India's AIDS control programme was cited as a success in Melbourne for its work with marginalised populations which have brought down the rate of new HIV infections.
The recently concluded 20th International AIDS Conference had an important takeaway for India - the momentum of the fight against HIV cannot be dropped.
India's AIDS control programme was cited as a success in Melbourne for its work with marginalised populations which have brought down the rate of new HIV infections. But there are numerous challenges on the ground. Analysts say there's a risk of reversing its gains if these challenges are not met.
UNAIDS executive director Michel Sidibe set the tone for the Melbourne International AIDS Conference when he called upon governments to be brave enough to stop public hypocrisy on sex and promote universal sexual and reproductive health, education and rights.
India is among countries that have yet to say yes to sex education in schools. It is an important channel to equip young people with good information and counseling that will allow them to stay safe, healthy and make a choice based on consent.
The country's AIDS control programme is showcased as a success story for its work with marginalised populations. And for the programme to continue in a stronger and strategic way it will also need to address its young people.
"If we don't start sex education for schoolchildren, we are getting into serious problems. Compared to what it was ten years back, today the Internet access is so good, even school students go to pornographic sites. Essentially we are leaving children to learn about sex from pornography and not from schools, which I think is a bad choice," said Prasada Rao, UN Secretary General's Special Envoy for AIDS in the Asia Pacific region.
A controversy had arisen over Health Minister Harsh Vardhan's recent comments on sex education and condoms. Though he clarified that he was misquoted, it polarised the debates once again.
Clearly, the confusion did not affect India's condom company, HLL Lifecare, which was at the conference. A public sector company under the Ministry of Health and Family Welfare, it aggressively promotes condom usage and seeks new markets.
HLL Lifecare is the second largest condom selling company in the world and exports to 165 countries. "We are now promoting the new version of female condoms. And that is the need not only in India but in different parts of the world," said Dr M Ayappan, the company's Chairman and MD.
However, the use of female condoms is low, even among sex workers. According to Manjula Ramaiah, Ashodaya Samithi/Global Network of Sex Work Projects, "In Mysore we don't get free female condoms, only male condoms. Female condoms are socially marketed. Sex workers are not ready to pay money and buy them."
There are other challenges on the ground. People living with HIV say there is a stockout of the free anti-retro viral drugs provided at government centres. The situation could cause lack of adherence or drug resistance.
"During the last three months, there have been over 15 incidents of treatment stock out. It's creating a lot of problems. We are very concerned," says Loon Gangte, founder, Delhi Network of Positive People.
At the conference, there was also demand for scaling up of prevention of parent to child transmission programme and viral load monitoring of positive people. These concerns are now being addressed by India's AIDS programme. "Viral load testing is the latest emphasis for determining the health of the AIDS patient. We carried out an internal assessment in super specialities which have viral load testing machines. We are trying to work out a system whereby sample could be sent there, rather than upscaling the ART centres, because viral load machines are expensive and needs a certain number of tests for its optimal use," said KB Agarwal, Joint Secretary in the Department of AIDS Control.
The message from the conference is that the battle is far from over. Even though India has done incredibly well in getting new infections down, now is not the time to reduce the commitment. The programme will require both funding and innovative approaches.
According to Prof Sharon Lewin, AIDS 2014 Local Co-Chair, "If we relax what we do now, it might mean going backwards. Going backwards means increase in new infections which will ultimately require life long treatment for everyone. So there are huge costs there. Every infection that we can prevent in Australia, it prevents about 450,000 dollars of medical costs life long. Every new infection we can prevent make a very big difference. Therefore maintaining prevention messages, maintaining harm reduction statistics, maintaining people who can access treatment lead to incredible benefits."
India's AIDS control programme is poised for integration with the national health mission, which will make it cost effective and sustainable. The concern, however, is whether the mainstream health system will engage with socially marginalised groups like sex workers, men who have sex with men, transgenders and drug users. The rate of HIV infections among them is high. Currently, HIV prevention services, for instance harm reduction for people who inject drugs, are largely provided by civil society groups.
As the national health mission evolves, it brings separate programmes like the national AIDS control programme on to a unified platform. Analysts say certain key populations, like men who have sex with men, transgenders and sex workers will require a separate and high degree of focus.