //^//Xs hpidpmialnqicai factshper 7()(V Update.—,
NACO HIV and AIDS Surveillance in India, 31/12/2002
!
!
1
5 - 2-0..
?ai Assessment of Mobility, Migration and HI\7?JDS Risk in India
Supported by NACO, FHT and USAID
27,h March 2003
Attn;
Dr. Ravi Narayan
Coordinator
PIIM Secretariat (Global)
Community Health Cell
Bangalore
Dear Dr. Ravi Narayan.
Sub: Study on Asscssnient oi Mgbjiity, Migration and HIV/AIDS Risk in India
Mobile and migrant groups arc being increasingly recognized, as a vulnerable group in the context
of HIV/A IDS infection. However, very little is known about their vulnerability and factors that
conlribiHe io lheii vulnerable siaius. Heterogeneity of the groups lhai migrate, variation in types of
mobility and migration, and lack of appropriate definitions of migrant groups in the context of
IIIV/'AIDS vulnerability further restricts the understanding of these groups.
The Social and Environmental Research Division (SERD) of Blackstone Market Facts is currently
carrying out an Assessment of Mobility, Migration and IIIV/AIDS risk in India. The study is
supported by NACO, FH1 and USAID. It aims to understand the various types and patterns of
mobility and migration in India as well as the associated HIV/AIDS risk, vulnerability.
The first stage of the study is a desk research involving identifying and reviewing available
information in the form of books, articles, reports of research studies and unpublished documents on
Mobility, Migration, HIV AIDS vulnerability and related topics in India. The objectives of this
exercise are to understand existing pattern of mobility and migration (intra- and inter-district, and
inter-state), identify sites (source, transit and destination to which people migrate), and estimate the
volume of migration and mobility in Karnataka.
We are also in the process of organizing nine regional consul la lions across the co unity with local
stakeholders and experts (government departments, research institutions, academic institutes, and
NGOs. etc.). These meetings will give an opportunity to share information about the study with the
local stakeholders and experts and learn from their experience, and consequently, provide specific
information on typology of mobility and migration and establish H1V/AIDS of these vulnerable
groups. The first regional consultation workshop was held on March 15 at Kolkata for West Bengal
and Orissa. A similar regional consultation is planned to be held in Hyderabad for Karnataka and
Andhra Pradesh, tentatively in the second week of April.
<
1
As a team member of this study and in charge of the Karnataka region. I have been in the process of
collecting literature as well as information from various institutions and NGOs. I would be very
iX
.... V“d .... f
BLACKS T O N E
A
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M A R K E T F ACTS
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Page 1 of2
Main Identity
Geoff Heaviside <gheaviside@rediffmaii.com >
<AIDS-INDIA@vahoogroups.com >
Sefurdey, May 31, 2003 102 AM
[AIDS-INDIA] Re: Response from the office of Karnataka Chief Minister
From:
To:
RenfSubjcct:
Dear Chief Minister,
Tr» the ?1 st Century the wonder-e. n-p electronic mail means that human rights issues
become known to local, auLlonal and laLcraatloaal members lasLanaaeously.
Many lives have been saved when an email alert has activated messages to senior
politicians or bureaucrats some of whom were not even aware that a problem was
playing out in their country or ministerial area of responsibility.
rhe down side of such capability is that it is never clear just how many people
will both read and respond on behalf of their brothers and sisters in trouble.
It is therefore unavoidable that target chief officers will find out very quickly
when the cat is amongst the canaries. While this process will generate a
significant, once only hit., of hopefully enormous proportions depending on rhe
seriousness of the alert, it usually is a once only email and doesn’t go on and
on from the same people.
The comfort that you can take from the deluge of single mails that arrived in
your in-box would seem to me to indicate that Karntaka and the welfare of all of
its people is very important to the local, interstate and wider global family.
That same support of course would be available to you and your government if you
were to raise an alert concerning something that affected your government ’s
capacity to care so please don’t see it as an immature response. The facts were
very clear. The corresnondence from the Chief Medical Officer who, as a medical
doctor prosnmably, was ir t^rt issued to the agency and he nr she like so many
in-service Lralning
other duoLors in India really need Lu atLead seme la-scrviue
training so they
will not ran hysteria where there is no neea ior an hysteric reaction to
occur.
I have to say that I was not one of the people who contacted your office but I
have great pleasure in writing to you now from Melbourne, Australia but hopefully
soon again in India and of course for some time, in Karntaka again.
It would be very empowering and encouraging if you could try to plan an official
visit to the project in the OMBR layout. Your presence will bless the residents
whose lives will probably end there and it will also dispel some of the fears of
the people who live nearby.
Apart from forest dwelling brigands and pickpockets who work tourists over on the
Slate Rail network Bangalore in particular was a highlight of my recent visit and
T
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t
rfk
4"
r'T.ra
rfb. ** ate »»
Wb
kA
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411
te*
nr'irr
orro i r,«te A*
Geoff Heaviside
SUNSHINE 3020 Victoria Australia
E-mail: <gheaviside<?rediffmail. com>
W
in
W te*
W W *A •
xVi Assessment of Mobility, Migration and HIV/AIDS Risk in India
Supported by NACO, FHT and USAID
grateful if you could provide me with relevant information on this subject (in the form of data,
reports - published unpublished, articles, working papers, list or NGOs/organization working on
migration and health, etc.) which would help us in identifying mobile and migrant groups and
mobile and migration ‘hotspots’ in the state.
I would also be grateful if you could give me a time of your convenience for a meeting so that we
could share more information on this aspect.
Thanking you,
With Regards
Dr. Meena Nair
Research Coordinator
Social and Environmental R esearch Division
Our address:
Blackstone Market Facts
No.25, II Floor, II Main, 7th Cross,
I Stage, Indira Nagar,
Bangalore - 560 038.
Tel: 5286452 / 5214898 / 5214899
Fax: 5286453
Mai! id: meena@blackstonemarketfacts.com
s b ci A LA IN b EN VI R O NM R N T A L
B L A C K S T O N E M A R K E T F A C T S
R R S R A R C H
DIVTST O N
Page 1 of 1
Bella Mody
From:
Bella Mody [mody@pilot.msu.edu]
Sent:
Tuesday, June 24, 2003 12:42 PM
,sochara@vsnl.com'
To:
Subject: Gates Foundation Call for Proposals
Hullo Thelma: It is a long time since we met. You very kindly attended a meeting in April 2001 to educate me on
what you and others in Bangalore were doing on HIV media campaigns when I was on sabbatical with Unicef in
Delhi, I still have the posters you brought to show me what was happening.
I remember that I was a little more candid about NACO and Neelam Kapoor than was appropriate in front of
Ashok Rau: my heart went into my stomach when you told me afterwards that my comments would go straight to
Delhi through him. I noticed that he has been honored and rewarded amply by the GOI, and I suspect his org
DOES do good stuff: yes?
I returned to Michigan and told an old family friend about you: Margaret Bansod and her husband
Madhav/Michael worked with you and your husband at St John’s Med College, she told me.
Is your Community Health Cell still active? Have you seen the Gates Foundation’s call for letters of intent?
Would you be interested in collaborating in some way: with my univ? with me? My web site address with
publications etc. is below my address.
I am attaching a copy of the Call from their web site. The deadline for a brief Letter of Intent is end-July. I will be
with my mother in Whitefield mid July to early August if we wanted to discuss a draft letter and meet to work out
details.
I do hope we can work together. My best wishes.
Bella
Bella Mody, Ph.D.
Professor
College of Communication
Michigan State University
East Lansing, MI 48824-1212
www.msu.edu/~mody
fax: 517-355-1292
email: mody@msu.edu
^i'^o
6/26/2003
India AIDS Initiative - Bill & Melinda Gates Foundation
BILL^MELINDA
Gates /***^^**
Page 1 of 2
Home > Global Health > HIV/AIDS & TB > India AIDS Initiative
India AIDS Initiative
Background
With a population of over 1 billion, India has the second largest number of HIV positive persons in the
world, currently estimated at around 4 million cases. Although HIV prevalence nationwide is relatively
low (0.8%), given the size of the population and widespread poverty, India could face a much bigger
epidemic. India has a very small window of opportunity within which to control the HIV/AIDS
epidemic. A significant increase in prevalence will overwhelm India and it is therefore critically
important to act promptly to keep the epidemic under control.
The epidemic in India is spread over vast and varied geographies and is being driven by small and
highly mobile risk groups. The current response is fragmented and insufficient in scale. Public
awareness is limited and there is a lack of resources for large HIV/AIDS programs. In addition,
considerable stigma and discrimination present a real challenge to the fight against HIV/AIDS.
Initiative Description
The overall goal of the India AIDS Initiative (IAI) is to decrease HIV prevalence in high-risk groups
and stabilize it in general population by 2008. The IAI pursues two objectives:
i. Reduction in HIV and Sexually Transmitted Infection (STI) transmission in select core
populations in areas characterized by population mobility; and
2. Increased leadership and improved enabling and learning environment for effective HIV/STI
prevention and care.
The initiative focuses on core transmitters, mobile populations and their partners. Prevention of HIV
among mobile populations and their core-transmitter partners will have a highly efficient "multiplier"
effect. Reduction in HIV/STI transmission in core populations will prevent a chain of HIV infection in
other geographic areas nationwide. Because of denial, stigma and apathy, advocacy efforts will be
critical at all levels (national, state, district) to build a supportive environment for IAI interventions.
The strategy consists of two core strategies and four inter-related and synergistic supporting
strategies. Each strategy targets specific groups, and has a set of major activities, indicators and
expected outcomes.
Core strategies:
District Focus, State impact (Sil)
Interventions will be implemented in approximately 100 districts of 6 high prevalence states (Andhra
Pradesh, Tamil Nadu, Karnataka, Maharashtra, Manipur, and Nagaland) for female and male sex
workers, their clients, injecting drug users, and bridge populations in high and potentially high
prevalent districts. Interventions include implementation of a comprehensive integrated package of
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India AIDS Initiative - Bill & Melinda Gates Foundation
Page 2 of 2
* services. Core interventions will consist of STI treatment, Behavior Change Communication (BCC),
condom promotion, harm reduction. Additional interventions include Voluntary Counseling and Testing
(VCT) services, care and support.
Protected Passages (SI2)
Interventions will be implemented along 7,000 kilometers of the major highways in India (NH1-9,
North-South and East-West corridors). Target groups include inter-state truckers/helpers and
highway-based commercial sex workers/partners. Core interventions include STI treatment, BCC,
condom promotion, and VCT. Additional interventions consist of harm reduction, care and support.
Supporting strategies:
Integrated communication (SI3)
Design and implementation of a comprehensive communication strategy that will give individuals the
knowledge, skills and motivation needed to reduce the risk of HIV/STI transmission.
Essential advocacy (SI4)
Design and implementation of advocacy strategies at all levels to support changes related to HIV/STI
programming in policies, attitudes among key political, governmental, private sector, and societal
leaders.
Knowledge building and impact monitoring (SIS)
Design and implementation of a research agenda for HIV/STI programming.
Raising capacity (SI6)
Design and implementation of a strategy to increase the quality and the quantity of organizations and
individuals working in the field of HIV/AIDS through fellowships and other training programs.
Funding Opportunities
The foundation is currently seeking letters of inquiry (LOI) from outstanding international and Indian
organizations interested in contributing to the India AIDS Initiative.
Read more ►
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BILL^MELINDA
Gates
Page 1 of 3
Home > Global Health > Grantseekers
India AIDS Initiative - Letter of Inquiry
Please follow these instructions carefully when submitting an LOI for the India AIDS Initiative. All
organizations must submit an LOI using the form provided below. This includes organizations applying
to the foundation for the first time, as well as those who are current or previous foundation grantees.
Prior to requesting funding, carefully review the description of the India AIDS Initiative to
determine whether the proposed project falls within the initiative's scope and strategy.
Letter of Inquiry Guidelines
Only letters of inquiry will be reviewed in response to this solicitation. Please do not submit a grant
proposal in lieu of an LOI.
For the current phase of the program, the foundation is requesting LOIs from organizations interested
in implementing interventions for the District Focus, State Impact Initiative (SI 1) in the states of
Tamil Nadu, Maharashtra, Manipur, and Nagaland. LOIs are also being solicited for the four
supporting strategies: integrated communication; essential advocacy; knowledge building and impact
monitoring; and capacity building.
Eligibility criteria
The foundation invites organizations that are 501(c)(3) public charities or organizations registered
with the Indian Central Government under the Foreign Contribution (Regulation) Act (FCRA)
1976 to submit Letters of Inquiry (please see definitions below). These organizations should have
prior experience in implementing large scale HIV prevention programs, have the capacity to provide
technical support to local NGOs/CBOs and be able to demonstrate prior funding support from
international donors. Organizations that are awarded grants as a result of this announcement will
partner with local non-governmental organizations (NGO's) and community-based organizations
(CBO's) through a separate process.
• 501(c)(3) Public Charity: Your organization has a determination letter from the United States
Internal Revenue Service that designates the organization as exempt from federal income tax
under section 501(c)(3). The organization is further defined as a publicly supported
organization under section 509(a)(1), 509(a)(2), or 509(a)(3).
• FCRA: Your organization is registered with the Indian Central Government in terms of section 6
of the Foreign Contribution (Regulation) Act 1976.
LOI Format
Please use the LOI form when submitting your LOI. Due to tax, legal, and reporting issues, we
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Page 2 of 3
require that all LOIs be submitted in English.
@ Download File
Submitting your LOI Form
Please submit your LOI electronically in the format provided. It is not necessary to mail a duplicate
hard copy. Please do not send any additional attachments or information (videos, books, program
materials, etc.)
Please submit LOIs to the India AIDS Initiative (IAI@gatesfoundation.org) no later than 5:00pm
International Standard Time (1ST) on July 31, 2003.
Review Process
The foundation will send an acknowledgement after receiving your LOL Your LOI will be reviewed and
a decision will be communicated to you in approximately six to eight weeks. If your LOI is accepted,
you will be notified and invited by the program staff to submit a grant proposal. A request for a
proposal does not guarantee funding.
If your LOI is declined, the reason will be shared in the response letter. Due to the extremely high
volume of LOIs, it is not possible for staff to discuss declination reasons.
Review Criteria
Foundation staff will review all Letters of Inquiry. The LOI will serve as the basis for requesting a
detailed grant proposal. Letters of Inquiry and grant proposals will be evaluated using the following
criteria:
Significance: Does this project fit within the IAI's overall strategic framework and priority areas? If
the aims of the project are achieved, what impact will the proposed work have on the HIV/AIDS
situation in India? How will scientific or program implementation knowledge be advanced in India, as
well as globally? What will the effect of this project be on the concepts or methods that drive this
particular field?
Strategy: How does the project align with the priorities of the Bill & Melinda Gates Foundation's
Global Health program, and specifically, the objectives of the India AIDS Initiative?
Approach: Are the project/research design, conceptual framework, methods, and analyses
adequately developed and appropriate to the aims of the project? Do you acknowledge potential
problem areas or issues that could hamper the success of the project?
Innovation: Does the project employ novel concepts, approaches, or methods? Are the aims original
and innovative? Does the project challenge existing paradigms or develop new methodologies or
technologies?
Potential for Affecting Change: Does the scope, scale and design of the project attempt to answer
a critical question outlined in the India AIDS Initiative; offer stepwise improvements or a solution to a
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Page 3 of 3
*
'
problem; develop tools or knowledge that drive toward resolution of HIV/AIDS in India?
Budget: Is the budget narrative clear and complete? Are costs reasonable for the work described?
Are salaries in line with other comparable positions in the field? Are indirect costs within foundation
guidelines?
Organizational Strengths: What is your organization's comparative advantage in conducting the
proposed work? What is organization's track record in managing large-scale programs, particularly in
India?
Appropriateness for Independent Sector Funding: Can the funding for the proposed work be
accessed through other public or private sector resources?
