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One nation, one resolve: fighting AIDS together
The basic constraint so far has been resources, but in terms of funding things seem to be looking up. We are also short of trained, skilled manpower, says S. Y. Quraishi, in an interview with Anusha Lall and Reeshma Nair of OneWorld South Asia.
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S. Y. Quraishi
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Could you tell us, briefly, about NACOs response to the HIV/AIDS threat in the country?
HIV/AIDS is one of the serious issues in the country. In 1986,there was only one case in which has now gone up to over 5.1 million in 18 years. We have responded with a National AIDS Control Policy, published in 2002 and one of the goals it outlines is to achieve zero rate of growth (spread) of HIV/AIDS by 2007. We have targeted interventions for highrisk groups like commercial sex workers, men having sex with men, truckers, or intravenous drug users. Although our policies in the past have proved successful, there is still a long way ahead. The pandemic has moved from the high-risk groups into the general population. Now from the six states that were categorised as highprevalence, it has gone to every single state in the country. We have launched a six-month long campaign with the intent that within this period the message dealing with AIDS awareness, its modes of transmission and means of prevention should reach everybody.
How would you describe your present strategies for combating HIV/AIDS?
Ninety per cent of our intervention is in terms of awareness-generation. But this does not mean that other details like care, support, and treatment should be neglected. We are working on these aspects too but broadly speaking our roadmap would talk about scaling-up our existing strategies and also go as close to the grassroots as possible. Earlier the country was classified into the high-prevalence, moderate prevalence and the low-prevalence states. But upon reviewing this classification, I felt that being categorised as a low-prevalence state creates a feeling of complacency. Therefore we have reclassified states into highly vulnerable and vulnerable states and are starting more interventions in the highly vulnerable states.
We have set up a communication consortium involving a number of donor agencies. We call it the India Communication Consortium on HIV/AIDS, or ICCHA. All the communication and multimedia activities would be carried out under ICCHA, in an integrated manner. We have also hired two professional advertising agencies and are in the process of briefing them towards a strategy. We are going to use market research agencies that will conduct a baseline survey and concurrent evaluation and campaign evaluation for us to see whether our efforts have made any difference. In addition, there was the National Media Leaders Summit held recently, where 25 media agencies participated and almost all of them committed themselves to taking up this issue.
We are also working on the concept of a national partnership on HIV/AIDS. We have named it the India Partnership on AIDS Control and Treatment, where all stakeholders will be partners. The slogan we have coined for this is One nation, one resolve we will fight AIDS together. At the same time we are trying to mainstream HIV/AIDS into parallel government structures. We have an inter ministerial committee with nine other Ministries, under the chairmanship of Arjun Singh, the honourable Minister for Human Resource Development. This committee has decided that every Ministry will make its own Action Plan for HIV/AIDS, with its own budget.
What is the Red Ribbon Express? How does NACO intend to use this initiative?
The Red Ribbon Express idea originated from the Rajiv Gandhi Foundation. In fact Shahnaz Akhtar gave the name. They had been running a lifeline express for fourteen years, which provided the inspiration. We have developed the idea through a partnership between NACO and Rajiv Gandhi Foundation and will have four specially remodelled trains running from the four corners of India and will travel for six months. One coach will be a hospital on wheels, one shall house exhibitions, another shall be the training coach, and the next one will have young people, performing artists, people doing street theatre, who will move out into the villages where the train would stop. There would be bicycle trips accompanied by the villagers, a kind of parade with banners carrying relevant messages. The operational details are still being worked out.
How does NACO intend to address the social dimension of AIDS the social stigma, discrimination especially at a time when there are medical practitioners who dont want to handle AIDS cases?
The stigma associated with AIDS is one of the key concerns or issues that we have to deal with, and we have to deal with it through persuasive media. One of the reasons that people never came forward earlier was that being diagnosed as HIV positive meant sure death. Now treatment and the possibility of prolonging life provide an incentive for victims to come forward.
There are already about 700 voluntary testing and counseling centres in existence, and we want to increase that number. Also, in a situation where AIDS can be viewed as just another disease the stigma will decline. The media can be responsible for spreading this message. The discrimination starts because people have misconceptions about how HIV/AIDS is transmitted.
What would be your comment on the level of political support that NACO receives in its efforts?
