Overview of National Policies in

HIV/AIDS Research

India

Rajesh Kumar Sharma

Lecturer
Himalayan College of Nursing
 HIV/AIDS – An epidemic

• 1st case in sex workers in Chennai, 1986

• > 5.3 million people infected
• 6 High prevalence States: Maharashtra,
Karnataka, Tamil Nadu, Andhra Pradesh,
Manipur, Nagaland
• India- world’s 2nd largest burden of HIV-infected
persons.
– One of every six new HIV infections
– two Indians become HIV-infected every minute
• Majority due to sexual transmission followed by
IV drug use and Mother-to-child transmission
• HIV epidemic is spreading from urban to rural
populations
Known modes of transmission,
2002
 Actions Taken

• After 1986, Government took a series of

measures
• Realized that AIDS had epidemic proportion in
Africa and was spreading rapidly
• Govt of India started pilot screening of high risk
population
 National AIDS Committee

• National AIDS Committee in Year 1986

– To formulate strategy & plan for implementation of prevention &
control of HIV/AIDS in the country,
– to bring together various ministries, NGOs and private institutions for
effective co-ordination in implementing the programme
• The committee acts as the highest-level deliberation body
– to oversee the performance of the programme
– to provide overall policy directions,
– to forge multisectoral collaborations.
• Created public awareness, introduction of blood screening for
transfusion and surveillance activities
• NACP -1987
 Medium Term Plan
for HIV/AIDS Control

• 1989, with WHO support, a medium term plan with US $10

million budget
• Implemented in 5 affected states & UTs (Maharashtra, Tamil
Nadu, West Bengal, Manipur, and Delhi).
• Focus on reinforcement of program management capacities &
targeted IEC and Surveillance
• Preventive activities like implementation of education and
awareness program, blood safety measures, control of hospital
infection, condom promotion, strengthening clinical services
gained momentum in 1992
 The National AIDS Control Project

Key objectives

• To reduce the spread of HIV infection in India

• Strengthen India ’s capacity to respond to

HIV/AIDS on a long term basis.
 National AIDS Control Program

• Implemented in 32 States/UTs & 3 Municipal

Corporations namely Ahmedabad, Chennai & Mumbai
through AIDS Control Societies
• The 3 new states (Chattisgarh, Uttaranchal,Jharkhand)
establishing their State AIDS Control Societies
• Access to highly active antiretroviral drugs
• Pharma industry instrumental in providing lower cost,
generic, fixed dose combinations for HIV-infected
patients
 Components

• Priority targeted interventions for populations at

high risk
• Preventive interventions for the general
population
• Low Cost care for people living with HIV/AIDS
• Institutional strengthening
• Inter-sectoral collaboration
 National AIDS Control Programme
Phase I and II
• Phase-I (1992 - 1999) was implemented across the
country with objective to slow the spread of HIV to
reduce future morbidity, mortality, and the impact of
AIDS by initiating a major effort in the prevention of
HIV transmission.

• Phase-II (1999 - 2006) was aimed at reducing spread

of HIV infection in India and strengthen India's
capacity to respond to HIV epidemic on long term
basis

Dr. KANUPRIYA CHATURVEDI

Significant Achievements of NACP-I &II
• Scaling up the high prevalence states.
• Increasing access to free ARV is one of the major
achievements of NACP-II.
• Recognizing the need of care and support for people
living with HIV and AIDS and scaling up of
Community Care Centers.

Dr. KANUPRIYA CHATURVEDI

 Contd.
• The effectiveness of the condoms as one of the safest
methods to prevent and control the spread of HIV and
other STIs has been well established.
• Initiating the process for developing draft legislation on
HIV and AIDS.
• Focus has shifted from raising awareness to behavior
change, from a national response to a decentralized
response and an increasing engagement of NGOs and
networks of people living with HIV/AIDS.
• The National AIDS Prevention and Control Policy and the
National Council on AIDS (NCA), chaired by the Prime
Minister, provide policy guidelines and political
leadership to the response.
 Phase-III (2007-2012)
• Phase-III (2007-2012)is based on the experiences
and lessons drawn from NACP-I and II, and is built
upon their strengths. Its priorities and thrust areas
are drawn up accordingly and include the
following:
– Considering that more than 99 percent of the population
in the country is free from infection, NACP-III places the
highest priority on preventive efforts while, at the same
time, seeks to integrate prevention with care, support and
treatment.
 Contd.
– Sub-populations that have the highest risk of exposure
to HIV receive the highest priority in the intervention
programs. These would include sex workers, men-
who-have-sex-with-men and injecting drug users.
Second high priority in the intervention programs is
accorded to long-distance truckers, prisoners,
migrants (including refugees) and street children.
– In the general population those who have the greater
need for accessing prevention services, such as
treatment of STDs, voluntary counseling and testing
and condoms, will be next in the line of priority.
 Contd.
– NACP-III ensures that all persons who need treatment
would have access to prophylaxis and management of
opportunistic infections. People who need access to
ART will also be assured first line ARV drugs.
– Prevention needs of children are addressed through
universal services. Children who are infected are
assured access to pediatric ART.
– NACP-III is committed to address the needs of
persons infected and affected by HIV, especially
children.
 Contd.
• NACP-III also plans to invest in community
care centres to provide psycho-social support,
outreach services, referrals and palliative care.
• Socio-economic determinants that make a
person vulnerable also increase the risk of
exposure to HIV. NACP-III will work with
other agencies involved in vulnerability
reduction such as women's groups, youth
groups, trade unions etc. to integrate HIV
prevention into their activities
 Policy on Antiretroviral therapy