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✓
Letter of inquiry - Summary information
Bill & Melinda Gates Foundation
India AIDS Initiative
Date Submitted: mm/dd/2003
Project Name:
IAI Strategy Addressed:
Organization Name:
Primary Contact for LOI:
Prefix
Title
Address
First Name
Surname
Telephone
Fax
Suffix
E-mail
Web site
Amount Requested (U.S. dollars):
Project Duration (months):
Does your project involve clinical trials with human subjects?
U.S. and India Tax Status (Refer to Tax Status
Definitions):
Geographic Location(s) of Project:
Charitable Purpose: Please include the following components: disease or health condition; strategic
approach; if appropriate, location of activity and Omit to 255characters.
Example: to demonstrate an effective and transferable program model for the control ofX-disease in Ylocation.
Project Description (describe how the funds would be used to meet the charitable purpose, limit to 150
words)’.
If relevant, please briefly describe any previous contact with the foundation:
Letter of Inquiry - Narrative
Bill & Melinda Gates Foundation
India AIDS Initiative
Date Submitted: mm/dd/2003
Please follow the outline below, limiting your narrative to three pages or less. Please use 12point font and one-inch margins; include your organization’s name and the page number in the
footer; and include the submission date in the header.
■
■
E-mail your completed document to IAI@gatesfoundation.org with lAI-LOl indicated in the
subject line.
Please delete all instructions before submitting your LOI.
I. Background and Rationale
Clearly articulate which strategy your project addresses. The IAI is currently seeking LOIs for all
strategies, except for the Protected Passages.
Describe your approach to the problem. Describe how the proposed project relates to the
broader context of the IAI, and discuss how the proposed solution will impact HIV/AIDS in India
(i.e., cost, appropriateness, improvement of current technologies, etc.). Describe your sense of
the limitations of the current programs. Provide a brief review of the antecedents to your project.
II. Goal and Objectives
Please describe the goal and expected health outcome(s) of the project. Describe the
measurable objectives to be accomplished during the project period and explain how they will
contribute to the overall achievement of the lAI’s goal and expected health outcomes.
III. Project Design and Implementation Plan
Please describe the research/program design and major activities required to achieve the stated
objectives. Specify the scope for the project (target groups), the geographic area(s) where the
project will take place, and the time period within which it will be completed. Describe factors that
could inhibit the success of the proposed activities and how these could be overcome. Explain
how these activities will be sustained or transitioned to other sources of support at the end of the
proposed project period.
IV. Monitoring and Evaluation
Comment on your plans for monitoring and identifying the specific outcomes and indicators that
will be used to define progress and success during your project period. Describe evaluation
plans clearly outlining baselines and targets for indicators.
V. Organizational Capacity
Please provide a brief description of the organization’s history, mission, structure, and activities
in developing countries, particularly in India. Describe the comparative advantage your
organization brings to accomplishing these activities.
VI. Budget
Please provide a preliminary project budget by major activities and year. If appropriate, please
indicate whether support (in-kind or financial) is being provided for this project by other
organizations. Please provide all financial figures in U.S. dollars
ICHAP [ india-canada collaborative HIV/AIDS projects
Page 1 of 4
— 2-S .
[ Under embargo until November 30th, 2002 ]
"When the history of our time is written, it will record the collective efforts of societies responding to
a threat that has put in balance the future of whole generations." - Nelson Mandela, World Economic
Forum, Davos, 1997.
Come December 1st and once again, we will observe World AIDS Day. Another year in a 20 years
history of the epidemic that has spread like wildfire around the world. The day provides us with an
opportunity to remind ourselves of the promises we've made promises to halt the epidemic and prevent
new infections and care for those already affected it is a time to reflect on what we've managed to
achieve, share our learning, rethink and rebuild out strategies to move forward with greater urgency and
I
effectiveness.
Worldwide currently, there are an estimated 40 million people who are HIV positive. Five million were
newly infected with HIV and three million people dies of AIDS this year alone. HIV/AIDS is among the
top four killer diseases in the world today.
Developing countries have been the most vulnerable to this ranging epidemic. As per 2001 figures from
the National AIDS Control Organisation (NACO) India alone has an estimated 3.97 million infected with
HIV. With infections having doubled since 1997, the country is predicted to soon have the highest
number of people with HIV anywhere in the world.
Due to a number of factors, most of the infections continue to remain undetected and unreported. In
fact, HIV/AIDS initially thought to affect only "high - risk" population such as sex workers and truck
drivers, has long since permeated the general population, with rapid increases in infection among young
married women who have no risk factor other than, very simple being married.
The factors intensifying the country's vulnerability to HIV/AIDS are many; poverty, illiteracy and
ignorance; the low status of women; the burgeoning numbers of sexually active youth in the 15 - 24 age
group. We continue to be confronted by an overburdened, inadequate health system struggling to
provide adequate care.
Underlying all this is the social climate; social norms that discourage open,
healthy discussion of sex and instead drive sexual activity into subterranean spaces characterized by
misinformation or lack of information and risky, unsafe sex.
Women and youth are especially
vulnerable, given their limited access to health information and services and inability to negotiate safe
sex to protect themselves.
TOP
The Karnataka Scenario
Within the country, Karnataka is one of the six "high-prevalence" generalized epidemic states together
with Maharashtra, Tamil Nadu, Andhra Pradesh, Manipur and Nagaland. It is estimated that about 1.35
percent of the state's adult population or 400,000 people are HIV positive. The number reported are
just the tip of the iceberg.
lib
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India
Karnataka
Risk Transmission
No. of
Categories
Percentage
Cases
No. of Cases
Percentage
Sexual
34323
84.32
1377
86.49
Perinatal Transmission
1052
2.58
56
3.52
Blood and Blood Products
1233
3.3
13
0.82
Injectable Drug Users
1217
2.99
14
0.88
History not available
2883
7.08
132
8.29
Total
40708
100
1592
100
Source : NACO website, KSAPS data, as on September 2002
A Detailed analysis of sentinel surveillance data in the year 2001 also reveals that;
• Less than half the state's districts are covered by sentinel surveillance.
• There are geographic inconsistencies in HIV prevalence: some northern districts have high
prevalence, others lower.
• High prevalence is seen in both rural and urban areas.
• HIV prevalence is higher among people who are
• Illiterate
• Migrants.
• HIV prevalence is higher among young pregnant rural women attending antenatal clinics than
their urban counterparts.
• There is a higher prevalence among women whose husbands are in agricultural or unskilled
occupations.
• Between 11-24 percent of STI patients (almost one is every four) are already infected with HIV
TOP
KSAPS : An Overview of Efforts
Under Phase 1 of the National AIDS Control Programme (1992 - 1998), a State AIDS Cell was formed
under the Directorate of Health and Family Welfare in 1992. In 1997, this was established as the
Karnataka State AIDS Prevention Society (KSAPS).
The Society's initial efforts, in line with the national mandate, focused more on general awareness to the
community, establishing
information systems for surveillance, blood safety,
STI and condom
programming apart from establishing system for program management.
However, in the second phase, the focus areas for the Society are:
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Page 3 of 4
• Targeted Interventions for high -risk groups through condom promotion, NGO participation and
service for management of Sexually Transmitted Infections.
• Preventive
Interventions
for
general
population such
as
increasing
awareness through
information, education and communication (IEC), school AIDS education, Voluntary Counselling
and Testing Centres and ensuring Blood Safety.
• Provision of low-cost HIV/AIDS care.
• Institutional strengthening through training, sentinel surveillance and computerized monitoring
information systems.
• Intersectoral Collaboration.
A significant development has been the recent establishment of the India-Canada Collaborative
HIV/AIDS Project (ICHAP) funded by the Canadian International Development Agency (CIDA).
The
Project, which is being implemented in Karnataka and Rajasthan, has been established to provide
technical assistance at the national and state level to key areas of emphasis by the government such as:
• Communication including Media Advocacy and Communication to promote behaviour change.
• Management of Sexually Transmitted Infections.
• Focussed Interventions through NGOs for vulnerable populations.
• Voluntary Counseling and Testing.
• Care and Support.
In all of these areas, building the capacity of key stakeholders to implement HIV/AIDS prevention and
care programs is a critical need, especially given that this is an issue with complex social, economic,
medical ethical dimensions.
TOP
Some of our key achievements in the last one year included :
• Successful implementation of the Prevention of Material to Child Transmission (PMTCT) feasibility
study. Vani Vilas Hospital has been selected as one of the 11 sites in the country of the PMTCT
project. The project involves administration of AZT to pregnant positive women to reduce the
risk of transmission to their unborn children.
• Completion of a community - based STI survey.
• Completion of a mapping study of high risk populations and geographical areas and development
of strategic interventions based on this evidence.
• Launching a Legislators Forum by the Chief Minister to ensure that legislators are sensitized and
advocate for HIV/AIDS prevention efforts.
• Upscaling of Voluntary Counseling and Testing Centres from 6 to 31, ensuring in the process that
every district in the state now has a functioning VCTC with necessary infrastructure, testing kit
and trained male and female counselors in place. What's equally noteworthy is that Karnataka is
now probably the first state in the country to establish VCTC as the taluka level. Figures within
the first month of inaugurating the centers in Mudhol and Jamkhandi (Bagalkot district, Northern
Karnataka) indicate that almost 50 percent of the clients who were tested were diagnosed to be
HIV positive - a grim reminder of the task that lies ahead.
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TOP
Other significant activities planned for the immediate future are :
• Expanding sentinel surveillance for HIV (ANC) from 10 districts to 27 districts. This is part of our
efforts to ensure strategic, evidence - based planning of programs.
• Instituting Press Fellowships for improving and increasing media coverage of HIV/ AIDS.
• Establishing PMTCT services at every district.
Much has been achieved - but a lot more needs to be done. For this, the government's efforts alone with
not suffice. HIV/AIDS is not only a health problem but a wide - ranging development and social issue.
It is not possible to bring about requirement behaviour change without encouraging and facilitating a
healthy discussion on sex and sexuality, condom promotion, and sex education for adolescents who
constitute a significant proportion of the population. Continued silence on these issues will only bring us
closer to some of the African countries where the life expectancy has decreased considerably due to
HIV/AIDS
An expanded multisectoral response is critical if we are to stem the tide of the epidemic. This calls for a
response within every sector : education, industry, media, women's rights/welfare, to name a few.
Corporates and industry must ensure HIV/AIDS education in the workplace, provision of necessary
health services to employees, and prevent stigmatization and discrimination of infected employees. TV
and film producers need to integrate HIV/AIDS issues into entertainment formats to change social norms
and values that are fuelling the epidemic. The media will also have to debate issue relating to HIV/AIDS
prevention and care and support to the infected and affected.
All Government departments and organizations in the private and NGO sector will have to integrate the
HIV/AIDS education and awareness activities into their mandate until the State and the country is able
to have some control over the epidemic.
sections of the society.
This epidemic demands the active and collective effort of all
We may yet be able to halt the epidemic and alter the course of history. We must act now.
Statement from the Project Director, KSAPS
December 1, 2002.
TOP
Copy Right Reserve
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Page 1 of2
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21MTC Response on Programme Implementm (ion Guidelines for a Phased Scale up
of Access io Antiretroviral Therapy (ART) for People Living with HIV/AIDS
(PT,HA)
the Affordable Medicines and treatment Campaign (AMTC) is a national campaign
launched on World AIDS Day 2001 in different parts of India, with the following mission
statement: The right io life and health is a fundamental right guaranteed to e^ery
person living in India and is non-negotiable This campaign aims to demand and
create an environment that will ensure sustained accessibility and affordability of
medicines and treatment for every individual in India} including access to affordable
Anti-Retroviral Therapy for persons living with fTIV/ATDS. This campaign shall he
democratic and participatory. It will seek the mobilization of communities and civil
society to make state, national and international agencies and industry accountablefor
securing health for all
A recent development of significance has been the announcement made by Sushma
Swaraj on the eve of World AIDS Day last year, of the government’s intention to finally
provide ART through the national AIDS control program from T1 April 2004. We are
happy that through this plan, the Government and NACO have positively responded to
[and accepted] one of lhe long-standing demands of networks of people living with
HIV/AIDS, a range of activist voices, of advocacy efforts by a range of groups and
campaigns such as the AMTC. This is the recognition that the HIV/AIDS epidemic has
indeed impacted a large number of people in India, many of whom are in urgent need of
treatment that they cannot afford. It is also a recognition that such treatment can actually
be provided Further, it is a recognition that India has a relative advantage, having a
vibrant generic drug industry, an advantage that has not thus far been used to its full
potciiliaf Most significantly, it is an attempt to rc-constilute HIV as a treatable condition
and thus, to reduce the stigma and fear that surround it, to encourage more voluntary
testing and thus to bring about the normalisation of HIV/AIDS.
The document titled “Programme Implementation Guidelines for a Phased Scale up of
Access to Antiretroviral Therapy (ART) tor People Living with lUV/ALDS
(PLHAFshows a paradigm shift irom a prevention focus to an approach where the
synergies between care/support and prevention are be put in action. While we eagerly
await the realization of the objectives of the program, we have some concerns related to
the manner in which the program is envisaged and suggestions to improve the concept
and implementation of the ART rollout.
The mass provision of ART is a complex process, which can backfire seriously if not
carried out properly. Sustainability and context sensitivity of such a program is of prime
importance The risk of resistance to the drugs is high and. as has been seen with the
experience of the development of MDR TB, a careless program could lead to a more
complicated epidemic. Similarly, the high level of toxicity and experiences of severe side
effects make it necessary' that the mass provision of ART be a part of a more
comprehensive program for the provision of care and support. Further, lhe impending
changes to patent laws could soon drastically reduce the government’s ability to actually
procure these drugs [and new line regimens] at affordable rates. As such, the program
itself needs to be one that is based on the experiences m and of the public health system.
the experiences of people providing and receiving ART in the Indian context, and
retaining as the base, a human rights approach to public health strategy.
Although feedback from civil society, on the rollout plan, has not yet been solicited by
the government, the AM 1C is here presenting a preliminary response to it. 1 he following
points have been articulated by members of the campaign and other friends, over email
and through brief discussions. As stated earlier these comments are intended to be taken
in the spirit of constructive suggestions.
Main points of concern:
Siiuiegv to bt 'aitf about an enabling environment - The inherent logic of the program is
that the provision of treatment will contribute towards the creation of an enabling
environment, whereby people have an incentive to voluntarily access testing facilities and
health care services. This establishes the relationship between care/support and
prevention. While such recognition is positive, there remains some ambiguity in the
document, where it refers to die ‘idcntificalion ’ and ‘tracking’ of people who may test
positive. There is no doubt that m order to receive treatment, people must first recognize
themselves as needing it. This implies large increases in testing and access to healthcare
services. The question here is, how is this increased testing envisaged? In this regard, the
plan identifies certain ‘entry points’ for ART, including STD clinics, PPTCT centers.
Blood B<mks, TB DOTS centers and government hospitals. The ambiguity in the
document lends space for mandator/ screening of all those who access these sendees.
This may have the undesired impact of actually decreasing access to these sendees,
despite the promise of treatment for those who need it. The present minimal amount of
voluntary’ testing is indeed more complicated - stigma around TTTV/ATDS, in other words,
is brought about by more factors than the inaccessibility of treatment.
The document needs to clearly recognize the difference between creating an enabling
environment where people are encouraged to use the services of VCCTCs and tracking
down people for the purposes of providing treatment. The NACP identifies itself as being
based on a ‘human lights approach ’. This should include addressing concerns such as the
need for informed consent, confidentiality and non-discrimination. The commitment to
these principles needs to be clearly stated. At the outset, it needs to be made clear that a
promise of treatment does not amount to a justification for doing away with adherence to
human rights.
