How NACO did it?: Positive on AIDS

[Guest guest]

Positive on AIDS

The war is far from over but in the fiercest battlezone down south,

there's a glimmer of hope in Tamil Nadu. Toufiq Rashid finds out how

NACO did it

Posted online: Sunday, August 29, 2004 at 0000 hours IST

ANBUMANI Ramadoss is upset. At the recent XV International AIDS

Conference in Bangkok, the world feted Thailand for its success in

controlling AIDS. The real template, the Union health minister

believes, was overlooked.

Tamil Nadu, agrees Meenakshi Dutta Ghosh, director-general of the

National AIDS Control Organisation (NACO). It is more of a success

because it showed it was possible to begin turning the corner in the

AIDS battle at a fraction of the Thai outlay for roughly the same

population strength.

The HIV surveillance 2003 — read with the latest figures collected

from 10 ante-natal clinic sentinel sites (where pregnant women are

checked at random for HIV) — indicates the decline in the spread of

the epidemic in the state. If 1.13 per cent of the women were HIV-

positive in 2001 and 0.88 per cent in 2002, in 2003 it fell further

to 0.75 per cent. STD clinics noted a similar drop: from 16.80 per

cent in 2000 to 9.20 per cent in 2003.

These figures, says NACO, are indicative of a nationwide fall in the

spread of HIV. The number of new cases reported in 2002 was 6.1

lakh; in 2003, it was 5.2 lakh. The figures are still worrisome, of

course, but the trends are encouraging, says NACO:

• India continues to be low-prevalence, with adult HIV pegged at 0.9

per cent of the total population.

• The six high-prevalence states of Tamil Nadu, Andhra Pradesh,

Karnataka, Maharashtra, Manipur and Nagaland show early signs of

sero-stabilisation in HIV infections in ante-natal and STD clinic

checks.

• None of the three moderate HIV-prevalence states — Gujarat, Goa

and Pondicherry — has moved into the high-prevalence zone.

• Not a single low-prevalence state needs to be classified

otherwise.

Team at work

THE NACO team is, literally, over the moon. Leading the AIDS

sharpshooters is Ghosh, a 1970-batch IAS officer who is credited

with introducing new-age options like emergency contraception in the

National Family Welfare Programme in 2002.

Next in line is her deputy, Dr N S Dharamshaktu, additional project

director of the programme. Then come four joint directors: Dr

Sadhana Rout, in charge of information, education and communication;

Dr Mohammad Shau-kat, in charge of surveillance; Dr P Salil, who

looks after blood safety; and Dr A S Rathore, responsible for

training.

For technical advice, the core team turns to a group of national

consultants. Implementation is decentralised, with each state and

the Ahmedabad, Mumbai and Chennai municipalities possessing their

own AIDS cells. The state societies work with NGOs, people with

HIV/AIDS and government agencies.

``While we work at many levels, our mission is simple,'' says

Ghosh. ``NACO gives first priority to preventing the spread of

HIV/AIDS. We focus on providing care, treatment and support without

discrimination to those infected with HIV.''

NACO's success, such as it is, is but a blip on a terrifying global

scenario. An estimated 40 million people live with HIV/AIDS. The

syndrome has already claimed 20 million lives and 6 million people

need treatment, according to the World Health Organisation. Of the

last, South Africa accounts for the largest segment, followed by

India.

In the 17 years since the first AIDS case was reported in Chennai

(see report, First case, first in control), NACO's concerns have

swollen manifold: By end-2003, the country is supposed to have had

5.1 million people affected with HIV/AIDS. Initially regarded as

a `fringe' disease — the victims were commercial sex workers,

injecting drug users, homosexuals and migrant labourers — the

epidemic is now moving to the general population.

Facts and figures

DESPITE those fearsome statistics, NACO is happy with the headway it

has made. ``The National AIDS Control Programme is firmly rooted in

evidence-based planning,'' says Ghosh. ``The most important step is

accessing evidence and providing accurate numbers so that nobody can

challenge the statistics.''

Ironically, it is those very statistics that brought it under fire

in the Comptroller and Auditor-General's report last week. Citing a

jump from 3.5 million HIV-affected in 1998 to nearly 4.6 million in

2002, the CAG criticises NACO for improper implementation of the

programme. NACO also gets rapped for its non-disclosure policy, with

the CAG pointing out that this could lead to HIV-positives infecting

the healthy.

To all this, Ghosh has only one defence: ``The CAG report refers to

a period of time after which significant progress has been made.''

There are others who couch their criticism of India's AIDS battle —

and NACO's role in it — in kinder terms. Says Selhore,

director of Project Sahara, an NGO running a care home for HIV/AIDS-

affected, ``Political will at the top is very high but it fades as

you go down the ladder. So, NACO in Delhi might be committed, but

how much of that is true of others? The system has to be monitored

so that local success stories are repeated elsewhere.''

Anjali Gopalan, executive director of Naaz Foundation India trust,

too, is sceptical of putting faith in numbers. ``Whatever NACO says

might be true at the macro level, but they don't work in the micro-

level. The achievements are there, but there are problems also,''

she says.

NACO, though, insists they are not working in isolation. ``Growing

evidence from around the world indicates that the HIV/AIDS challenge

is best met with a strategy that combines prevention and care,''

says Ghosh.

Its focused grassroots reach, believes NACO, is what helps it cut

costs and be more effective. Case in point: Tamil Nadu.

Case study

FAR away, in a corner of Delhi, five-year-old Meena returns from

school. Clinging to her is her two-year-old brother Rahul. Meena is

HIV-positive, Rahul is yet to be tested for the virus. The siblings

were thrown out of their Garhwal village after their mother died of

AIDS, now they live with an NGO called Akankshay in the capital.

Some months ago, Girilal, 38, turned up at the NGO, claiming to be

the children's father. But just as Meena and Rahul were set to

return home, Girilal lost his eyesight to the disease he had passed

on to his wife and children.

However, that is not the end of the story: At Akankshay, Girilal

gets free anti-retroviral treatment (ART) from the government, he is

optimistic his sight will return: ``Earlier, I couldn't see a thing.

After about 45 days on ART, I can see forms and shapes.''

Girilal is one of 11 people registered with Akankshay who gets free

AIDS drugs from the government; there are 1,000-odd people like him

across India.

Lucky as Girilal is, the gap between demand and supply is indicated

by the fact that this one NGO had 80 patients in urgent need of the

drugs.

``This is an area where we want to sustain our efforts,'' says

Ghosh. ``This year alone, 25,000 patients are to receive ART. For

2005-06, we have a target of 50,000, by 2007, we want to reach a

lakh of people.''

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