Fortunately, the government is very keen to take up this issue in a serious manner. There are three things in the National Common Minimum Programme, which affect us. One is the resolve of the government to increase the public sector outlay on health, from 0.9 per cent of GDP to 2-3 per cent; second, they would like to focus on communicable diseases; third, but the most important is that the UPA government would provide leadership to national AIDS control efforts.
The Prime Minister has asked us to prepare a roadmap for our efforts (under the National Common Minimum Programme). The work has begun with a series of discussions and consultations with people in the field, experts, doctors, and other involved persons.
How is NACO placed in terms of financial resources?
Our budget last year was INR 2.59 billion but it has been increased now to 4.26 billion, which is a big jump. And it reinforces the present governments determination to combat HIV/AIDS. For the year 2005-2006 we have proposed a budget of INR 5.62 billion to the Planning Commission and are confident that it will be approved. For the Communication Consortium we are getting funding from various donors directly through a secretariat at the UNICEF. These finances are in addition to the government funding.
However, we need a lot of support from the media, as our media budget is very poor. Our IEC budget this year is only INR 90 million. However, we are trying to maximize our resources through partnerships. We are exploring the possibility of superimposing our slogan on various advertising material, where we could piggyback on the reach of products like Coke and Pepsi.
Do you think that ICTs can help you meet the challenge that is presented by the HIV/AIDS pandemic in India?
We are using all possible electronic mass media, folk media, street theatre, etc. But we do face a communication challenge. Our appeal to all media is that they include the issue of HIV/AIDS into their programming we are not asking for extra space or slot since that may have cost implications for them but just to integrate the same into their ongoing programmes. I am happy to know that recently Sanjivini, an ongoing serial on STAR Plus has introduced HIV positive character. The Internet of course offers a great opportunity.
Given the advent of new patent laws, and their implications for the cost of anti-retroviral drugs, how does NACO propose to meet this challenge?
This concern breaks down into two aspects: the first is treatment. We have a target to set up 25 Anti Retroviral Therapy centres by the end of March 2005. Twenty one of these centres have already become operational, and four more will be operational by mid-February, positively ahead of schedule. Our overall target is for 100, 000 patients to be treated through 188 centres by 2007. This is to ensure that treatment goes hand in hand with prevention. About the drugs, we have three companies that are supplying ARVs not only to India but to other parts of the world as well, at about one third or half of the price of international brands. The debate regarding the impact of the WTO regime is still going on. However, the WTO agreement provides that any government can give a compulsory license in the public interest, for drugs that are life-saving or for public health. We are examining the legal implications of this provision, and considering what steps to take.
What role do you envisage for civil society, and the corporate sector?
We have about 1000 NGOs working for us, and we are now looking at the possibility of involving NGOs working for other Ministries as well. For instance, NGOs working on Reproductive and Child Health (RCH), while talking about RCH can also talk about HIV/AIDS issues. There are about 500 NGOs dealing with drug abuse programmes. While they take up the problem of drug abuse one of our core concerns, intravenous drug use, can be addressed side by side.
On the other front, I am very disappointed with the response of the corporate sector. They have not understood the gravity of the problem for themselves. The nation is made of individuals, many of who work in these factories and offices. Thus the initial outreach itself could make a big difference, and can have a multiplier effect. We are thinking of big initiatives for reaching out to the corporate sector, and we do hope that they will respond, because the implication for them is economic. It is said that prevention is better than cure, in this case it can be said that prevention is cheaper than cure.
What are the constraints that NACO faces in its mandate?
The basic constraint so far has been resources, but in terms of funding things seem to be looking up. We are also short of trained, skilled manpower. The entire NACO staff from the Director-General to the driver and the peon stands at forty. We need more experts, to create more departments - especially a research department. We need a good library, a documentation centre, and a comprehensive monitoring and evaluation system. So a lot of strengthening is required, and we are proposing various measures to the government towards this end.
How would you describe the path ahead?
We want to focus more on advocacy. Instead of just taking on implementation we want to play an increasingly catalytic role. We are focusing on mainstreaming, partnerships, and our awareness and communication programmes. Another role or priority that we see for ourselves is capacity building for our partners. Finally, we need to institute a monitoring and evaluation mechanism to gauge how the nation is responding to our programmes.
About S.Y. Quraishi: He is the Additional Secretary, Ministry of Health and the Director General of the National AIDS Control Organisation, Government of India.
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