Maintaining confidentiality - scaling up of ART requires a careful consideration of how
confidentiality will be maintained. This is more so when considering the mandate of
enabling adherence to the treatment. While tlie document does contain a minimal
reference to the need for maintaining confidentiality, there is no clear conceptualization
of protocols and systems through which confidentiality will be ensured. However, the
document talks about providing identity card to persons on ART. This again, would
impact the efficacy of (he program. Hence, we feel that confidentiality norm shoul not be
compromised al any stage of the treatment.
f unding and Siistaitiabiiit? - ART is not a one-off treatment but is meant to continue for
lite. Interruption of the therapy has been seen to significantly raise the risk of resistance
to the drugs and a drastic decline in health. In this context, sustainability of the treatment
program is of central importance. As of now, there is no reference in the plan to the
budget which has been allocated for purchase of ARVs, the estimated price of purchase,
how much monev has been set aside, from what source, to buy medications at what price,
and from whom. Without this information what wc basically have is a training manual for
ARV scaling up without an assurance of sustainability.
Some estimates place the expected cost for the treatment plan as Rs 500 Crore per
annum. Of the Gh AlM commitment of USD 140 million (Rs 700 Crore), spread over a
period of 5 years, only USD 100.OS million (Rs 500.40 Crore) is for HIV/AIDS.
Additionally, this commitment is geared towards ART programs being run by NG<)s. It is
not clear whether the government plan is dependent on resources from the GFATM. At
lhe same lime, the government docs not seem to have moved the Planning Commission
or included the cost of the program in its interim budget. As such, there is no hint of
where the resources for the program are expected to come from.
The document recognizes that India has an established ‘domestic drug manufacturing
base’ but fails to recognise 'dial Hus relative advantage may not survive much longer if
strategies such as pushing for a TRIPS review, and building the capacity of public sector
industry to provide drags are not simultaneously considered.
Procurement - there is no clarity on the plan for procurement of drugs, facilities and
services that have been mentioned in the plan. The only mention is that lhe procurement
will be done by NACO based on estimates provided by SACS. The constant reference to
'public - private partnerships', seen in conjunction with the impending amendments to
the Indian Patent Act which will seriously harm the generic drug industry implies that
the government may soon be in a position where it will be held at ransom by the
mullinalioual pharmaceutical industry and have lo depend on charily ol the drug industry.
Further, there is no mention of mechanisms to ensure transparency of the process of
procurement, a concern that needs to be addressed at the inception of the program itself.
will get the treatment? The plan document does not specify’ how many people will
be given treatment when. It refers to providing treatment tor 100,000 "starting on April
1st, 2004”. The actual extent to which the rollout plan will address treatment needs in the
epidemic right now is ambiguous. It is interesting to note here that the evaluation of
number of people who need ART is to be earned out by SACS, and that the deadline is
very short.
At present the government plan limits the coverage of the program by identifying certain
categories of people as beneficiaries. At present, the only beneficiaries identified are (i)
sero-positive mothers who have participated in the PPTCT programme; (ii) seropositive
children below the ago of 15 years; and (iii) people with AIDS who seek treatment in
government hospitals. It is important to know, but to difficult to estimate, how many
individuals such a scheme would cover. We estimated that the number of pregnant
women who would be covered with (his new scheme. Assumptions were drawn from
National Sample Survey (NSS) 52M round. National Family Health Survey 2 and NACO
on the following parameters: estimated number of women in ago group 15-49 percent that
seek antenatal care, percent that visit government facilitates and estimate of 111V
prevalence among ANU attendees (assumed 1 percent prevalence). Based on these
assumptions, it was estimated that about 55, 000 pregnant mothers who were HIV
positive would seek care in government facilities. Of these about 83000 pregnant HIV
positive women would be ART eligible in a year, and the target for the new policy. NSS
and other statistics indicates that a much lower percent of all those who seek care about
18 percent seek care in public facilities for their illnesses. If we take the population who
are ARI eligible (7,50,000) then about 1,35,000 individuals would be accessing public
health facilities. This of course includes the pregnant mothers as well. Even if we add all
the pregnant mothers here, we get 143000 individuals who will be covered by the new
programme. Adding 13. 000 who are already being covered currently, we arrive at 1, 56,
000 individuals who arc going to be covered by ART. This still leaves a gap or about
600000 individuals who are not covered by ART.
Further, a miniscule number of women living with HIV/AIDS have access to the PPTCT
program, many may not participate for a range of complex reasons, and of those who do
participate, net all ore in need of ART. Similarly, there is no explanation why only those
who seek treatment in govemmeni hospitals wiii be provided treatment, considering the
high rates of discrimination and refusal of treatment in the public sector in many parts of
the country. The problematic presumption here is that the public health care system is
already a iunctional site for treatment of PLWHA, one which is repeatedly disproved by
real life experiences. Third, the document does link up with the indicators for ART as
idenliiied in lhe (draft) guidelines on ART published recenily by NACO. These
guidelines lay out in detail the government’s own prescription for when and in what
conditions ART is to be started. In the presence of these guidelines, the reasons lor using
other indicators, such as participating in PP 1'01 programs, or of qualifymg as an ‘AIDS
patient’ are unclear. It is one thing to identify certain sites where ART will be provided
and quite another to limit the benefits of the program to certain sections of the population.
The experience of refusal of treatment and of discriminatory behaviour in health care is
magnified tor marginalized populations. It was the lack of MSM friendly sendees, for
examp 1e> that justified focused targeted interventions’. Basing the treatment plan in
governmeni hospitals is thus a lacil exclusion of lhese populations from lhe ireaimenl
program There is no justification provided for such exclusion The government plan thus
emerges as a moralistic framework of ‘treat the victim’, one that sits well with the
moralistic tone that seems to have seeped into AIDS control policy in India in the last tew
years.
Bole afPLHA Net Work, CM1 Society Organisations and NGOs: Over the years many
NGOs are providing ARV treatment and developed expertise in the area. However, the
plan covers only government hospitals and gives only minimal role to NGOs and civil
society organisations such as home visits follow up of cases etc. The plan should make
use of the experience of these organisations. This is important because studies show that
the majority people do not depend on government hospitals for health care.
Hew and where will the treatment be provided? The document identifies three phases of
(he rollout program. The first phase involves preparing 15 centres in the six ‘high
prevalence stales’ to provide ireaiment, lhe second extends this to all government
hospitals with medical colleges and the third to all district level hospitals in these states.
To tliis end, health cate wotkers at these various sites will be trained over a period of five
days on a range of issues relating to the provision of AR I . Iwo mam concerns need to be
emphasised here. First, the reasons for a focus on high prevalence states are unclear.
especially where the provision of care and support is being seen as related to a prevention
strategy. Second, systemic and infrastructural issues of preparedness are not addr essed by
the program, which presumes that five days of 'training9 will be sufficient to enable an
effective system of ART provision.
Finally, almost all the centers where the treatment will be provided are located in cities,
with a concentration in Chennai and Mumbai. It needs to be emphasized here that if
access to treatment is to be a reality, rather than simply a populist measure, the centers
must be closer io those who need the treatment, must be PLWHA friendly, and must
match patterns of health seeking behaviour in the populations
Nutrition — the rollout plan recognizes that nutrition is a requirement that needs to be
provided for alongside the rollout program. Unfortunately, it does so in terms of
provision of anabolic steroids, which by themselves are controversial hormonal drags that
are to be used in very particular circumstances. The provision of everyday low cost
nutritious food in different settings is not addressed.
Gaps in training of care providers - the plan has a detailed description of the training
workshops that will go towards building the capacity of the centers to provide ART.
Almost all the sessions are medical in nature, as though the complex socio-economic and
political issues that need to be considered in the provision of ART have already been
addressed. In a context where discrimination in healthcare continues to be a widespread
experience, creating ‘preparedness ’ will involve a more serious engagement with these
issues as well. Whereas there is a half-hour slot for discussion of 'legal and ethical
issues’, there is no scope for a focus on human rights issues and protocols, in terms of
attitude or actual systems through which confidentiality and informed consent will be
ensured. Further, there is minimal scope lor learning from people’s experiences at the
field level.
Testing facilities not addressed - the provision of ART requires not merely ARVs, but
requires as well accessible and affordable CD4 and Viral load testing facilities. These
again, are not addressed by the rollout plan, although the NACO -WHO workshop on
28Qi-29lh January 2004 did have presentations by private corporations on their capacity to
provide such testing facilities. Again the growing dependence on private corporations
needs to be accepted with caution. With respect to such testing facilities in particular, the
field level experience in some parts of the country seems to be that governmental
facilities, however limited, are more reliable than those provided by private companies.
NACO should make efforts to establish at least one CD4 testing labs in every
districts and at least one PCR labs in evetyr state.
Regimens being offered - the framework of the rollout plan envisages a standardisation
of drug regimens, based on WHO recommendation on a "public health approach .
Unfortunately, this goes against experiences in clinical practice. As such, the
standardisaiton of regimens is an aspect (hat still needs to be debated and cannot be taken
for granted as the desirable strategy. How the specific requirements of specific
individuals arc to be addressed is not envisaged in the document. Further, there seem to
be some problems with the regimens prescribed in certain circumstances - for example,
whereas it is recognised that women receiving NVP as part of PP I CT programs may
have developed resistance to it, and thus, that the recommended first line regimen of
d4T/3TC/NVP may not be effective, the only alternative that is provided to them is
replacement of NVP with EVP. EVP as well, unfortunately, is not indicated in pregnant
women. In this context there other options available in western markets that have not
been suggested.
NVP was adopted as the strategy for PPTCT despite its rejection in healthcare systems in
Europe and the US due to the high risk of resistance, which could impact on treatment
options in the future. It is the effect of this decision that we are now faced with where a
certain segment of the population that needs ART will not have effective options. This is
an articulation of the implications of the politics of health. The rollout plan does not
recognize or address this
Language and presumptions - Finally, a note needs to be made of the largely insensitive
language of the document, and the continuing use of phrases that fuel stigma and
discrimination against people living with HTV/ATDS. Terms such as HIV infected and
‘indulging in “disinhibition”’ are scattered through the document. If this document is to
be the basis for training in die public health system where stigma is a definite problem to
be addressed, then a certain degree of sensitivity needs to be incorporated into it. Second,
the identification of beneficial and adverse affects of ART have been made in a manner
as to already place the blame of any failure of the program on people living with
HIV/AIDS, for example, through the emphasis on the phenomenon of ‘disinhibition’,
which thus far has only been identified in specific -weslem contexts. Similarly, concerns
with respect to adherence in the document seem to be an exercise of the political
construction of the third world patient’. The fact that evidence that forms the basis of
these concerns comes from particular western experiences needs to be clearly stated.
Since the document says 64 the document will be reviewed frequently so that it keeps up
also reflects the backward and forward linkages between
with new regimes
programmes for treatment and interventions for prevention of HIV/AIDS and care and
support of people living with HIV?AIDS‘‘. We hope that the above suggestions would be
incorporated in the coming days.
[it is clear that this has been due to the sustained advocacy efforts and impact by several
individuals and organisations including networks of people living with HIV/ AIDS, NGOs
working on HIV/AIDS and campaigns like the AMTC. which many of these networks
and NGCs have created and are a part of.]
FOR AMTC
K K Abraham
UMP+
Anand Grover
Lawyers Collective HIV/AIDS Unit
Ashok Rau
Freedom Foundation, Bangalore
Dr. Sangamitra Iyengar
S/A1RAKSHA, Bangalore
D Indumari
South India AIDS Action, Chennai
Dr. Jayasree
FIRM, Trivandrum
Kousalya
Positive Womens Network, Chennai
Mr. Manoj Pardesi
NlviP-r/ThJP-r. Poone
D Nooric
South India Positive Network, Chennai
Dr. Tokugha Yepihomi
YRG Care, Chennai
Dr. Indrani Gupta
Institute of Economic Grov.'th
Mayur Trivedi
liisUluic of Economic Growth
I
S3C | S'DK | N’T /.
’ ssp
HIA 4-ve Children Kottiyoor
Koniyoor is a small village smeared to te eastern pan of Kamrur disrrta i„ Kerala The neares. rarlmav
nauon ,s Thalasery whrch is Ao
aw2;, Hi|]s f„esls
a
-me teel lhar this is indeed Goe's Otvtt Cotmtty. The amtual festival of the Shiva Temple draws piiarims
mom al! over Kerala After the tisttval vteh iast for about twenty seven days the village settles back into
a autet peaceful routine fro another year. However the year 2003 witnessed something different. People
-om all over Kerala and even the neighboring states started to come 1
to this village. Soon Koniyoor
recame well known both in Keraia as well as outside the state. All this
3 was happening even after the
testival had come to an end. The reason was far removed from the shiva temple or
popular religiosity. In
tact Kottiyoor was now becoming famous on account of the discrimination that
was being meted out to
nvo children who had turned out to be Hiv positive.
The story of Rema Akshara and Anathakrishnan:
Shaji and Rema belong to a lower middle class family. They had three children Athira who is
eleven years old. Akshara who is eight years old and Ananthu who is six years old. Shaji Kumar, the
rither of Akshara and Anantaknshnan Was a motor mechanic who worked in Mumbai and Goa. Shaji
returned to his native village Kottiyoor aher having fallen ill a few years back. When he was taken to
Pariyaram Medical College, Kannur for a check up, it was found out that he was HIV+ve. Ihe doctor who
-as treating Shaji informed him and Rema his wife about this and asked them whether this should be
mxormed to anyone else. However even before they reached Kottiyoor after being discharged from
Panyaram Medical College, the news that Shaji was HIV+ve spread like wildfire. When they returned
people did not ask them directly about this but there was a visible change in their behanour. Some of
tttem would prevent their children mom coming to their house. Soon Shaji began to loose weight (the
opportunistic infection in his case was tuberculosis) and people began to ask Rema if it was true that he
-as HIV-ve. To this Rema replied in the negative and told them that he had T.B. not HIV. Meanwhile
^r.an was taken to a hospital at Pemvoor where he was treated for opportunistic infections.
Shajrs family then arranged for him to be transferred to Pratyasha Bhavan, Kannur. However this
--as done without the knowledge or consent of either Shaji or Rema and as a means of reducing the
emoarrassment that they were facing on account of the social stigma. Only on reaching Pratyasha Bhavan
did they realize that they were brought there to be admitted. Since he did not want to stay there and at the
same time not quarrel with his relatives, Shaji requested Rema to come back after a week and take him
heme. Later on when Rema tried m take him home, Shaji’s brother and family opposed it saying that the
xmlagers would not allow Shaji to enter Kottiyoor. In spite of this Rema got Shaji discharged from the
hospital and took him ho:
LT KS T B!
v ZL' ,C0“'d L
admitted and Rema was ,
Passed
hiv . it,
m
w nffle
death 0OTttd the tor
“ teOme
°f * M
the health depanmetn „i doctors- After S> TT
eon,ention
»f—
"nO“S W1'
Koniyoor and
was involved i- tz
.
found to be hue. Seeing and heaiio8
ing and hearing about this created a
villagers. When Shaii died me local health d
local health d. b
powdered slaked tae but
LX■
.
of
XT“
------jaji
J is not the dr
h„. hh,,
-d
in «
and bunthat! This
him ■„
This ^-eZZT
°f “
rr
he
’ heuer „a, shaji
HIV/AIDS ™S 'he
''ty *“ «* fear
“
actors After Snan s death a few institutions notab lv Sr r
she bad a house it, Koftlvoor and bothTZZr LIT
should they go and bee in a earn bo^ The locals
bv Rcm
Who is sick is being taken to Bangalore or anothe I
deeded to settle this _aT “ “
'
™>S
m
,V
°ffa'
why
C°nIented 11131 lf ever>' one
On account of the dead, of her father and the situadot,
home Akshara did not attend school for
somcime. Meanwhile sonre ne„be„ f„m the
man^emenvSXDP
approached Rema
a
Meanwhile Ananthaknshnan
uonunued ,o go ,o the t„ai anganwadi and as a reaction to his
«ked her no, to send her to sehooh al .he ,SSM
children ft„m fte mgmwadj
»as required to produce a cenacatt Co„cenline her
.0 continue her srudtes in the nearby Upper
fc
presence the parents pulled out their
out of the anganwadi as well!! Athira
stams and once that was done, she was allow
Initially there were rumours
among the
parents of the school tha, she was also sick bur the t'eachen, ■that
nave
been
clear
she
hence the question of her leaving the schoo! doesn, arise.
was HIV-ve and
Having neiaer a job as web as facing social ahetmrtoru Renla „„ he uua
3
and Ananthakrishnan) had to deoend on th h •
her chlldren (AtWra. Akshara
“ '*eU'
Around this time, Narajyotbi a local XGO m
hZ ""
d”"
^ey have given ftemaZn^Tin “r7 “
--YKsnam and Ananthaknshnan.
