Making VCT centres widely available will reduce stigma and discrimination in our society, will encourage people to find out their HIV status and will eventually contribute to reducing HIV transmission across the country. Increasing evidence suggests that there is a need to move beyond awareness generation to behaviour change communication. IEC (Information, education and communication) efforts are mindful about being sensitive to the concerns of the people living with AIDS.

IEC is projected as a means of raising awareness and communicating a need for behaviour change.

Generating a demand for services and a tool for debunking myths and misconception, dispelling stigma and discrimination and breaking the silence. While NACP has now a wide range of interventions for prevention, care and support of the people living with HIV/AIDS, it is obvious that prevention and treatment should proceed in tandem because the availability of effective treatment motivates people to come forward for voluntary counselling and testing (VCT).

Higher VCT uptake rates will result in more people receiving prevention counselling. Providing greater access to equitable ART for all HIV infected persons is a critical goal for HIV control programmes. However, the ultimate solution in combating the spread and prevalence of HIV/AIDS across the country rests overwhelmingly with effective prevention of new infections.

Access to treatment provides an important incentive for people to respond positively to prevention campaigns by being tested and if found infected by proceeding to obtain complete and accurate information for appropriate care and support. The present decade of the epidemic has witnessed extra-ordinary progress in developing combined anti-retroviral therapies (ART) as well as continuing progress in preventing and treating opportunistic infections (OIs). ART has reduced the incidence of OIs and thus extended life substantially.

However, admittedly anti-retroviral regimes inhibit efficient replication of the HIV virus, and reduces viraemia to undetectable levels. Lower frequency of opportunistic infections significantly reduces the cost of management of HIV. This helps people lead more productive lives with perceptibly reduced stigma and discrimination.

Successor achieved in terms of ART delaying the onset of AIDS, has now transformed the common perception about HIV from being an immediately fatal scourage to somewhat more manageable chronic illness although devasta-tingly debilitating in the long run. ART is a life long commitment. Adherence to treatment is the most important factor to suppress HIV replication and avoid the emergence of drug resistance.

Successful outcomes on this parameter with improved adherence restores the balance within the immune system, slows or halts disease progression, prevents drug resistance and improves the quality of life. WHO recommends adoption of a public health approach to the administration and distribution of ART. Greater access to affordable ART drug regimen is an important strategy in prevention and control of HIV infection.

We need to develop innovative strategies and tools to support treatment adherence and safe behaviour to prevent transmission of HIV. Treatment education should be an important component of this strategy. It is important that the person knows how drugs work in the body and why it is important to adhere to treatment regimens.

Whereas the challenge in the provision and scaling up access to anti-retroviral (ARV) treatment to achieve the goal that prolonging survival and restoring the quality of life for individuals with HIV/AIDS by providing universal access to free anti-retroviral therapy (ART) as human rights within the context of a comprehensive response to HIV/AIDS needs to be addressed.

Sustained national leadership will ensure that the programme for ART once started will continue uninterrupted. Availability of ART should ensure significant reduction of stigma and discrimination and this will improve access to diagnosis and treatment. Prevention support must increase with ART. We need to anticipate correctly the needs of increasing number of HIV infected people.

Nationwide NACO supported ART centres are physically adjunct to Government (Dist) hospitals/medical colleges and provide counselling, adherence monitoring, and treatment. There are also other sites where ART treatment is offered for free and are covered by NGO sector and by the private sector.

PLHA are excellent allies in effective monitoring of treatment adherence to ART to prevent the development of drug resistance ensuring greater involvement is a true reflection of political commitment, or a right based approach while acknowledges that people have a part to play in decision that affects their lives. People living with HIV/AIDS can be involved in the areas like Advocacy, Counselling, Identification of AIDS patients and referred and provider as educator or expert patients and ensuring adherence.

The primary development objective has been to reduce the rate of growth of HIV infections.

Targeted interventions (TIs) for high risk groups and preventive interventions for the general population are in hand. Political commitment at the highest level has given impetus to the programme across the nation. The second development objective has been to strengthen India's capacity to respond to the challenge of HIV/AIDS.

The project has established nationwide systems for: Blood-safety, HIV sentinel surveillance, computerised management information system (CMIS), behaviour sentinel surveillance (BSS), project financial management, and an expanding partnership with non-governmental organisations (NGOs). All of this has contributed to the development of national and state level implementation capacities.

Experience across the globe demonstrates that directing our prevention efforts towards high-risk groups most vulnerable to HIV infection is an effective strategy and has a multiplier effect. Targeted interventions among these groups involve multi-pronged strategies such as behaviour change communication counselling, health care, treatment for STIs and provision of condoms along with activities that can help create an enabling environment for behavioural change.

There are people amongst us whose lives are at constant risk of contracting the HIV virus in the vulne-rable, bridge and the general population. These risk are often not of their choo-sing but a manifestation of situational compulsions. Sometimes there are also people in our society whose lives have been ra-vaged, ignored and silen-ced.

NACO stand committed in striving ceaselessly to reverse that trend. NA-CO sees these individuals as more than just targets for interventions but hope to partner with them in creating an India safe from HIV, and a nation caring of those who live in it. NACO firmly believes that future of AIDS prevention and control in the country lies in the success of its NGOs intervention programme.

All the way, State AIDS Control Society co-ordinates and effectively monitors to realize the vision as envisaged by NACO. Today, it is the gender inequality which is also driving the epidemic. NACO believes that the added risks and vulnerability of women would be significantly reduced through gender equality and women empowerment and stress the need of gender sensitivity in programme implementation.

Nowadays, it is feasible with the timely administration of chemical prophylaxis to interrupt the transmission of HIV from a HIV positive pregnant women to her unborn child. NACO aims to provide options to all HIV positive pregnant mothers covered under PPTCT programmes and supports a package of primary prevention, family planning, voluntary and confidential counselling and testing (VCCTC), infant feeding counselling and ARV prophylaxis quality PPTCT services are in place through medical colleges and Govt/ district hospitals in six high prevalence states and all the sites extending far and wide across the length and breadth of the country.

It is estimated that more than 7 million pregnant women and their families will receive counselling by 2008 for HIV prevention and will be provided with services for testing and by 2008, an estimated 70,000 infections of HIV among infants would have been averted. In all the high prevalence districts across India, the prevention of parent to child transmission is being integrated and mainstreamed with services for reproductive and child care (RCH).

The most widely deployed strategies to promote and protect the needs and rights of adolescents against acquiring HIV are
i) to provide young people with knowledge and information and
ii) to equip young people with life skills to put knowledge into practice.

Research and experiences have shown that information alone is not enough to protect young people from health risk. Young people also need skills to manage challenging situations and take charge of their own health within supportive communities and environments. The issues of HIV/AIDS are therefore placed in context within more holistic issues of family life education.

However, care and support services for people living with HIV/AIDS (PLHAs) becomes a crucial component to any and all efforts at prevention. In those states which have been designated as high prevalence states, the State AIDS control societies support home-based and community based care, short term hospice or cost effective common opportunities infection interventions.

— to be continued...

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