World Bank on HIV/AIDS in India

[Guest guest]

World Bank on HIV/AIDS in India

In 1991, the Government of India and the World Bank expanded their

collaboration on infectious disease control programs and by 1992 the

first National AIDS Control Project was launched with a World Bank

credit of US$84 million. The project helped the government to

broaden prevention efforts and to establish institutions and

procedures necessary to curb the spread of HIV/AIDS. Building upon

lessons learned from the first project, India requested World Bank

financing for a follow-on project. With a World Bank credit of

US$191 million, the Second National HIV/AIDS Control Project was

started and this is increasing the pace of implementation through

the use of State AIDS Societies to speed the distribution of funds

at the state level.

The Bank has also undertaken analytical work to strengthen the

national response, including an analysis of the full array of costs

and consequences likely to result from several plausible government

policy options regarding funding for anti-retroviral therapy (ART).

Currently, the Bank is carrying out sector work on the economic

consequences of the HIV/AIDS epidemic on India and is actively

supporting the design of the third National AIDS Control Program.

Issues and Challenges: Priority Areas

Limited Overall Capacity: There are severe institutional capacity

constraints, both structural and managerial, at the national and

state levels. It is critical that these factors be addressed as the

program attempts to scale-up its response to the epidemic. NACO will

require a change in its role and responsibilities to provide the

necessary leadership and steering role for a stronger multi-sector

response for the next phase in India's fight against HIV/AIDS while

the states will need to provide implementation capacity to put a

robust program into place. The capacity to mount a strong program is

weakest in some of the poorest and most populated states with

significant vulnerability to the epidemic. There is a need for

tailored capacity-building activities and the introduction of some

performance-based financing approaches. In addition, they also

experience some of the greatest turnover of state level project

directors, resulting in limited continuity and variability in

performance across states. This puts program growth at risk.

Donor Coordination: At present there are over 32 donor agencies

working with NACO in different states and on different programs.

Each donor comes with its own mandate and requirements, as well as

areas of focus. The transaction cost to the government as a result

of attending to the various demands of the donors is huge. There is

a need for better coordinating mechanisms among the donors and clear

leadership by the Government to reduce the transaction costs.

Use of Data for Decision Making: There remains a need for greater

use of data for decision making, including program data and

epidemiological data. A lot of data that is being generated is not

adequately used for managing the program or informing policies and

priorities. Results-based management and linking incentives to the

use of data should be explored.

Stigma and Discrimination: Stigma and discrimination against people

living with HIV/AIDS and those considered to be at high risk remain

entrenched. A lot of this is a result of inadequate knowledge.

Stigma and denial undermine efforts to increase the coverage of

effective interventions among high risk groups such as men having

sex with men, sex workers and injecting drug users. Harassment by

police and ostracism by family and community drives the epidemic

underground and decreases the reach and effectiveness of prevention

efforts. Though there is significant increase in awareness due to

efforts by the government, there is much room for improvement.

Low Awareness in Rural Areas: Sentinel site behavioral surveillance,

completed in 2001, showed high HIV/AIDS basic awareness levels (82.4

percent in males and 70 percent in females). However, rural women

demonstrated very low rates of awareness in Bihar (21.5 percent),

Gujarat (25 percent), and Uttar Pradesh (27.6 percent). New

approaches need to be tried to reach rural communities with

information about HIV/AIDS, safe sex and how to prevent and treat

HIV/AIDS

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