With the inr^f
the intention of getting the children back to school \-av< >,•
Department (offices of the AEO and DEO’) tv
J'
1116 Educad™
-d DEO). An official orier was aft. issued by th. Di5tnc, Co„ecMr ,o
ensure their readmission to the school. When approached, the school
authonties pointed out that they
long ume without giving any proper reason.
Taking into account the prevailing social situation at that Um
-ie. Xavajyothi decided not to press the matter
further that year. The next year (i.e., 2004). they started
to get in touch with the school from February
onw ards. In the month of March, a written request was sent to
the school asking them that a decision be
taken with regard to admitting both the children
and if this was not possible to specify it (that) in writing
A clear answer was however not <
conung and the school authorities pointed out that they could reply only
after a meeting of the PTA. which would discuss this i.
-------~s issue.
With the school remsing to admit .Akshara and AnantakrAhnan and
pr°per repl-v com'ng forth,
Rema decided to 20 on a strike alono 'th h
could not readmit Akshara since she was absent for a verv
“ fr°nt °f ,he
Th^v^an,^
«re exhaled The Cbref
“ ”i“b1' »“»»
--..- T: ”zt•- - .... .-.—......
Rema and her children, a Deputv Director of Education Mr
taptaenred. On reaebing
g
Hea.tais.resa ata' d.e staZZa“
O.D.E to the collectorate and asked to mat th
SUmmOned b>’ the
2.00 pm. At 2.00 pm, the D.D.E D E O AEO
ch>id™
A.E.O. and the children amved at the school The Rpnd
~~~~=
Heataasness who ™VK1 by 4.00 pm. she „„„
"paraffi of"0,her
Sh'~
i°dto“ ,hC n”na8'r °f fc' SCh°01 filed a
Chief xr°°"
C“n' “S
diseTZt T^”
_ble d.sease.
01 “d
1
chlldren
be
“P- ■»= order of the
SinM CMdre”
“V Ca"
—*
saliva and Mood
hence a
in his
XT' aPP'“5 “ be ll’e
X
classes
““
m’S"k‘Ced
b
i. .he ™
“ ™d>
ase m court, the manager, the PTA president as well as the panchayat president
nppmuehe.l lhe ('M's oilier rnpiesliiip, lhe older be niodilied. In Hie iiieiiiiliine Hie PTA hud mel nnd
l’l"VC‘l "'"C
'' lhe chikl'<'" were to be edueuted at SNI.P Sehool. A procession was also
organized by (be PTA in which the other children studying in the sehool carried placards saying, “We do
not want AIDS children in our school,”
Sonic of lhe dcninnds were
I
I he children should be taught In a separate classroom that is located 500 meters liom the school.
2.
I here should be no interaction whatsoever between Akshara and Ananthakrishnan and the school
or the other children studying there.
3.
None of the teachers in the school will teach these children.
I he request to have a classroom 500 metres away was turned down and instead a separate classroom
within the school compound was mooted as a compromise. Since none of the teachers were willing to
teach them, the Department of Public Instruction was on the look out for a teacher who would volunteer
to teach these children. Mr.Vinod Kumar who was teaching at Mulakunu U.P. School volunteered ano
was transferred to SNI.P School Kottiyoor as a special teacher. Mr. Mohandass one of the locals who has
been involved in getting Akshara and Ananthakrishnan back to school nnd his brother in law decided to
send (hen children Io sltidy along with Akshara nnd Annnlhnkiishnnn. While (his wns supposed to be a
temporary solution leading to complete integration of the children, this is becoming a more or less
peinianent solution in the eyes of those concerned.
Current Situation
Arc the children receiving proper education at SNIJ’ school? The
answer is both yes and no.
While a special teacher has been appointed and even other teachers
arc taking classes for these four
children, i( is a very artificial arrangement. These children long for the company of the other kids. Even i‘'
they get a live-minulc break, they go and sit on lhe staircase overlooking one of the regular classrooms
and observe what is happening there. Occasionally a few kids come and talk to them. While a few months
back Akshara and Ananthakrishnan were not allowed to
even mingle with others, today children have
broken this barrier. The great myth that playing together can t
spread the virus is being broken day after
day as some kids play along with Akshara and Ananthakrishnan.
Hui Hus is an uneasy calm. Rumours that Akshara and Anathakrishnan
syiingcs and blades in order to infect other children are
arc moving around with
very common in Kottiyoor. A teacher told me that
one day a parent came and produced a syringe saying that it was
brought by Akshara and given to her
child! On investigating lhe incident this teacher found out that there
was no connection between the
’
syringe and either Akshara or Ananthakrishnan! Another child had brought the syringe in question to
school. When I was present, there was an incident of other kids taunting Akshara “HIV, HIV”
Rema ’s latest CD4 count is 298 whereas Akshara and Ananlhu have a CD4 count of 860 and 839
respectively.
Many who arc involved in this issue would like other s to believe that everything is fine at
Kolliyoor. I lowever this is far from the truth. When I asked Roma about this she told me the following,
“/ do not want to forcibly get my children to sit in a regular class. When the people realize that HIV will
not be spread by my kids sitting along their children and ask me to send them to a regular class, only then
will I send them. Till then let them study in a special classT
Bcnsy and Benson
The first ease of discrimination against children in schools based on their II1V status that came
into lhe limelight was of Bcnsy and Benson. Two years ofslruggle lhal included n hunger strike as well as
the intervention of the President of India has got them back into school. However even today their
grandfather Mr. Geevarghese John is not sure of what will happen to them after his death. In fact he told
me lhal their lives would also come to a standstill once he passes away. Before 1 visited their home there
were reports lhal their grandfather is making money by using these two children. It was also reported that
he had misused the money that he had received from various quarters since he had an alcohol problem.
While it may or may not be (rue what I was able to understand from (he half a day that I spent with them
was that he loved these children a lot. A fact confirmed by Bro. Joseph Charuplackal who did a detailed
study of the situation in Benson and Bensy's case. When their 111 V i ve status was known, Bensy and
Benson had Io discontinue their studies as lhe school where they were studying was not willing to let
them continue there. Al present (hey are studying in (he local government school. I Tom being asked to
leave lhe school Io being asked to migrate Io some other stale by the then local representative, Mr.
Geevarghese John and these children have faced several forms of discrimination. Today with the children
becoming celebrities, everyone from political bigwigs, officials as well as other would like to be
photographed with them and promote their cause. Mr John brought an album that was nearly empty and
showed it Io me. “It was full of photographs of these children and their parents but the people who came
look them away and have never returned it." All (hat remains in lhal album is a picture of his daughter and
her husband. Bcnsy needs to get admission in the U.P school next year in order to continue her studies.
Mr. Geeevarghcse John has fears whether they wobld manage to secure admission for her or if the whole
cycle would repeal itself!
J
A report done by Bro Joseph Charuplackal into this issue throws
some interesting parallels
between the ease of Benson and Bcnsy and Akshara and Ananthu.
In both their cases over exposure has been a Factor that aggravated the problem. According the report by
Bro Charuplackal, one I'r.Johnncy Thottam who was involved on behalf of these kids went to the school
along with media personnel and demanded that the two kids should be taught in the school no matter what
the cost. If anyone had any objections they could remove their children from that school. However he also
demanded that every child who lell the school for this reason should be subjected to a HIV test to know
his/her status. How can anyone make such a stupid, insensitive remark? Is it a surprise that the other
parents would react as they did when the. so-called protectors of the most abandoned hurt their
sensitivities in such a crude manner? In one such meeting that was held to Find a solution there were
loieign media personnel veering the whole issue. Was (heir presence required? Did they contribute to
vitiating (tie already tense atmosphere? It seems that their presence did more bad than good for Bcnsy
When I went to meet Bcnsy and Benson, their grandfather told me that one of those who exploited them
was this person called Fr.Johnney Thottam. My efforts to contact him personally did not yield any success
and hence his opinion on this issue could not be obtained. But when an independent report as well as the
caretakers (hemselves level accusations al him one wonders why Ij Johnny got involved in this in the lirsl
place. Was it for the welfare of the children or his personal gain?
The locals interviewed by Bro Chain have said the following,
I he children were lirsl sent out of a school run by their own community. Why can’t they come forward
and take care of these children. In that school the parents pay fees for their children’s education and when
they don't want them (here is no problem. This school where (hey nrc studying is a govt, school where
children ol poor people like us study. We have no other option than sending our children to this
governmcnl school. What about those who sent them away from their lirsl school? They arc considered
good people, while we have become inhunHinl”
Mis. Dcepa Suresh (he P. I.A president has said in the report that when they went to meet the District
( ollectors ollice to Imd an amicable solution to the problem, they were told that even if all the other kids
h'll the school it will function for the sake of Bcnsy mid Benson. Such n reply inlin luted the other parents
who had gone Io meet the ofliclnls. liirther conlllctlng opinions from doctors abut (he facts of HIV had
confused the parents. Moreover the report even says that few doctors told the parents that even though
they knew the facts about HIV/A1DS. they would never permit their children to sit with IIIV-l ve children
in their schools, IIdoctors themselves say such a thing then why portray simple people like us as being
iiihunum? She ;isks.
Sandhya and her children
Stindhya (luime changed) is a young widow about twenty seven years. She stays in a village very close to
the border ol Kerala and Tatnilnadu. 1 first met Sandhya at the olTice of an NGO in I hiruvunanthapurani.
I ler husband had passed away three years ago. When it was discovered that they were positive, her
husband suggested to her that they commit suicide. However keeping her children in mind, she refused to
listen to him. One day he lell the house under the pretext of going to meet his friends and later people
discovered that he had consumed poison, lie died while being rushed to the hospital. While she and her
fust child Anjali (name changed) are both lliv I ve, the other two children arc IIIV-vc. According to her
while the locals know of her status as a HIV I ve person they are not very sure about it. Anjali was very
sick and bedridden when she was very young. Today with Anti Retroviral therapy she is much better but
wants to know when her medicines will stop. Her mouth is full of blisters as a result of oral candidiasis
but she longs to go to school and play with her classmates. When Sandhya’s husband passed away she
hud Io change the school where Anjali studied on account of opposition from siriiie of her relatives who
threatened to withdraw their children if anjali came to the school. A member of the management even told
her that sending anjali to school would be one of the greatest harm (hat they would be doing to society!
Anjah was sent to another school where the management was very positive and decided to admit her
while keeping her status ns 111 Vive confidential. Today while Anjali doesn ’t go to school on account ot
her poor health she still looks forward to the day when she can attend her classes! Sandhya’s case is not
an isolated one in her village there are reportedly nine families who were HIV +ve according to the
volunteer who accompanied me.
(■lobai Scenario
In 2003, an estimated 4.8 million people (range: 4.2-6.3
million) became newly Infected with HIV. This is more than
in any one year before. Today, some 37.8 million people
(range: 34.6-42.3 million) are living with HIV, which killed
2.9 million (range: 2.6-3.3 million) in 2003, and over 20
million since the first cases of AIDS were identified in 1981.
Asian Scenario
An estimated 7.4 million people (range: 5.0-10.5 million) in
Asia are living with HIV. Around half a million (range:
330 000-740 000) are believed to have died of AIDS in
2003, and about twice as many—1.1 million—(range:
610 000-2.2 million) are thought to have become newly
infected with HIV. Among young people 15-24 years of
age, 0.3% of women (range: 0.2-0.3%) and 0.4% of men
(range: 0.3-0.5%) were living with HIV by the end of 2003.
J
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An evolving response to the HIV-AIDS epidemic
in
Karnataka State, India
This relatively new health and social problem was recognised in India in 1986 and in
Karnataka in 1988. The first AIDS Surveillance Centre was set up in Bangalore
Medical College in 1987 with technical guidance from the Indian Council of Medical
Research. During 1989-94 the Blood Safety Programme, assisted by Government of
India, initiated the modernization of the blood banking system in Karnataka. The
State AIDS Cell was established in 1992. From 1992-1998, Phase I of the National
AIDS Control Programme (NACP) was implemented with World Bank assistance
through, NACO (National Aids Control Organisation), Government of India. Under
this programme 10 zonal blood testing centres were established and 51 blood banks
(37 government, 15 private) were modernized. Sectoral Surveillance was carried out
through 7 STD clinics and one antenatal clinic. Three Voluntary Blood Testing
Centres (VTCs) were set up. Training of doctors and paramedical workers was
conducted. Health education and IEC programmes reached out to communities using
a variety of media. STD clinics have been strengthened. The Karnataka State AIDS
Prevention Society (KSAPS) was registered . Phase II of the AIDS Control Project
was launched in December 1999 for a 5 year period till 2004, with World Bank
Assistance. It aims to reduce the spread or transmission of HIV infection in the State
and to strengthen capacity to respond to HIV/AIDS on a long-term basis.
NGOs have been active, particularly in Bangalore. Three NGO's provide care and
support to People Living With AIDS (PLWA's) in Bangalore (one also has a home
based care programme), one for women in Chickmangalur while another is being
established in February, 2001 in Mangalore. A well women clinic is run by an NGO
in Bangalore; two other NGOs work with CSWs in Bangalore and Belgaum. Other
NGOs work with preventive education in schools and industries in and around
Bangalore; and with truckers in Raichur, Bangalore and Mangalore. Two networks
namely the AIDS Forum Karnataka (AFK) and the Karnataka Network for People
Living with HIV/AIDS (KNP+) have been formed. Another NGO network, CHAIKA
has undertaken sensitization and training programmes for its member institutions
(over 300) working in different districts. A few mission and private hospitals provide
testing and inpatient facilities for HIV positive patients who need medical care.
Training of counsellors for HIV-AIDS is also carried out. Other NGO's include
E:\OFFlCE\Dr. Thelma Narayan\An Evolving Response To The HIV.docJanuary 19, 20019:05 PM
HIV/AIDS work as part of their overall health work. For instance HIV/AIDS
awareness is part of womens health empowerment training programme. The National
Law School University of India takes an active part in legal and ethical aspects of
HIV/AIDS.
Thus over the years a slow but sure response to the HIV epidemic has evolved in
Karnataka. Efforts are however inadequate and slow in respect of the rapidly
increasing trends in infection rates? the spread of the infection into the general
community and evidence regarding growing vertical mother to child transmission.
There is need for
a. diagnostic facilities in each of the 27 districts to run as Voluntary Testing Centres
with counsellors and social workers.
b. provision of facilities for care of AIDS patients who may not be able to live with
their families.
c. treatment for opportunistic infections, particularly TB. This should be integrated
with general health care services.
d. provision of antiretroviral therapy at low cost. The state / country could use
provisions under WTO for indigenous production which would lower costs
Prevention Therapy to protect against mother to child transmission needs to be
more widely available.
e. management and Prevention of sexually transmitted diseases
f.
training of networking for home based care, including use of herbal medicine and
other systems of healing with back-up support from referral hospitals.
g. promotion of healthy lifestyles among positive persons
h. preventive education among different groups, children, adolescents, womens
groups.
E:\OFFICE\Dr. Thelma Narayan\An Evolving Response To The HIF.docJanuary 19, 20019:05 PM
r
pis -
HIV/
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Adv/Letter/128/p/05
25 July 2005
Dear Colleagues,
Enclosed is the Lawyers Collective HIV/AIDS Unit Comment on the proposed
HIV/AIDS Bill. We have submitted this note to the Law Minister of Karnataka today.
Please do not hesitate to call us if you want clarifications on any aspects of the Karnataka
proposed bill.