• Efforts to exempt customs duty on drugs to reduce cost

• The ART is not provided under National Program
• However, in training for doctors rationale use of ART
emphasized.
• ART drugs provided in cases of post-exposure
prophylaxis to health care providers and the feasibility
study project on prevention of mother to child
transmission.
 Initiative
• The WHO declared lack of access to ART as a ‘global
health emergency’ in September 2003
• Joint WHO/UNAIDS emergency plan to scale up
access to treatment for at least 3 million by 2005.
• Government of India has issued guidelines for phased
scale up of access to antiretroviral therapy for people
living with HIV/AIDS.
 Initiatives in India
• 1 million people in 6 high prevalent states will receive
antiretroviral (ARV) drugs free of cost from 1 st April
2004 targeted to 3 vulnerable groups
– mothers who participated in the Prevention of Parent to Child
Transmission (PPTCT) program as seropositive antenatal
cases
– seropositive children below the age of 15 years
– people with AIDS who seek treatment in selected
government hospitals
• Govt of India in dialogue with pharma to optimize
additional potential reduction in cost of ARV drugs
 State Level Srengthening

• Strengthen program management at state level

• Established organizations as per the guidelines of the
strategic plan
– State AIDS control societies (State AIDS cells),
– Technical advisory committees
– Empowered committees State AIDS Control Societies
• takes the policy decisions for implementation of the HIV/AIDS
control program
• administrative and financial actions
 Recent Initiatives
• In Dec 1998, Prime Minister, Mr Atal Bihari Vajpayee
acknowledged that HIV/AIDS was a serious public health
problem
• In July 2003, the Prime Minister gave call to elected
representatives to display political courage to address
HIV/AIDS issues
• Momentum in political advocacy continued strongly
• Parliamentary forum of elected representatives (Members of
Parliament) was established for HIV/AIDS research that
comprised members from all major political parties
 contd

• Feasibility study to reduce mother-to-child transmission

initiated by NACO in Mar 2000 in 11 maternity
hospitals with little experience in HIV/AIDS research
• Decision to scale up services to reduce mother-to-child
transmission in six Indian states
• Rapid change from non - recognition to acceptance as a
public health problem
• Decision to provide free ART to persons having
advanced HIV disease was taken
 Course of Events

• International AIDS Vaccine Initiative (IAVI) undertook an

effective campaign for HIV vaccine trials
• The President of India, Mr. Abdul Kalam supported conduct
of HIV vaccine trial
• In Feb 2005, the first Phase I HIV vaccine trial was initiated
in the National AIDS Research Institute (NARI), Pune.
• Another HIV vaccine trial using an indigenously developed
vaccine is expected to be initiated in Tuberculosis Research
Centre, Chennai by the end of 2005.
 HIV/AIDS Trial
• NACO, ICMR entered into a Memorandum of
Understanding (MOU) with global, not-for-profit
International AIDS Vaccine Initiative (IAVI) in
December 2000
• An extensive 2 year exercise was undertaken to prepare
the site, design the study and mobilise the volunteer
groups before initiating the HIV vaccine trial
• Adopted a multiple AIDS vaccine candidate approach
 Vaccine Trial Preparedness activities in
India
• Preparedness activities initiated in 2002 & Ph II in
Feb 2005
• Effective campaign for political advocacy helped
accelerate implementation of HIV prevention &
treatment strategies, research responses and its
implementation
• Strong political support strengthened research
efforts in institutions already involved in HIV/AIDS
work and also those who were not adequately
exposed
 Involvement of Policy Makers

• Vaccine programme initiated with a Policy Makers

conference in May 2002
– brought together parliamentarians from 8 developing countries
to share their perspective
• Program received strong support from top political
leadership
– Prime Minister of India, Leader of Opposition, Hon’ President
of India and Chief Ministers of high prevalence states.
• Effort to keep policy makers engaged with programme
– Held policy workshops, one-on-one consultations, regular
briefings at national level, specific workshops with state
legislators at the regional level
 Processes
• Community Involvement
• Formative Community Research
• Study to see willingness to participate for the Phase
I Vaccine Trial
• Committee of Parliamentarians
• Civil Society Stakeholders Interactions
• Media Orientation
• National AIDS Vaccine Advisory Board (NAB)
 Advisory Expert Panels

• Expert panels were set up to address the concerns

and issues that emerged from the consultations
with the various stakeholders
– National AIDS Vaccine Advisory Board
– Informed Consent Group
– NGO Working Group
– National Consultation on HIV Care and Treatment
– Gender Advisory Board
 Major Achievements

• HIV sentinel surveillance mapping of high risk & vulnerable grps

in over 30 states and UTs
• National Blood Policy, 2002 & Action Plan on Blood Safety, 2003.
– Action Plan has mandated revelation of HIV status to result seeking donor,
& brought in accreditation of blood banks
• Care & support and introduced ART
• Mobilized grants for managing the opportunistic infections
and extending antiretroviral treatment for AIDS.
• Awareness generation, expanding services for people with AIDS
• Creating new partnerships
• Initiation of the HIV/AIDs Vaccine trial
Thank you