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A decade-and-a-half after
the AIDS programme took off in India, there is no consensus even on the
number of HIV-positive people in the country. Figures vary wildly
between 3.5 million to 100 million! Why do governmental and non-governmental
organisations remain completely unaccountable? What has the National Aids
Control Organisation achieved? Is it guilty of creating a fear psychosis
in the country and inflating AIDS figures to get more funding? Is India
being exploited by the huge HIV/AIDS industry?
How big is the AIDS bazaar
anyway?
The first AIDS case
in India was detected in 1986. Since then, HIV infection has been
reported from all our states and union territories. As of November
30, 1999, 3.36 million samples, mostly from high-risk groups, have been
tested, of which 91,809 have been found to be HIV-positive. During
the same period, 9,695 AIDS cases have been reported to NACO (National
Aids Control Organisation). The Government of India launched a National
AIDS Control Programme in 1987. A comprehensive five-year strategic
plan was launched during the Eighth Plan Period (1992-97) with World Bank
credit to the tune of US$ 84 million. The project was extended upto
March 31, 1999.
The objectives of Phase I of the National AIDS Control Programme were: to prevent HIV transmission; to decrease morbidity and mortality associated with HIV infection, and to minimise the socio-economic impact resulting from HIV infection.
To meet the challenge of the AIDS epidemic, the National AIDS Control Organisation was set up with a project director and supporting technical staff at the centre. The National AIDS Committee was constituted under the chairmanship of the minister of health and family welfare, to co-ordinate the activities of various ministries, non-governmental organisations, and private institutions. The National AIDS Control Board was set up under the chairmanship of the Secretary (Health), to review policies on the prevention and control of HIV and AIDS. State AIDS Control Societies were established in 26 states and six union territories to implement the approved scheme. The State AIDS Cells were headed by senior technical persons from the State Health Services. Adequate technical and administrative manpower was provided to the State AIDS Cells for the implementation of the scheme.
The second phase of the National AIDS Control Programme (NACP-II) was formulated by the Government of India with two key objectives: (i) to reduce the spread of HIV infection in India; and (ii) to strengthen India's capacity to respond to HIV/AIDS on a long-term basis. Negotiations for credit for NACP-II were held between representatives of the Government of India and IDA in Washington from May 7-12, 1999. The IDA Board in its meeting held on June 15, 1999 approved credit of US $191 million.
In addition, USAID and UFID have offered financial assistance of US $41.5 million (Rs 166 crore) and 28 million pounds (Rs 104 crore) respectively for the HIV/AIDS Control Programme. The USAID project extends over seven years, starting 1999, for the state of Maharashtra, while the DFID project is for five years starting 1999 and covering the four states of Andhra Pradesh, Orissa, Kerala and Gujarat.
The total outlay for the second phase of the National AIDS Control Programme is Rs 1,425 crore for the next five years. The details are given below:
Outlay For National Aids
Control Project Phase
-
Rupees in Crore
II IDA credit (1999-2004)
1155
USAID assistance for
AVERT
Project in Maharashtra
166
Projects for the states
of Andhra
Pradesh, Gujarat, Kerala
and
Orissa.
104
DFID assistance for
Sexual
Health
Total
1425
The NACP-II Project has five components:
1. Priority targeted
intervention for populations at high risk:
This component of the
project aims to reduce the spread of HIV in groups at high risk by identifying
target populations and providing counselling, condom promotion, treatment
of sexually transmitted infections etc. This component would be delivered
largely through non-government organisations, community-based organisations
and the public sector.
2. Preventive interventions
for the general population:
The main activities
would be: (a) IEC (information, education and communication) and awareness
campaigns; (b) voluntary testing and counselling; (c) reduction of transmission
by blood transfusion; and (d) occupational exposure.
3. Low-cost care
for people living with HIV/AIDS:
Under this component
come financial assistance for home-based and community-based care, including
increasing the availability of cost-effective interventions for common
opportunistic infections.
4. International
strengthening:
This component aims
to strengthen effectiveness and technical, managerial and financial sustainability
at national, state and municipal levels.
5. Inter-sectoral
collaboration:
This component would
promote collaborations amongst the public, private and voluntary sectors.
The activities would be co-ordinated with other programmes within the ministry
of health and family welfare and other central ministries and departments.
