Moving Towards the Triple Zero Goal : ICAAP 11 at Bangkok

Swapna Majumdar *

International AIDS Candlelight Memorial at JN Dance Academy Hall, Imphal in May 2013 :: Pix - Deepak Oinam

"Why wouldn't you want to share my chocolate?" What would be your answer if a young five year old girl infected with the Human Immunodeficiency Virus (HIV) asks this innocent question? The Indian government Department of AIDS Control (DAC) is hoping that thought provoking questions like this on HIV and AIDS printed on tickets to the popular annual international trade fair held from14 to 30 November in New Delhi will give visitors something more than just entry to the exhibition.

"Many people still believe that the infection can be acquired if they shake hands or share food with people living with HIV (PLHIV). Stigma and discrimination against PLHIVs can end only when there is greater understanding about this infection. This is the first time that our National AIDS Control Programme is using messages on trade fair tickets to spread awareness on HIV. Considering the diverse groups of people who attend the fair, we believe that this will draw visitors to our information booth in the fair," said Mr Lov Verma, Secretary, Department of AIDS Control (DAC), Ministry of Health and Family Welfare, in an exclusive interview given to Citizen News Service (CNS) in lead up to 11th International Congress on AIDS in Asia and the Pacific (11th ICAAP).

According to Mr Verma, this initiative is part of their information, education and communication (IEC) strategy towards achieving the target of zero discrimination, one of the three global HIV/AIDS targets. The other two targets are 'zero new infections, and zero AIDS-related deaths.This goal of attaining 'triple zero' is also the theme of the 11th Congress on AIDS in Asia and the Pacific (ICAAP 11) to be held from 18 to 22 November 2013 in Bangkok, Thailand.

Boosting the government's efforts is the 'End AIDS' India campaign, a collaborative effort of five well-known Indian nongovernmental organizations. According to the campaign's Honorary Chairperson Mr. J V Prasada Rao, former Head of DAC (also known as the National AIDS Control Organization) and UN Secretary General's Special Envoy for AIDS in Asia and the Pacific, public attitudes towards affected communities and PLHIV are incrementally starting to shift, though stigma and discrimination are still very real issues for many.

Ending stigma and discrimination is the most important way to ensure zero AIDS-related deaths says Ms Surang Jaynam, director, Service Workers in Group (SWING), a community based organization working for sex workers in Thailand. "If we can stop the stigma and discrimination, everyone will come to get treatment and no one will die from AIDS," she says.

It was to ensure universal access to prevention, treatment, care and support to the HIV affected that the HIV/AIDS Bill in India was put together. The Bill aims to provide legal redressal against discrimination in both public and private sectors. The Bill is important because it ensures that all HIV positive people get complete treatment, including antiretroviral (ARV) drugs, diagnostics, treatment for opportunistic infections and nutritional supplements as a right. Under this, the private sector has been brought within the ambit of discrimination and the Bill would provide redressals against discrimination in both public and private sector.

While the DAC is hoping the Bill, prepared by the Ministry of Health and Welfare in 2006, will be passed in the upcoming winter session of Parliament starting from November 22, it is pushing to bring down new infections in its bid to achieve the 'zero new infections' target. It aims to decrease new infections down by 50% from the base level in 2007, that is from 1,23, 890 to 61945 by 2017.

The adult HIV prevalence at national level has declined from estimated level of 0.41% in 2001 to0.27% in 2011 say Mr Verma. He points out that ongoing 1825 targetted interventions focusing on behaviour change and increasing condom use in the country has led to a drop in HIVprevalence among female sex workers at national level (5.06% in 2007 to 2.67% in 2011).

It also come down among men who have sex with men (7.41% in 2007 to 4.43% in 2011), and injecting drug users (7.23% in 2007 and 7.14% in 2011).

According to Mr. Verma, the scale up of free antiretroviral treatment (ART) since 2004 has saved over 1.5 lakh lives in the country till 2011 At the current pace of the scale up of ART services, it is estimated that annual 50,000 – 60,000 AIDS- related deaths will be averted in the next five years.