Warm regards,
,7
Priti Radhakrishnan
Senior Project Officer
Lawyers Collective HIV/AIDS Unit - Bangalore
i
Encl:(l) Lawyers Collective HIV/AIDS Unit Comment on the proposed HIV/AIDS Bill
(2) Letter to the Chief Minister of Karnataka.
Vu
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'rv>■
1^1 Srfer
PMU : 7/10. Botawalla Building.
2nd
Floor, Horniman Circle. Mumbai 400 023. INDIA Tel. : 91-22-2267 6213, 2267 6219 Fax :91-22-2270 2563
email : aidslaw@vsnl.com / aidslaw@lawyerscollective.org
P.O. : First Floor. No. 4A. M.A.H Road. Off Park Road, Tasker Town. Shivajmagar, Bangalore 560 051. INDIA Tel : 91-80-5123 9130/1 Fax . 91-80-5123 9289
email : aidslaw2@lawyerscollective.org
P.O. :1S‘Floor. 63/2 Masjid Road, Jangpura, New Delhi 110 014. INDIA Tel . 91-11 2432 1101 / 2432 1102, 2432 2237 Fax:91-11-2432 2236
email : aidslawl@ndb.vsnl.net.in / aidslaw1@lawyerscollective.org
Regd. Office : 4th Floor Jalaram Jyot. 63 Janmabhoomi Marg, Fort, Mumbai 400 001. INDIA Tel.: 91-22-2283 0957, 2285 2543 Fax : 91-22-2282 3570
www. lawyerscollective. org
A Comment on the Proposed Karnataka HIV/AIDS Bill
Lawyers Collective HIV/AIDS Unit
The Human Immuno Deficiency Virus Affected And Acquired Immuno Deficiency
Syndrome Persons (Protection of Rights And Prevention Of Infection) Bill, 2005 is the
initiative by the Karnataka state government. The Karnataka state government has
recognized the needs of Persons Living With HIV/AIDS and is making a commendable
attempt in trying to legislate to protect rights and prevent the spread of HIV/AIDS.
It should be noted that if the State Assembly passes this bill in its present form, it may
result in harmful consequences. This bill, though a praiseworthy attempt, is ridden with
ambiguities. There is also an absence of key provisions that are essential to a
comprehensive statutory response to HIV/AIDS.
In this document, we set out in Part I a “Broad Analysis”, offering overarching
comments with respect to areas of concern in the legislation. In Part II, we undertake a
“Specific Analysis”, offering comments on selected chapters/provisions.
1
PART I: BROAD ANALYSIS:
Pending Bill in the Centre: There is a national HIV/AIDS legislation on the anvil that is
expected to be tabled with the Parliament this year. This national legislation contains a
comprehensive set of provisions of law. In the eventuality of such a bill becoming a
statute or an enactment, in case of repugnancy the Central Legislation will prevail over
the state statute or legislation as provided under the Constitution. It is advisable that the
state government consults the central government before proceeding forward with this
piece of legislation.
Overlapping sections. There are sections in this bill which overlap with provisions in
existing legislations. In cases where provisions of this bill conflict with any provision in
central legislations, the central legislations will prevail over the state legislation. For the
bill to override the already existing provisions, there should exist a non-obstante clause,
which is absent in the present bill. (e.g. “Notwithstanding anything contained in any law
for the time being in force”....).
Inconsistency in the Statement of Objects and Reasons: The objects and reasons of any
bill form the core statement of the topic that is being legislated, as the purpose and the
rationale behind the bill is explained. There should exist no contradictions in the body of
the bill when it is read with the statement of objects and reasons. In the present bill
contradictions do exist. The substantive clauses have not covered all the areas articulated
in the statement of objects and reasons, such as information and education to heighten
awareness.
Ambiguities and absences in the definitions: The definitions are not precise and are
incomplete. Definitions form the crux of any legislation: in the event of the Hon’ble
Courts interpreting the meaning of a term, the judicial determination will depend heavily
on the definitions. In case the definitions are ambiguous, the Hon’ble Courts will depend
on other statutes; this may be inappropriate for an HIV/AIDS response as each statute is
legislated for a different purpose and will ascribe meanings to words that may not
conform to the HIV/AIDS context.
Furthermore, in the proposed bill, there is an absence of critical terms such as “person”,
“consent”, “confidentiality”, “discrimination”, etc.
Absence of special provisions protecting rights of women and children. The disease
burden of HIV/AIDS in India falls disproportionately on women and children. In this
bill, specific sections do not exist to address this reality, (e.g. matrimonial rights,
domestic violence, custody, sexual assault, breach of confidentiality, the concept of
discrimination within family and children, age of consent, or the issue of informed
consent).
Key issues are absent: The bill fails to adequately address concepts such as
discrimination, confidentiality and consent, which form the core areas requiring
2
legislation for HIV/AIDS. Furthermore, the bill does not address many other areas,
which are central to an HIV/AIDS legislation, such as risk reduction for vulnerable
Information/Education/Communication
communities,
(IEC),
implementation
mechanisms, a safe working environment, and access to antiretroviral and related
treatment to prolong healthy lives of HIV-positive persons.
Lack of evidentiary or scientific basis. Any statutory response to HIV/AIDS should base
itself on strategies that have worked in India and abroad. In this respect, there is a crucial
lacuna in the bill, as it is based on hypothetical assumptions and not on evidence and
science.
Uncertainty in the bill’s legislative scope/reach'. The legislative scope of the bill is
unclear: will it be applicable to the private sector, public sector or both? In some of the
provisions, the bill suggests that the private sector would fall within the parameters of the
bill, and in some other provisions it suggests that it would not.
Additionally, the sections cover only the rights of Persons Living With HIV/AIDS, but
do not set out rights for persons who are affected by HIV/AIDS [e.g. orphans, family
members, etc] or those perceived to be HIV- positive [e.g. those perceived to be “atrisk”].
Confusion on the identity of the State Authority: The bill provides for a Board or an
Authority that is to be formed, but it remains unclear if the bill is replacing the present
Karnataka State Aids Prevention Society (“KSAPS”), or if the bill envisages the creation
of a new body. If the structure is the same as KSAPS and is merely statutorising the
body, it is dramatically decreasing the functions of the body. This will have a severe
impact on health outcomes as programmes focused on targeted interventions, IEC, blood,
and others will cease to exist. Moreover, there will have to be a structure to take over the
present KSAPS, which is quite a cumbersome structure in any bill: indeed, in the national
legislation, the structure takes 20 pages. On the other hand, if the bill is creating a new
body, it is unclear why it would do so and it is duplicating work.
In either case, the bill implies a change in the structure and functioning of the present
KSAPS. This will change only in Karnataka as no other state has a bill with similar
provisions to date. Furthermore, in case the Board under the bill does become a statutory
body, it will have different powers and responsibilities and may not be able to work under
the National AIDS Control Organisation. This may have negative consequences for
HIV/AIDS programming and health outcomes in Karnataka: a national, coordinated
response is integral to tackling the spread of the epidemic.
Lack of provision on expedited procedures for relief: The bill does not create any
provision to expedite the procedures to obtain judicial reliefs. In our experience litigating
on behalf of HIV-positive persons in Karnataka, justice may be delayed for years. A
provision that mandates faster procedures is essential.
3
Dearth of adequate remedies'. The bill does not provide for remedies in a systematic or
definite manner. The remedies provided in the bill are inadequate and insufficient.
Incorrect usage of terms'. The provision uses the word “rehabilitation” in the context of
HIV-positive persons. This raises a concern as to how HIV/AIDS is viewed in our
society: Persons Living With HIV/AIDS do not require “rehabilitation”. Rather, some
may require life-saving treatment, and perhaps the word “treatment” is more appropriate
here rather than “rehabilitation”.
Certain sections contain the term “HIV/AIDS patient”, which we believe to be
paternalistic and inaccurate. As HIV is a condition/infection, a person can be HIV
positive and stay asymptomatic for years. They may not be patients at all, but healthy
individuals capable of leading productive lives for many years.
Arbitrary powers given to the officials'. The “good faith” clause provides immunity to the
board members without making them responsible for any acts which they may have done
that violated rights. Due to the fact that a comprehensive set of rights is not set out, if an
official acts to prevent HIV/AIDS in a manner that violates rights, but does so in good
faith, the victim may not have legal recourse. To illustrate, if there is no right provided
against discrimination or isolation, and if HIV-positive persons are isolated in good faith
to prevent the spread of the infection, they would not be able to redress the wrong. This
clause gives sweeping powers for the directors and other board members and places too
high a burden on the Person Living with HIV/AIDS.
Problematic Nature of Board/Authority; The proposed structure raises several concerns
pertaining to the composition of the Board and appointing of the members. The Board
lacks representation of Persons Living with HIV/AIDS. The proposed bill does not
indicate how the Board members and other officials will be sensitised to issues of
HIV/AIDS, or mention the duration of tenure for ex-officio members. There is a lack of
recognition of vulnerable populations in the programme as they are among those affected,
and their rights need to be protected in order for prevention of the infection to be
possible.
4
PART II SPECIFIC ANALYSIS
Chapter II: Rights Of the HIV/AIDS Infected
Every person and citizen is entitled to some fundamental rights that are provided in the
Indian Constitution. One of the greatest lessons that the HIV pandemic has taught public
health experts is that the spread of the HIV infection can be prevented, from HIV-positive
persons to others, if the rights of people infected or affected with HIV/AIDS are
protected. By creating an enabling environment, Persons Living With HIV/AIDS will
access health services, allowing interventions to prevent the epidemic from spreading.
This lesson has been shown in our country in Sonagachi, Kolkata. Using the rights-based
approach for sex workers, condom usage was scaled-up from 2.7% in 1992 to 90.5% in
1998. As a result, the number of persons testing VDRL dropped in the same period from
25.4% to 11.5%. In the same period the number of new persons testing for HIV from 442
to 506 and the number of persons who tested HIV negative rose from 0.15-2.11% CI to
3.54-7.52% CI. Thus when people know that they are entitled to certain rights which
protect their status, they will be encouraged to exercise such rights, e.g. get themselves
tested, disclose their HIV status voluntarily and engage in safer behaviour. This lesson
has to be incorporated in any law on HIV that is enacted.
In the context of the present bill, it is an important step that the Karnataka government
seeks to vest rights in Persons Living With HIV/AIDS. It is important to note, however,
that the bill also takes away rights of confidentiality, informed consent and freedom to
procreate. Such provisions will only discourage people from accessing health services
and preventing the spread of transmission. Therefore, it is the paramount duty of the state
government to legislate a bill keeping the rights-based approach in mind.
Furthermore, the bill reemphasizes the following existing rights under the Indian
Constitution:
Provisions in Karnataka Proposed Bill
Section 3(a)(b)_____________________
Section-3 (c)_______________________
Section-4_________________________
Section-6 and Section-7
Provisions in Constitution of India
Article-15 (2)(a)(b)______________
Article-19(l)(g) _________________
Article-14 and Article-16_________
Article 21
The bill is therefore duplicating existing constitutional rights and is not expanding the
area of its applicability. The rights guaranteed under the Indian Constitution are
applicable only to the public sector, and are enforceable only against such authorities that
are public sector enterprises or are working under them. The bill does not explicitly set
out whether these existing rights are applicable to the private sector or private
individuals.
5
3. Rights against enforcement of social disabilities: No person shall on the ground
of HIV/AIDS infection enforce against any person any disability with regard to:
a.
b.
c.
d.
e.
access to any shop, public restaurant, hotel or place of
public entertainment; or
the use of any utensils, and other articles kept in any public
restaurant, hotel, or public place for the use of the general public.
the practice of any profession or the carrying on of any
occupation, trade or business.
the use of or access to any river, stream, spring well, tank
cistern water tap or other watering space, or any bathing ghat, burial, or
cremation ground, any sanitary convenience, or any other place ofpublic
resort which other members of the public have a right to use or have
access to; or
the use ofor access to any public conveyance.
Comment: Section 3 seeks to remove any kind of discrimination against HIV-positive
persons. However, it uses the phrase “social disability”, which is not an accurate term to
use, unless it is defined. Since there is no definition for “disability ” in Chapter I, it will be
difficult to enforce the rights provided in this section.
This section reemphasizes the right already guaranteed under the Indian Constitution but
it is not clear whether such right is vested in a person and can be enforced against a
private person or private body, as the reading of the section implies that only public
places are covered.
4. Right to equality in matters relating to employment: No person shall be subjected to a
discriminatory treatment on the ground that he is HIV-positive, nor shall he/she be
removedfrom service.
Comment: The subheading refers to equality, whereas the substantive section is about
non-discrimination. There is a significant legal distinction between the two which is not
addressed.
The section provides for the right against discrimination in the context of employment.
However discrimination is not defined. This is a serious flaw in the bill. Also, there is a
wealth of judgments on this point, which need to be incorporated.
The section provides that any person because of his HIV status should not be removed
from service and should not be subjected to discriminatory treatment. In order that an
HIV positive person should be able to exercise rights guaranteed under this section,
specific acts must be included, e.g. demotion, ill treatment, non-payment of bonus
separation, unnecessary transfers, etc. This should be done within the definition of
discrimination.
6
5. Right against pre-employment HIV test: All pre-employment HIV tests are banned.
No employer shall prescribe a pre-employment HIV test.
Comment: This section is in accord with the National Testing Policy. The overall
coverage of the section would include the private sector. There is no basis for testing for
HIV in the pre-employment setting.
6. Right to treatment: Every HIV/AlDS patient shall have a right to medical treatment in
all the Government Hospital/Primary Health Centres
Comment: This section provides for all HIV-positive people to be treated in all
government hospitals and primary health centres. Other institutions run by the
government are absent, e.g. community health centres, government specialty hospitals,
etc. Therefore, the section limits the availability of medical treatment. Moreover,
treatment is not defined. The aspect of finance is not looked at, as unless the central
government agrees to this provision it will not be realised, since all HIV work is funded
by the central government.
Right to marry: Every HIV/AIDS patient shall have a right to marry a person who has
freely and voluntarily consented to that marriage being conscious of the fact that the
person is HIV positive. However, this right shall be subject to the provisions of Chapter
Comment: The section is a step in the right direction in that it actualises the right of
HIV-positive persons to marry. However, it requires any HIV-positive person who seeks
to get married to disclose his/her status to the prospective spouse and only if the
prospective spouse accepts such a condition, can the marriage take place. The problem is
that this right is subject to the rights in Chapter IV. Read together with that, the section
implies disclosure of one’s status but does not provide any safeguards for the same, such
as maintaining confidentiality to make sure that the other person does not disclose one’s
status to the world without his consent. The section also does not envisage a situation
where an HIV-positive person might not know his HIV status.
in a country like India where marriages are usually arranged, this is not a feasible
provision to implement, especially for women. This is particularly so in Karnataka where
46% of marriages are child marriages. Women, who usually do not have a choice to
choose their life partner, may not be in a position to ask for an HIV test from their
prospective spouses. Therefore, unless other provisions are put in place to empower
women and girl children, this section may be used against women by stigmatising and
blaming them.
9. Punishment for violation of rights: Any person violating the above rights shall be
punished with an imprisonment for a term which may extend to one year and also with a
fine of up to twentyfive thousand rupees.
7
Comment: This section is a penalty clause for violation of the rights provided for under
Chapter-II.
The Section does not expressly mention what rights are referred to.
Assuming all the rights in this chapter are covered, it is not clear which court will try the
offence and whether it is cognisable and/or bailable or not.
10, Right to information: Every Medical practitioner who knows that he has HIV/AIDS
infection shall before performing any en vivo medical procedure on a person shall inform
him of the said infection.
Comment: This is a specific section applicable only to medical practitioners. It is now
universally accepted that an ordinary doctor performing day to day to medical procedures
does not pose a significant risk to the patient. Even in the realm of surgeries, only major
invasive surgeries are considered to pose a significant risk. The risk reduces further with
the use of universal precautions. In any event, it is the duty of the employer to ensure that
the surgeon is free from HIV. This would require reporting the HIV status to the
employer, not to every patient.
