The significant downward revision of India’s caseload of people living with HIV/AIDS will bring all round relief. The revised figure, based on new estimates, has been arrived at by UNAIDS, the National AIDS Control Organisation, and other agencies using a variety of data sets such as prevalence of infection among pregnant women, drug users injecting with needles, and men having sex with men and the National Family Health Survey. The number of people with HIV/AIDS is now placed between two and three million, while the 2006 estimate was 5.7 million; the prevalence is thought to be confined mainly to high risk groups. The sharply lower estimate (which follows a similar reduction in Kenya) has removed India from the top position among countries with the highest number of HIV positive people. Experts and policymakers who expressed doubts over the high caseload estimates for India are bound to feel vindicated now. Much as this is a welcome denouement in the campaign against AIDS, the positive status of even three million people is a major public health challenge, given the general weaknesses of the government-funded healthcare system, budgetary pressures due to high prices of anti-retroviral drugs, and crucially, the stigma associated with HIV.
The third phase of the National AIDS Control Programme scheduled to run between 2007 and 2012 aims to improve voluntary counselling and testing, anti-retroviral treatment, and preventive strategies through integration with national health schemes; it also hopes to scale up community support and advocacy.
But the elimination of stigma and discrimination remains a daunting challenge. There are distressing reports of schools denying admission to HIV positive children even in progressive States like Kerala, while discrimination has deprived many patients of their jobs. The lack of state support for those affected is painfully evident. HIV positive individuals have been running a hotel in Ahmedabad to help provide vocational training and even food to those facing discrimination. Many are denied treatment by hospitals if they test positive. Such affected people can only hope that the legislative protection promised by Health Minister Anbumani Ramadoss against discrimination at the workplace and in healthcare and educational institutions will soon be available and enforced with vigour. Much work also needs to be done to ensure universal access to anti-retroviral drugs, including the costlier second line medication. Although incremental improvements have been made in ARV treatment, access is far from universal, and children in particular have become the invisible victims of poor coverage.