Although AIDS-related deaths decreased by around 42% during 2007 to 2011 in the high prevalence states, the DAC has signed a Memorandum of Understanding with the Ministries of Shipping, Coal and Higher Education earlier this year on provision of prevention, care, support and treatment services of HIV/AIDS. The Department has trained about 3.1 lakh persons to provide these services.

While these statistics indicates that India is making efforts to achieve the global targets of 'zero new infections, zero AIDS-related deaths and zero discrimination', the programme faces some challenges. Finance ministry sources reveal that the budget for the programme has been cut from Rs 1785 crore to Rs 1400 crore. There has also been a drop in funding from foreign donors. Additionally, with a significant number of people likely to require first and second line ART treatment in the coming years, the government needs to guard against complacency arising from the decline in HIV prevalence rate. It remains to be seen whether the national AIDS programmewill be able to sustain the 'prevention' focus and intensity in the areas where significant declines have been achieved while giving equal attention to the emerging hot spots of the epidemic.

AIDS in Asia and Pacific, public attitudes towards affected communities and those living with HIV are incrementally starting to shift, though stigma and discrimination are still very real issues for many. Ending stigma and discrimination is the most important way to ensure zero AIDS-related deaths says Ms Surang Jaynam, director, Service Workers in Group (SWING), a community based organization working for sex workers in Thailand. "If we can stop the stigma and discrimination, everyone will come to get treatment and no one will die from AIDS," she says.

It was to ensure universal access to prevention, treatment, care and support to the HIV affected that the HIV/AIDS Bill i India was put together. The Bill will provide legal redressal against discrimination in both public and private sectors. The Bill is important because it ensures that all HIV positive people get complete treatment, including ARVs, diagnostics, treatment for opportunistic infections and nutritional supplements as a right. Under this, the private sector has been brought within the ambit of discrimination and the Bill would provide redressals against discrimination in both public and private sector.

While the DAC is hoping that the Bill, prepared by the Ministry of Health and Welfare in 2006, will be passed in the upcoming winter session of Parliament starting from November 22, it is pushing to bring down new infections in its bid to achieve the 'zero new infections' target. It aims to decrease new infections down by 50% from the base level in 2007, that is from 1,23, 890 to 61945 by 2017.

The adult HIV prevalence at national level has declined from estimated level of 0.41% in 2001 to0.27% in 2011 said Mr Verma. He pointed out that the ongoing 1825 targetted interventions focusing on behaviour change and increasing condom use in the country have led to an over 2.3% drop in HIV prevalence among female sex workers at national level (from 5.06% in 2007 to 2.67% in 2011). It has also come down among men who have sex with men (from 7.41% in 2007 to 4.43% in 2011), and injecting drug users (from 7.23% in 2007 to 7.14% in 2011).

According to Mr. Verma, the scale up of free antiretroviral treatment (ART) since 2004 has saved over 1.5 lakh lives in the country till 2011. At the current pace of the scale up of ART services, it is estimated that 50,000 – 60,000 AIDS- related deaths will be averted annually during the next five years.

Although AIDS-related deaths decreased by around 42% during 2007 to 2011 in the high prevalence states, the DAC has signed a Memorandum of Understanding with the Ministries of Shipping, Coal and Higher Education earlier this year on provision of prevention, care, support and treatment services of HIV/AIDS. The Department has trained about 3.1 lakh persons to provide these services.

While these statistics indicate that India is making efforts to achieve the global targets of 'zero new infections, zero AIDS-related deaths and zero discrimination', the programme faces some challenges. Finance Ministry sources reveal that the budget for the programme has been cut from Rs 1785 crore to Rs 1400 crore. There has also been a drop in funding from foreign donors.

Additionally, with a significant number of people likely to require first and second line ART treatment in the coming years, the government needs to guard against complacency arising from the decline in HIV prevalence rate. It remains to be seen whether the National AIDS Programme will be able to sustain the 'prevention' focus and intensity in the areas where significant declines have been achieved while giving equal attention to the emerging hot spots of the epidemic.