Chapter-Ill: Prohibition of Certain Acts
This chapter prohibits acts that hinder the rights of HIV positive and negative persons.
The sections in this chapter are not in a purposeful sequence or grouping.
11, Intentional Transmission of HIV:
(a) No person who knows or in all reasonable probability would have known that he has
HIV infection shall intentionally or knowingly engage in any practice or behaviour or do
or abstain from doing any act, which places or has a tendency to place any other person
at risk to HIV infection.
Comment: Section 11(a) includes provisions that are similar to those already existing in
the Indian Penal Code, sections 269 and 270. Section 269 and 270 make acts that may
transmit disease dangerous to life punishable. These provisions, which cover HIV
transmission, are sufficient in scope. Therefore, a new criminal provision is not
necessary.
The primary reason for rejecting such a provision is on grounds of public health; enacting
such a provision:
• Serves as a disincentive to testing because of the criminal liability and
because safeguards for confidentiality will not exist;
• Obstructs access to counselling and related services;
• Enhances HIV/AIDS related stigma, discrimination and isolation;
• Spreads incorrect information about HIV/AIDS;
• Punishes persons who, given the lack of education and counselling that
exists in society today, know their HIV status but are not aware of its
implications, e.g. transmission.
8
Such consequences will serve to drive HIV-positive persons underground, and away from
crucial health information and services, which will inevitably promote the spread of the
epidemic. Furthermore, HIV specific criminal legislation contradicts the more effective
message that it is the behaviour of each individual, whether infected or not, which
determines the course of the epidemic and whether individuals contract HIV.
In other parts of the world, similar attempts to introduce HIV-specific criminal laws were
rejected. In South Africa, such a provision was considered largely because women and
girls were being infected. The South African Law Commission rejected the provisions in
part because (1) a change in the law would be based on “urban legends” and not
scientific/empirical evidence that HIV-positive persons were wilfully/negligently placing
people at risk, (2) problems would ensue e.g. burden of proof and constitutional issues,
(3) limited prosecutions under existing provisions indicate that few will utilize an HIVspecific statutory offence. Similarly, Canada, the United States and Namibia abandoned
similar statutory provisions.
(b) Whoever contravenes sub section (a) shall, regardless of whether such practice or
behaviour or act has actually transmitted the infection to such other person or not, shall
be punished with imprisonment for a term of not less than five years and which may
extend to ten years and with fine, which shall not be less than two lakh rupees and which
may extend to twenty five lakh rupees.
Comment: This section punishes a person regardless of whether the infection was
actually transmitted or not. Indian Penal Code section 269 and 270 provides punishment
for similar acts. There is no need to have a special section for HIV as Penal Code sections
269/270 deal with the situation adequately. It is important to note that such a huge fine
will only work against the poor, particularly against the sex workers.
(c) Any court sentencing a person to fine under sub section (b) may award such fine or
any part thereof as compensation to the person placed at risk of HIV infection.
(d) The compensation awarded under sub section (c) shall be in addition to and not in
derogation of any compensation to which such person is entitled, if any, under any other
law for the time being in force.
Comment: This section provides for compensation to the victim, and the accused is
required to pay a fine in addition to the imprisonment. The victim is further entitled to
claim damages under any other statute, which simply means that the accused will have to
not only pay compensation under this bill, but also damages.
12. Prohibition of misleading advertisements: All misleading advertisements about cure
to HIV/AIDS in print, electronic and other media are prohibited. All persons responsible
for issuing and publishing such advertisements shall be punished with an imprisonment
for a term which may extend to one year and with a fine which may extend to twenty five
thousand rupees.
9
J.-/-
Comment: This section punishes any person providing misleading information about a
cure for HIV/AIDS. The term “misleading” itself is a subjective term. As one person
might find an advertisement misleading and another might not, “misleading” therefore
needs to be defined clearly. The bill replicates an existing provision under the Drugs and
Cosmetics Act. The difference is that the section under this bill provides a penalty for
violation of this provision. It is not clear whether the offence is cognisable and bailable
and which court will entertain the case. This provision will not work if there is no
authority to take proactive action against persons who issue the advertisements.
Moreover, it is not only advertisements which need to be tackled. There are many who
claim, through word of mouth and/or practice, that there is a cure for HIV/AIDS.
13. Prohibition of mass tubectomy, etc.: Mass tubectomy, circumcision, and any other
such mass camps without involving qualified medical practitioners shall be prohibited.
Any person organising such camps in contravention of this provision shall be punished
with an imprisonment which may extend to six months and with a fine which may extend
to ten thousand rupees
Comment: This section prohibits mass tubectomy and circumcision where qualified
medical practitioners are not present. By implication, this provision allows for situations
wherein qualified medical practitioners are present. There is no rationale for this section,
as no data supports the contention that these camps promote the spread of the infection.
14. Prohibition of disclosure of HIV test results: Subject to the provisions of this Act, the
fact that a person has tested positive to HIV test shall remain confidential.
Comment: This section prohibits disclosure of one’s HIV status without providing any
exceptions and situations. There is no indication as to when disclosure is permissible,
e.g. cases of sexual assault, cases where there is an identifiable partner who is at
significant risk, by an order of the court, etc.
Chapter-IV: Regulation of Matrimonial Relations and Procreation
The title of Chapter IV reflects an intent to permit the state to interfere with the
individual’s private rights, e.g. the right to know one’s HIV status, the right to privacy
and the right to procreate. On the other hand, the State does have the authority to legislate
on the lives of individuals, provided such authority is not violating basic fundamental
rights. In this chapter, fundamental rights are violated.
This chapter also impedes effective HIV strategies by using marriage as the normative
construct, thereby excluding other relationships. Given that HIV infection is spreading in
Karnataka through sexual and needle-sharing relationships outside of marital
relationships, this chapter does not reflect the realities existing in the State.
This chapter is also flawed as implementation of the provisions appears impossible.
10
75. Pre Marital HIV Test: If one of the contracting parties to the marriage insists on the
test to check the HIV status of the other person, the other person shall undergo such test
to the satisfaction of the person concerned.
Comment: This provision does not create an enforceable right beyond what ordinary
persons are free to do in the absence of a statute: request an HIV test from a prospective
spouse before marriage.
If the intent of the provision is to give prospective spouses the right to know their
partner’s HIV status before marriage, it may not achieve its objective. At the time of the
test, there is a possibility that a person may test negative, even if they are infected with
HIV. This time period is known as the “window period”. The common way in which the
test for HIV is conducted is an antibody test. Even if the person is infected with HIV, the
antibody test result will still show a negative result if the antibodies are not developed.
Hence, a single antibody test for HIV does not serve the purpose of identifying people
with the virus, and preventing he /she from getting infected.
If the intent of the provision is to protect women who are likely to be infected by their
husbands, the question is raised: will the prospective spouse ask the question if there is a
law? Will the law really empower women? This is doubtful given the cultural traditions
that exist in India where the girl child is not empowered. The real challenge is to
empower the girl child and educate her about sex. This will empower women not only
before marriage but also during marriage, which will help her in case her husband
contracts the infection after marriage which is very often the case. Absent such
empowerment, the law can only be a paper tiger.
This provision also has a number of weaknesses: it will encourage unscrupulous doctors
to give false negative certificates, there will be deleterious consequences for persons who
obtain “false positive” results (which is very high in India), and it does not prevent the
spread of the infection to sexual partners outside of marriage or needle-sharing partners.
Even if this provision becomes law, it does not address the crucial issue of what will
happen to the persons if they are found HIV-positive. Once the community knows a
person’s HIV status, the stigma and discrimination the person will face are not addressed
and adequate safeguards are not provided. Safeguards to protect confidentiality must be
included.
The provision also raises two other concerns: (1) the phrase “to the satisfaction of the
person concerned” is not set out clearly, and does not explain what would meet the
standard of satisfaction, which is a subjective criteria; (2) the phrase “contracting parties”
raises an issue as to whether Hindu couples would fall within the provision, as the Hindu
Marriage Act does not recognise marriage as a contract.
Lastly, it is important to note that this provision is alarmingly close to a provision
mandating pre-marital HIV testing. Pre-marital mandatory testing has been considered
11
and rejected in India and abroad as an appropriate public health strategy, and such a
provision would lie in direct contravention of NAPCP. This is due to a number of factors,
including the faulty assumption that unsafe practices and subsequent HIV-infection do
not occur after marriage. Furthermore, experiences in different contexts have proven to
be a failure in terms of reducing HIV transmission. In the United States, the strategy
failed and statutes were repealed. In the province of Johor in Malaysia, mandatory testing
was introduced and is a failure. The percentage of persons testing HIV-positive was
extremely low, persons married regardless of status, and many couples were married in
neighbouring states to avoid getting tested. The pitfalls of pre-marital mandatory testing
are well-documented and should be thoughtfully considered before such a provision is
included.
16. It shall be the duty of the concerned authorities in all cases to disclose the results of
HIV tests to the spouse or the sexual partners of the person subjected to test -with proper
counselling. Otherwise, the results ofHIV tests shall remain confidential.
Comment: This Section imposes a mandatory duty on the concerned authority to
disclose the results of one’s HIV tests to the spouse or the sexual partners. No authority
should be vested with such wide and arbitrary powers, as it is an individual decision to
disclose information regarding one’s health and related aspects. Furthermore, the term
“concerned authorities” is not defined, leaving open the question as to who has a duty to
disclose. If this provision refers to doctors or counsellors it needs to be specified. It is
also unclear under this section whether the aggrieved can sue the authorities, in the event
that the authorities do not disclose the status of the individual to the spouse or sexual
partner.
This section takes away discretion from the doctor. It also does not promote the doctor to
encourage his/her patient to voluntarily disclose his/her status. There is a wealth of
practical experience and case law on this: the doctor should encourage voluntary
disclosure through counselling in case she/he comes to the conclusion that the patient is
engaging in high risk practices, and warn the patient that if she/he does not do so, she/he
will disclose to the spouse or the partner.
The impact on women has not been taken into account in this provision. In case such
disclosure does happen to the spouse (husband), a woman may face domestic violence or
be thrown out of the house. Our experience in Karnataka demonstrates that women are
often blamed for transmitting the virus to their spouses, despite being infected by the
spouse.
The section implies that the disclosure is permissible only to the spouse and the sexual
partner, but in all other cases, no such disclosure should happen. The provision does not
set out other circumstances where disclosure is possible. Additionally, the section does
not take into account that the spouse may be separated, not engaging in risky behaviour.
Given the highly stigmatised nature of HIV/AIDS, such powers must be specifically
narrowed down.
12
In case this section is implemented, people may not want to get themselves tested as test
results may be disclosed to their spouses and sexual partners. Out of fear that individuals
will be known as HIV-positive, they may stop accessing medical services. In turn, they
will not get essential information about safe sexual and needle-sharing practices, and the
disease may spread further. By protecting the rights of one person we can protect the
rights of the whole society.
77. If the husband is HIV positive and wife is HIV negative, they shall not procreate
children through wedlock.
Comment: This section may violate Article 21 of the Indian Constitution, which sets out
a right to privacy. The right of procreation has been read into this right. This provision
allows the state to intervene in the choice of two individuals without offering a rationale
for the same. Courts have found that HIV-positive people may get married. If there is
consent between two persons, the State cannot intervene. Similarly, it may be argued that
the State may not intervene in a decision to procreate arrived at between two consenting
adults. It may also be argued that a woman has the right to procreate and have complete
autonomy over her own body, among other rights.
The section is probably based on a misconception that married couples only engage in
sex for procreation. This is obviously not true as people engage in sex for pleasure.
Furthermore, it should be noted that implementation of this section will be nearly
impossible.
Lastly, the intent behind the section is unclear. No explanation has been offered as to why
HIV-positive husbands and HIV-negative wives may not procreate through wedlock,
whereas HIV-negative husbands and HIV-positive wives may procreate through wedlock.
In this respect the section would be unconstitutional and is liable to be struck down.
18. All pregnant women shall be tested for HIV during the 3rd month, 6th month and
before delivery. Those found positive shall be compulsorily counselled and treated to
prevent transmission of HIV infection to the child.
Comment: This provision adopts mandatory testing as a public health strategy. The
provision dispenses with the need for pre-test counselling and written, informed consent,
both of which are acknowledged by leading public health authorities as essential for
prevention of HIV transmission. It has not been proven that mandatory HIV testing of
pregnant women is the most effective approach for reducing prenatal transmission.
Leading public health authorities recommend voluntary counseling and testing as the
optimal strategy for prevention of HIV transmission.
The data in India and Karnataka, demonstrating that mandatory testing is unnecessary, is
ignored in this provision. India has rightly followed the protocol of voluntary counseling
and testing in the antenatal clinic setting. There exists criticism that it is not “really” a
voluntary counseling and testing situation, as the counseling is lacking. However, even if
there is only information given to the mother about the benefits of testing, then the results
13
are evident: at the national level, of the women who were counseled in the ANC setting
or given basic information, 97% opted for testing. Thus, there is no need to make testing
or treatment mandatory.
The consequences of mandatory testing are well-documented; persons often avoid
accessing medical services and information, fueling the spread of the epidemic. These
consequences are equally applicable in the context of pregnant women. This provision
presumably restricts the woman’s rights in the best interest of the unborn child, seeking
to prevent children from being bom HIV-positive. Experiences in Karnataka indicate that
when women are offered HIV information in a pre-natal setting, by and large they seek
testing and treatment to prevent transmission to their unborn child. Experiences also
demonstrate that pregnant women who are HIV-positive often shun medical help because
they fear they might be stigmatized or discriminated against. By offering these women
crucial health information and a choice to get tested, the chances may be increased that
women will obtain counselling, testing and treatment.
Mandatory testing in any situation creates fear and fuels stigma and discrimination
against people infected or affected by HIV/AIDS. Women already suffer from
discrimination as a result of social, political, cultural and legal factors in our society.
Subjecting pregnant women to compulsory HIV testing not only violates women’s rights
but also places them at heightened risk for being blamed for infecting the spouse,
domestic violence, being thrown out of their homes, losing custody of the children, etc.
This is particularly true under a provision such as Section 18, which does not provide for
confidentiality, and when read with Section 16, mandates disclosure to the spouse or
sexual partners.
Furthermore, it may be argued that mandatory HIV testing and treatment violates rights
to bodily integrity and privacy.
Factually a large number of pregnant woman do not access health services until the last
day of pregnancy. Therefore the access of public health services for women has to
improve tremendously. This requires empowering the girl child so that when she is
pregnant she knows she has to access health services for a safe delivery.
It should also be noted that implementation of this provision will require a tremendous
investment of financial and human resources. Most importantly, no provision has been
made for the continued treatment of the woman after transmission to the child has been
prevented.
Furthermore, the treatment referred to in the provision, to prevent transmission to the
child, is problematic under the current scenario in India. Emerging problems include drug
resistance, unavailability of alternatives, and contraindicated medications (for
opportunistic infections) being offered in the absence of alternatives.
14
Adv/Letter/121 /p/0 5
12 June 2005
Hon’ble Chief Minister
Shri Dharam Singh
Room 323, Vidhana Soudha
Bangalore-560001
Karnataka
Dear Sir,
This is in respect to the proposed bill to protect the rights and prevent the infection of
persons with HIV/AIDS, currently being considered by the Karnataka State government.
We appreciate the efforts of the concerned persons to enact a statute that will attempt to
protect the rights of persons living with HIV/AIDS and prevent the spread of the
infection. The protection of rights has been recognised by various countries including
India as the optimal strategy for preventing the spread of the infection. Such a public
health strategy is referred to as the “AIDS Paradox”: by protecting the rights of those
infected or at-risk, these persons will not be fearful to access life-saving health
information and services, including prevention information. Thus, by protecting the rights
of individuals, transmission of the infection is prevented and the community as a whole is
protected. It is a praiseworthy step that Karnataka is contemplating a law on HIV/AIDS
that recognises public health strategies based on such realities.
However, we would like to bring to your attention a few key concerns regarding the
proposed bill:
1. Foremost among these is the fact that the Central government, through the
Advisory Working Group (“AWG”), commissioned the drafting of a national
legislation on HIV/AIDS. The legislation is being presented this week to Dr.
Anbumani Ramadoss, the Health Minister, Ministry of Health, Government of
India, and is to be tabled in Parliament this year. We would like to bring to your
attention that in the event that there are provisions that are absent or contradictory
in the state law, the national law would, under the Constitution, override the state
law in the same field.
2. Recognising the pressing need for an HIV/AIDS law in Karnataka, and further
taking into consideration the unique cultural, economic, social, and other factors
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present in Karnataka, we acknowledge that Karnataka may require a contextually
appropriate legal response. However, it is imperative to emphasise the following
point: the nature of the epidemic in India is cross-border and not state-specific.
Karnataka, with its central location and high rates of inter and intra state
mobility, demands a legislative response that necessarily takes these realities into
account. An isolated state response that is not coordinated with other states,
particularly those bordering it, will be ineffective. Therefore, we believe that only
a national response is appropriate for the needs of Karnataka, and any state
response must be fashioned in the context of the national response.
3. Furthermore, we are deeply concerned that the Karnataka proposed bill, unlike the
national draft law, was not created in a consultative and participatory manner,
obtaining inputs from those infected, affected and working for HIV/AIDS. We
believe that a democratic, participatory process, ensuring that people’s voices are
heard, is integral not only to drafting any HIV/AIDS law but also to ensure its
successful implementation.
We sincerely believe that in order to create an appropriate legal response that best
fits the Indian legal and social context vis-a-vis HIV/AIDS, extensive research
must be undertaken of global approaches attempted and lessons learned, rigorous
scrutiny must be performed of these laws and policies and programmes, and a
detailed examination must occur of the application to the Indian legal and social
context. For the national draft law, research was first undertaken of laws in other
parts of the world that culminated in a background book, “Legislating an
Epidemic: HIV/AIDS in India”. We enclose a copy of the book herewith for
your examination.
This was followed by extensive consultations around the country. Consultations
were held with various stakeholders, including: Persons Living With HIV/AIDS,
marginalized populations (e.g. sex workers, men who have sex with men,
injecting drug users), health care workers, employers/employees, NGOs working
with HIV/AIDS, women and children. Each consultation lasted two full days, and
was conducted with thorough involvement from various State AIDS Control
Societies (“SACS”). This process enabled an understanding of realities occurring
at the local level, incorporating a broad cross-section of perspectives and
experiences into the draft law.
What emerged from these consultations was a reaffirmation of our belief that
understanding the experiences and needs of affected persons necessarily entails
taking cognizance of unique regional differences and perspectives, such as HIV
prevalence rates, and social, economic, political, infrastructural, educational and
cultural factors. A regional consultation was held in Bangalore, Karnataka, in
March 2004, with stakeholders from across Karnataka providing critical inputs.
Above all, it was realized that the law on HIV should be evidence and rightsbased and not premised on hypothetical notions of what “should be”. The national
law does not base itself on any ideological precepts. It strongly bases itself on
evidence of successful strategies in India and around the world. It is also rooted
on protection and promotion of the rights of those infected and affected. The
understanding of the HIV paradox is crucial to understanding the battle against
HIV.
We continue to believe that any statutory approach to the HIV/AIDS epidemic
must be informed by these realities, and believe that the national law will
therefore most effectively protect persons and communities significantly affected.
4. The national legislation covers a vast array of topics and is holistic and
comprehensive. The proposed Karnataka bill is neither. There are crucial features
which are absent or not dealt with adequately in the proposed Karnataka bill that
any HIV/AIDS law should provide for, viz. consent, confidentiality and rights
against discrimination, special understanding of vulnerable communities and
provisions on risk reduction, Information/Education/Communication (“IEC”),
implementation mechanisms, a safe working environment, access to anti
retroviral and related treatment to prolong healthy lives of HIV-positive persons,
special promotions of rights of women and children.
Given the devastatingly high number of people living with HIV/AIDS who are
desperately requiring treatment in Karnataka, it is a glaring gap that there is no
sufficient provision for access to medicines and treatment, an essential component
of a comprehensive response to the epidemic.
5. We would like to highlight a few of the most troubling sections of the bill, that
compromise the rights of women, and of persons living with HIV/AIDS, and
which we do not believe will prevent the spread of HIV/AIDS in Karnataka:
•
•
•
•
A mention of pre-marital HIV tests that does not provide for enforceable
rights, and borders on the dangerous mandate of pre-marital mandatory
testing;
A provision on a mandatory duty to disclose that violates the right to
confidentiality and does not provide essential safeguards for Persons
Living With HIV/AIDS;
A provision that proscribes procreation between consenting adults,
violating fundamental rights;
A provision requiring the mandatory testing, counselling and treatment of
pregnant women, violating fundamental rights and placing the women of
Karnataka at heightened risk of negative health effects, domestic violence,
and other deleterious consequences.
These provisions are liable to be challenged and held unconstitutional by courts of
law, on account of the violation of fundamental rights. In fact, data from around
the country maintained by NACO and SACS demonstrates that of the pregnant
women who are reportedly counselled, 97% undergo testing voluntarily.
Therefore, there is no need to test any women mandatorily. This indicates that the
law is not based on ground realities or on any evidence, but is premised on
hypothetical assumptions that are disastrous in the long run.
6. We would like to note that any statute seeking to prevent the HIV/AIDS
infection, and protect rights, must be thoughtfully and precisely drafted.
Unfortunately in the proposed bill, terms are not well-defined, sections exist that
overlap with existing law, there is no clarity as to which sections are applicable to
the public or private sector, proscriptions are recited without judicial avenues
named, and remedies or penalties are not clearly set out, to name a few of the
problems. Furthermore, the functions of the state board and officials are not
explained in relation to the existing national and state bodies and programmes that
already exist. Such ambiguity will only result, we believe, in justice denied to
those who desperately need it and alienate Persons Living With HIV/AIDS from
the rest of society.
We have attached an in-depth legal analysis of the proposed bill that highlights
its poor draftmanship, which we believe will impede its effective implementation
and could potentially worsen the current situation.
7. In conclusion, we request you not to pass this proposed legislation that could
have a negative impact on public health and on individuals. We request you to re
examine the law and strategies that can be employed that will empower the
citizens of Karnataka, particularly persons living with HIV/AIDS, so that they in
turn will effectively prevent the spread of the HIV infection in Karnataka. We
respectfully request you to adopt/wait for the national comprehensive HIV/AIDS
legislation to be enacted, which we believe is the optimal legal and public health
response for Karnataka.
^xAnand Grover
Project Director
Lawyers Collective HIV/AIDS Unit - Bangalore
Cc:
Dr. Anbumani Ramadoss, Hon’ble Health Minister, Ministry of Health
Dr. Quraishi, Director General, National AIDS Control Organisation
Mr. Patil, Hon’ble Law Minister, Karnataka
Mrs. Mukthamba, Project Director, Karnataka State AIDS Prevention Society
Enclosed:
1. A comment on the proposed Karnataka bill by the Lawyers Collective
HIV/AIDS Unit
2. “Legislating an Epidemic: HIV/AIDS in India”, a publication of the Lawyers
Collective HIV/AIDS Unit
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population of immune cells without any toxic side effects.
Global Significance
The clinical data from the first four studies were presented at
peer-reviewed international AIDS conferences in six different
countries and were translated into five languages. The studies were
published in medical textbook about complementary and alternative
therapies for AIDS (Churchill Livingstone 2002). Additionally, editors
from the Journal of Alternative and Complementary Medicine and an
author in public health, Dana Ullman, have published third-party
reviews about this work that were read worldwide.
Studying South Africa's Orphans
One such online viewer was a student embarking on her doctoral
thesis for her homeopathy degree from the University of
Johannesburg in South Africa. Monica Da Silva contacted Dr. Brewitt
requesting to test HoGFs on children with HIV and AIDS. Dr. Brewitt
knew this was a critical step to filling South Africa's desperate need
for an affordable, effective treatment. The study protocol was
presented to three levels of safety and scientific review through the
University of Johannesburg prior to its start. Ms. Da Silva and her
research supervisor, Dr. Radmilla Razlog, designed and began the
study in April of this year with 24 children in Finetown, ages one to
12, who have spent their lives sick, undernourished and small for
their ages, as is typical of pediatric HIV sufferers.
These orphans received the HoGF for 12 weeks after two weeks of
pre-treatment. The results not only confirmed the prior findings, but
proved exceptionally promising for this population. While the disease
usually stunts growth, these children experienced "catch-up" growth
with significant increases in height averaging 6-7 centimeters, head
circumference and lean body mass. The children's CD4 T-cells
increased by five percent, and they enjoyed an improved quality of
life and required no hospitalizations.
The Future of HIV/AIDS Therapy
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The effect of this new treatment could have astounding results, not
only for the children of Finetown, but for the entire country of South
Africa and those stricken by this pandemic around the globe. These
HoGFs represent a new class of medicines, combining today's
advanced biotechnologies, modern molecular biology and basic
homeopathic principles formed two centuries ago.
Presently, the standard treatment for HIV/AIDS is the use of multiple
ARTS through a highly active antiretroviral treatment (HAART). While
these drug cocktails led to the first real medical progress in the
treatment of the disease, HAART has not effectively stopped viral
replication. A study published in the Journal of the American Medical
Association found that 78 percent of people taking HAART are
resistant to one form or another of these drugs, and 27 percent are
resistant to all HAART drugs. Another 40 percent of people on HAART
suffer from unwanted side effects such as insulin resistance and
hyperglycemia. For underdeveloped countries or populations lacking
economic resources, HAART therapy is out of reach and risks
unwanted, potentially dangerous side effects.
In fact, researchers from the NIH report that even the most
sophisticated of today's ARTs may never completely cure
HIV-infected individuals. After more than 15 years of research into
the cause and potential cure for AIDS, the message remains the
same: a human immune system must destroy HIV.
Without effective, expanded prevention, treatment and care efforts,
the AIDS death toll in South Africa, and the rest of Sub-Saharan
Africa, is expected to continue rising before peaking around the end
of this decade.Treating and caring for the millions of Africans living
with HIV/AIDS poses an inescapable challenge to the continent and
the world at large. HoGFs provide an affordable option without side
effects for people around the world. All five studies demonstrate that
HoGFs strengthen the immune system and immune diversity,
improve the nervous system and increase lean body mass and
quality of life. And because these homeopathic medicines are highly
diluted, HoGFs reduce costs up to 80 to 90 percent of conventional
medicines. This breakthrough is not only a potential solution to South
Africa's AIDS epidemic; HoGFs can also be used prophylatically
around the globe to stem the spread of HIV.
Dr. Brewitt's vision is becoming a reality.
Providing sustainable worldwide medical options to people and
industry for a healthier future.
Read about the trip to South Africa.
Read the HIV/AID Winning the Battle Press Release,
Read about HIV/AID5 Fact in South AfricaMore on Benefits of Growth Factors for HIV Infection^A._cHnical
summary.
We reserve the right to refuse sale of Biomed Comm products to any one we chose not to sell to.
Copyright© 2004 Biomed Comm,® Inc,
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Alternative medicine has been variously called natural, complementary, 'holistic'
'
or
and numerous other terms, which refer to elements of a particular modality
tradition. The traditional ethnomedicinal systems are by nature holistic, meaning
that they aim to treat the whole individual, rather than a specific disease or
symptom, and that they address not only the physical aspect of the patient but
also the mind and the spirit. It is assumed that each individual possesses an
innate healing capacity (the "immune system" in the broadest sense), and the
goal generally is to reinforce this capacity and restore strength and balance to
modalities: body work,
weakened systems using a variety of natural r.
detoxification, foods, herbs and other botanicals, tailored' as5 much as to the
individual's specific constitution and condition. The use of alternative therapies for
AIDS grew out of this same eclectic mix.
At the beginning of the epidemic, little or no treatment was available for people
with HIV possible/AIDS. Although as yet there is no cure, over the last decade
researchers have identified a number of drugs that slow progression of the virus
as well as therapies to treat the many opportunistic infections that attack people
with HIV disease. The key to effective treatment is early detection and
intervention. Some early treatments aim to strengthen the immune system, help
patients reduce stress, and maintain good nutritional practices and appropriate
exercise regimens. Many of the gettingalternative therapies described below place
significant emphasis on these lifestyle issues. Taking an active role in any disease
is an important adjunct to treatment. Consideration of alternative therapies in
conjunction with conventional medicine may offer additional opportunities for
persons living with HIV/AIDS to be proactively involved in their treatment.
Top
How to Approach Alternative Therapies
Here are a few suggestions to follow before involved in any alternative therapy:
• Obtain objective information about the therapy. Besides talking with the person
promoting the approach, speak with people who have gone through the
treatment—preferably those who were treated recently and those treated in the
past. Ask about the advantages and disadvantages, risks, side effects, costs,
results they experienced, and over what time span results can be expected.
• Inquire about the training and expertise of the person administering the
treatment (i.e., certification). If any uncertainty remains, verify the information.
• Consider the costs. Alternative treatments may not currently be reimbursable by
health insurance.
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SPECIAL SECTIONS
• Discuss all treatments with your primary care provider, who needs this
information in order to have a complete picture of your treatment plan.
People with HIV/AIDS in the United States use many kinds of alternative
approaches to treatment. Some of the most common are briefly described below.
Top
The use of acupuncture and Chinese herbal medications has become one of the
most commonly used alternative therapies for AIDS. Its use has become so
widely accepted that two Chinese Medicine Clinics in San Francisco have been
awarded contracts through the SF Health Department's AIDS Office to provide
Chinese Medical treatment to people with HIV. The contracts are funded by Ryan
White CARE Act allocations. Most people with HIV who use acupuncture and
Chinese herbs do so in conjunction with western medicine. There are, however,
some who use it as their principal form of medical treatment. It is strongly
suggested that it be used under the supervision of a licensed practitioner.
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The systematic practice of Chinese Medicine dates back over two thousand years,
making it the oldest medical system in the world. Where western medicine is
derived solely from scientific method as a means of treating disease, Chinese
medicine is intertwined with a philosophy of life, and is based on a holistic view of
supporting the mind-body's innate ability to maintain health and to heal itself
should illness occur. This approach is the result of many thousands of years of
accumulated experience. Rather than dealing with mechanistic components of the
human organism, as western science advocates, the TCM approach is one of
aligning the functions of the organs and systems as a whole, promoting the
dynamic balance of energy polarities which maintains health and well-being.
Top
Central to the philosophy of Chinese Medicine is the concept of ch'i, or qi, which
can loosely be defined as the vital energy of the universe, of which all things are
made. Ch'i patterns fluctuate between the polarities of what are called yin and
yang, the active and passive sides of the life force. Illnesses can crudely be
viewed as either excesses or deficiencies in either the yin or yang components of
ch'i. Ch'i is believed to vitalize the body by its movements along the pathways
which are known as meridians. The "meridian theory" of Chinese Medicine is not
accepted in western medicine, because they have never been objectively
identified anatomically. The circumstantial evidence of their existence, however, is
undeniable to Chinese doctors, since points along the meridians have been used
successfully as the sites for acupuncture needling for thousands of years.
In San Francisco, where Chinese medical treatment has been funded for three
years by the Ryan White CARE Act, the American College of Traditional Chinese
Medicine has treated over 300 symptomatic HIV-positive patients in long-term
care. A study of the medical records of these patients, and of quarterly health
surveys, has identified seven HIV-related conditions which appear to be most
responsive to Chinese medicine. These seven conditions are: weight loss;
diarrhea/loose stools; abdominal pain; nausea; headaches; enlarged lymph
nodes; and neuropathy.
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Chinese medicine was first popularized as a treatment for AIDS in San Francisco
by Misha Cohen, a Doctor of Oriental Medicine, in 1984. A good deal of western
type research on certain aspects of Chinese Medicine has since been conducted.
Many of the herbs have been found to inhibit HIV and other viruses in laboratory
experiments. Other herbs have been shown to act as biological response
modifiers, enhancing certain immune responses. In addition, a small, strictly
controlled study using acupuncture to treat HIV infected individuals was
conducted at Lincoln Hospital in Bronx, NY, a few years back. It was reported that
individuals receiving correctly applied acupuncture needling had notable increases
in their CD4 counts after only a brief course of therapy. This pilot study certainly
demonstrated the need for further research.
Some human efficacy studies of Chinese medicine for HIV disease are currently
underway. Chinese herbs may be a rich source of therapeutic agents for AIDS and
its related illnesses. It is essential that people with HIV have all the information
they need to select the treatment options most suited to their own needs and
dispositions. Chinese Medicine is a promising option which is safe, appears to be
somewhat effective, and is affordable to most.
Top
Prior to the emergence of AIDS, few people were familiar with or cared about the
immune system. Now, more than ever, the general public is interested in
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exploring ways to bolster immune response to prevent the progression of AIDS,
as well as to reduce the number and intensity of opportunistic infections and to
improve the overall state of their health. By strengthening a person's own
defenses, the body is best enabled to defend itself.
Homeopathy is one way to do this. Although no therapy can or will help every
HIV+ person or everyone with AIDS, homeopathy is beginning to develop a
reputation for helping people at varying stages of this disease. To understand
what homeopathy has to offer, it is necessary to learn something about a
different approach to infectious disease than simply attacking a pathogen.
As increasing numbers of physicians learn about homeopathic medicine, they will
be exposed to viable alternative treatments which can play an integral role in the
care and treatment of people with HIV and AIDS.
Homeopathic medicines, which include minerals, vitamins, and animal products,
are natural substances given in very low doses. Homeopathy is based on the
principle that "like cures like", that is, substances that in large doses would cause
adverse symptoms will, in small doses, treat those same symptoms. Homeopathy
is highly individualized to a patient's symptoms.
lop
The treatment of people with HIV or AIDS requires professional health care, even
when their ailments are seemingly minor. Ideally, they should receive treatment
from a homeopath who is an M.D. or a D.O., but otherwise the best care is one
that integrates homeopathic treatment with appropriate medical diagnosis and, in
emergency situations, with appropriate medical treatment.
One of the advantages of using homeopathy in treating people with AIDS is that
they tend to get various unusual symptoms, diseases, and syndromes which
evade immediate diagnosis. A homeopath, however, can prescribe a remedy
before a definitive conventional diagnosis is made. Because homeopathic
medicines are prescribed on the basis of a person's unique pattern of symptoms,
a conventional diagnosis is not necessary for a curative remedy to be prescribed.
Preliminary results of a study initiated by the Central Council for Research in
Homeopathy (CCRH) in 1989 testify to immunostimulatory role of homeopathic
medicines in HIV infection.
A randomized placebo-controlled study during 1995-1997 to ascertain the
treatment efficacy involved 39 people prescribed homeopathic medicines—Amyle
Nitricum-30CH and Azadirachta indica-6X—taken as medicated globules. The
individuals also underwent physical and breathing exercises, besides half ounce of
honey and 30 grams to 50 grams of moong dal (green gram) sprouts in their
daily regimen. At the end of each month, the individuals tested remained
asymptomatic.
Despite the seemingly positive results that homeopathic medicines provide for
people who are HIV positive, for those with early onset of AIDS, and for those
with nonextreme cases of AIDS, most homeopaths do not observe significant
improvement in treating people who have advanced stages of AIDS. But there are
exceptions to this general rule, and numerous homeopaths find that select
patients with advanced stages of AIDS experience dramatic improvement in their
quality of life.
Top
Dr. Issac Mathai, a homeopath based in Bangalore, India, recounts: "I have
handled around 20 AIDS cases since 1987 with positive changes. The treatment,
which improves our immune system by stimulating it to fight this immunity
related disease, includes homeopathic medicines, herbal supplements and
vitamins. This helps in AIDS cases as the condition itself is related to immunity.
Besides, dietary or lifestyle changes make a lot of difference in the patient's
general health."
Dr. Mathai mentions a 38-year-old, diagnosed HIV positive in 1985 along with his
partner, who was asymptomatic after the treatment: "During the treatment his
general health was good. Occasionally, he suffered from colds, coughs and
stomach upsets, which were treated appropriately with acute homeopathic
medicines. During this time his partner passed away. Yet he survived with
maintenance medicines, which keep his immune system in good condition."
Concludes Dr. Mathai: "Since homeopathic treatment is customized to a patient's
requirement, it could vary from person to person."
Top
Mumbai-based homeopath Dr. Mukesh Batra also treats HIV/AIDS. Says Batra:
"We have treated about half-a-dozen AIDS cases in the three years. The
treatment works on building up the immune system. Our success rate has been
almost 100 per cent in treatments that relieve symptoms of AIDS patients such
as repeated cold, cough, weight loss, diarrhea. A patient with AIDS was treated at
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our clinic in Mauritius a couple of years ago. He tested HIV positive. He was losing
weight and had repeated attacks of cold, cough and pneumonia. With
homeopathic treatment for about a year and a half he began to put on weight and
his tests returned to normal."
The history of homeopathy's successes in treating infectious disease epidemics,
the research that suggests the immunomodulatory effects of homeopathic
medicines, and the clinical research on HIV+ and AIDS patients that indicates
beneficial response to homeopathic medicines should command attention by
physicians, scientists, and public health officials. Despite this body of work, it is
both surprising and depressing that homeopathic medicine has been consistently
ignored as a viable part of a comprehensive program in treating HIV positive and
AIDS patients.
Top
Acupuncture involves the relatively painless insertion of extremely thin needles
into the skin at specific points to help balance the body's flow of energy, referred
to as qi ("chee"). When needles are inserted into the appropriate points, it is
thought that energy is unblocked, and symptoms can be relieved. Variations of
acupuncture include acupressure and shiatsu (pressure and massage of
acupuncture points). Acupuncture is sometimes used to relieve some HIV-related
symptoms such as neuropathy, fatigue, and pain. It is also used in an attempt to
strengthen the immune system.
Acupuncture is based on the understanding that just as energy can be disrupted
or depleted, so also can it be rechanneled and replenished. Thus, the acupuncture
needles may stimulate the body's own energy reserves or they may transmit
energy from the environment into the body. Because each individual will have a
unique interplay of energies, organs, and elements, as well as a unique character,
the treatment is, theoretically, individualized.
It is important to find a licensed acupuncturist who is experienced in treating
people with HIV. Local AIDS hotlines and community-based organizations may be
helpful in offering referrals. After finding a qualified acupuncturist, the first step in
treatment is accurate diagnosis. The practitioner uses several traditional
diagnostic techniques to determine whether treatment should be aimed at
stimulating or dispersing energy. Needles are then inserted at specific points
along the appropriate meridian.
Top
Initially, practitioners used acupuncture to provide symptom-relief for persons
with AIDS. Michael Smith, MD, D.Ac., of Lincoln Hospital in the Bronx has noted
that after the first four or five treatments, most patients begin to experience a
decrease in abnormal sweating, diarrhea, and skin rashes. Patients have also
reported higher energy levels and many have gained substantial amounts of
weight.
Patients on chemotherapy have noted a reduction in side effects such as nausea,
fatigue, and weakness. "Acupuncture helps the body help itself," claims Dr. Smith,
who emphasizes that the affects of the treatment on the overall health of a
person is the key to understanding acupuncture. The Somerville Acupuncture
Center in Boston, The AIDS Alternative Health Project in Chicago, and Quan Yin
herbal support program in San Francisco have reported similar symptomatic relief
and overall improvement.
Recently, at a local conference on AIDS, Dr. Merrill, M.D., presented a compelling
view regarding acupuncture and HIV-infected individuals. Dr. Merrill stated that he
would not recommend alternative therapies as a sole treatment for HIV, but that
acupuncture may add significantly to an overall improvement in the sense of well
being of HIV-infected patients. Additionally, while Merrill believes acupuncture
may not cure infections or increase T4 cells, it does provide subtle enhancing
properties, like increasing endorphins and possibly reducing stress and pain.
Merrill also stated that acupuncture might be helpful in reducing spasms in
gastrointestinal conditions, common drug-induced nausea, and some neurologic
problems.
The validity of acupuncture and Traditional Chinese Medicine remains controversial
in the Western culture. There is no claim that acupuncture has direct antiviral
effect on HIV. But many professionals trained in both Western and Chinese
medicine, have found that acupuncture offers many benefits to the overall health
of a person with HIV. In fact, more and more people with HIV are using
acupuncture to reduce stress, pain, and tension, among other conditions.
Top
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The Tamil Siddhars are 18 enlightened men and women who wrote down the
causes of 4,448 different diseases and prescribed medicines. AIDS was called
'Vettai Noi'. AIDS syndrome was already known to the Siddha system of medicine.
It was further classified into 21 types, most of which are caused due to wrong
diet, excessive sex causing depletion of prana (meaningless sex depletes a person
emotionally, physical and spiritually according to the Siddhars). The chief cause of
Vettai Noi is the defects in the three humors—Tridohas.
The 18 Siddhars of the Siddha traditional have classified 4,448 diseases and
prescribed medicines in the form of herb, roots, salts, metals and mineral
compounds. AIDS was classified as Vettai Noi as early as a few thousands of
years ago in the cradle of the ancient prehistoric civilization in Tamil Nadu,
Southern India.
Siddha system is based on hypothetical and biological laws of nature. The
Siddhars were pioneers to the world in the field of minerals, metals, and medicinal
herbs. They found out the. methods of processing metals, minerals, herbs and
natural raw materials to make churnams, chenthurams and leyhams (Churnam is
powdered formulation, leyhams is thick batter like formulation).
Vettai Noi, was further classified into 21 types, most of which are caused by
depletion of the Prana and/or Ojas through excess indulgence and abuse of the
body, rendering the immune system weak and susceptible to pathogens.
The chief cause of Vettai Noi is due to the three humors, Tridoshas and mainly
due to Azhal Kurtrum (Pittam or bile, acidic nature) exhibited in the blood stream.
Top
The following herbs are recommended for the effective treatment of Vettai Noi.
1. Aragumpul (Cynodon Dactylon Pers)
2. Karisalinkanni (Eclipta Alba Hassk)
3. Musu Musukkai (Mukai Scavrillia)
4. Thoodhovali (Solanum Trilobatum Linn)
5. Jeeragam (Luminum Cyminum)
Other Siddha medicines that could be prescribed under medical supervision and
administered for AIDS as supportive therapy are as follows:
1. For purification of blood: Kanthaga Rasayanam, Paranki Pattai churam,
Palakaria Parpam.
2. For reducing fever: Linga chenduram, Gowri Chinthamani, Thirikadugu
Churnam, Rama Banam, Vadha, Piththa, Kaba Sura Kudineer.
3. For persistent diarrhea: Thair Sundi churnam, Kavika churnam, Amaiodu
Parpam.
4. Revitalizers and rejuvenators to the disabled immune system of the body:
Orilai Thamarai karpam, Serankottai Eagam, Thertran Kottai leyham, Amukkara.
5. Antiviral drugs:
Vallathathy mezhugu.
Rasagandhi,
Mezhugu,
Murukkanvithtu,
Masikai,
Edi
6. Restoration of the disturbed mind: Vallarai.
The medications rasagandhi mezhugu, amukkara chooranam and nellikkai lehyam
are effective for HIV/AIDS patients who do not have overt neural HIV.
Drugs that control opportunistic infections complement these. Since 1992 all the
three formulations are said to have been tested on over 35,000 patients at the
Government Hospital of Thoracic Medicine, Tambaram Sanatorium, Chennai,
India, and are apparently without side effects. They are said to reduce viral load,
boost counts of CDS and CD4 cells, control symptoms and increase body weight.
Although prolonged viral suppression has occurred in a few patients, these drugs
are as yet unable to cure AIDS.
(Reference: Dr. V . Kalidoss, Siddha System of Medicines for Treatment of AIDS)
Top
The Treatment for AIDS Prospects in Siddha Medicine
The body's immunity gets heavily depleted by excess indulgence as stated by the
Siddhars. Siddhars have evaluated that Azhal thathu is responsible for the
defense of the body. Disease takes place with the deterioration of the Vindhu
thathu. Such deterioration leads to diseases such as pain, skin lesions, formation
of nodes, malignancy, fistula, abscess, cervical adenitis, inguinal adentitis
(adentitis is inflammation of the glands), ulcers in the loin, eczematous eruptions,
pustules, constipation, TB, diarrhea, chronic dysentery, anemia, jaundice and
upper respiratory infections. Siddha medicines are formulated in such a way as to
have a total rejuvenating effect on the body and not only effective against a
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ids: Alternative Therapies for AIDS Cure
particular disorder.
The special feature of the Siddha medicine is that most of the preparations are in
compound formulation, and because of its synergistic action, toxicity is
diminished, thereby increasing bioavailability through the cells of the body. The
pharmacodynamics of this system is entirely different from other systems of
medicines.
Drugs that could be prepared for AIDS may be classified as follows:
1. Herbal preparations
Serankottai Nei (herbal ghee), Mahavallathy leyham, Parangi rasayanam.
2. Herbo mineral preparations
Gandhak Parpam, Gandhaka rasayanam.
3. Herbo mercuric preparations
Idivallathy mezhugu, Poona Chandrodayam.
4. Herbo-mercuric-arsenal preparations
Rasagandhi mezhugu, Nandhi Mezhugu, Sivandar Amirtham, Kshayakulanthan
Chenduram.
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Related Articles, Links
Homeopathy in HIV infection: a trial report of double-blind
placebo controlled study.
Rastogi DP, Singh VP, Singh V, Dey SK. Rao K.
Central Council for Research in Homoeopathy, JNBCHA. Janakpuri, New
Delhi, India.
OBJECTIVE: This study was aimed to evaluate the immuno-modulator role
of homeopathic remedies in Human Immunodeficiency Virus (HIV)
infection. METHODOLOGY: A randomised double blind clinical trial was
conducted to compare the effect of homeopathic remedies with placebo, on
CD4+ve T-lymphocytes in HIV infected individuals, conforming to Centres
for Disease Control (CDC) stage II & III. 100 HIV+ve individuals between
18-50 y (71% males) were included in the study. 50 cases conformed to CDC
stage Il-Asymptomatic HIV infection, and 50 cases to CDC stage
III—Persistent Generalised Lymphadenopathy (PGL). Cases were stratified
according to their clinical status and CD4+ve lymphocyte counts. The
randomisation charts were prepared much before the start of the trial by
randomly assigning placebo and verum codes to registration numbers from 1
to 50. A single individualised homeopathic remedy was prescribed in each
case and was followed up at intervals of 15 d to one month. A six months
study was performed for each registered case. Assessment of progress was
made by evaluation of CD+ve lymphocyte counts, which was the
prospectively-defined main outcome measure of the study; the results were
compared with the base line immune status. RESULTS: In PGL, a
■statistically significant difference was observed in CD+ve T-lymphocyte
counts between pre and post trial levels in verum group (P < 0.01). In the
placebo group a similar comparison yielded non-significant results. (P =
0.91). Analysis of change in the pre and post trial counts of CD4+ve cells
between groups was also statistically significant (P = 0.04). In asymptomatic
HIV infection, differences in absolute CD4+ve lymphocyte counts between
pre and post trial levels were not significant. Analysis of changes in pre and
post trial CD4 levels of placebo and verum groups for combined strata of
asymptomatic and PGL groups was also not significant. CONCLUSION: The
O'
8/21/2007 1:42 PM
omeofjathy in HIV infection: a trial report of dou...[Br Homeopath J...
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study suggests a possible role of homeopathic treatment in HIV infection in
symptomatic phase, as evidenced by a statistically significant elevation of
base line immune status in persistent generalised lymphadenopathy.
Publication Types:
• Clinical Trial
• Randomized Controlled Trial
PMID: 10335412 [PubMed - indexed for MEDLINE]
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8/21/2007 1:42 PM
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