Collaboration would be focussed on: (i) Learning from the innovative HIV/AIDS
programmes that exist in other sectors; and (ii) sharing the work of generating
awareness and advocacy.
The second phase of the AIDS Control Programme (NACP-II) became controversial even before it was formally launched.
Accountability of NACO
Soon after the formal
launch of NACP-II in December 1999, a delegation of prominent women activists
like Suman Krishnakant (wife of the vice-president), Mohini Giri, Romi
Chhabra, Meera Shiva and others met Prime Minister Atal Behari Vajpayee
to protest against the launch of NACP-II and demand that it be scrapped.
They called for a complete re-evaluation of NACP-I, which, they averred,
was fundamentally flawed and fraudulently evaluated by NACO. Instead
of preventing HIV/AIDS, they claimed, it was spreading the epidemic.
In the garb of HIV/AIDS control, it was "legitimising and giving social
sanction to prostitution". The women's delegation urged Vajpayee
to stop further "commodification of women" through NACP-II. The prime
minister assured this delegation that he would look into the whole issue
and order a complete re-evaluation of NACP-I by an independent agency.
Delhi-based private research group ORG was then assigned the task of re-evaluating NACP-I. Officials of NACO, on condition of anonymity, told this writer that ORG has already submitted its interim report. But they refused to divulge the details of the report. However, Purushotaman Muloli of Delhi-based JACK (Joint Action Council, Kannur) says, "The ORG report is a complete whitewash. In fact, ORG was asked by NACO to just concur and repeat NACO's earlier evaluation findings. So, you cannot expect anything critical of NACO in this report". Muloli says that UNAIDS, the World Bank and other international donors have been pressurising the government not to scrap NACP-II or even make major changes in it. He says that the World Bank once threatened not to release grants and loans for development projects unless the government gave its sanction to NACP-II.
In recent months, NACO has been in the news nationally. NACO has been accused of jacking up HIV/AIDS figures in the country to create a panic and attract foreign funds. It was also accused of promoting bogus AIDS NGOs which have been taking funds and doing little. Maharastra has been projected as the state most affected by HIV. No wonder the biggest financial scams and bunglings by NGOs have been reported from that state. In the first phase of the AIDS control programme, there has been very weak monitoring by NACO and concerned agencies.
However, officials of NACO are so defensive that they refused to entertain any questions from this writer. A long chase for the elusive NACO director proved futile because either he was in some "meeting" or "busy" or "out of the country". A lot of journalists are now receiving these standard replies from NACO.
Dr Bitra George who has been working for and treating HIV/AIDS patients and is associated with Delhi-based NGOs Sharan and Salam Balak Trust says: "Funding came to NACO in two phases. The first phase was from 1992-97 but it was extended right up to 1999. The second phase of funding is coming now. There are a lot of NGOs that misutilised funds in the first phase of the programme. There was no effective monitoring mechanism. This led to money being given indiscriminately to NGOs which existed only in name. They were given funds for activities which they were not even capable of doing. In fact, a report of the Maharashtra legislature's Estimates Committee has found that 50 per cent of the NGOs in the state existed on paper only. A lot of money had been given by NACO without any proper evaluation of NGOs... The biggest problem has been accountability of NACO and NGOs. But I am not saying that all the NGOs are bad. There are a few NGOs that have created a bad name for all the NGOs who are working in the same area... a lot of NGOs have jumped onto the HIV/AIDS bandwagon because of the funding that is available from the World Bank and other international funding agencies. These NGOs have no expertise in running programmes on AIDS... NGOs don't think of long-term goals. They always think in terms of short-term monetary benefits. It is a major problem."
Rajesh Jha, Programme Manager of NAZ Foundation, says: "A year ago the Delhi Aids Control Society or NACO, I can't remember exactly, had called a meeting of NGOs interested in receiving funds from the government. I was shocked to see that there were over 200 NGOs claiming to be working in the field of HIV in Delhi alone, whereas in the AIDS NGO Forum we have only seven NGOs as members -- and there could be another handful who are known for their services in the field of HIV/AIDS. But the figure of more than 200 NGOs was really amazing."
The AIDS numbers game
On November 9, 1999
the National AIDS Control Organisation (NACO) released the official estimate
that there were 3.5 million HIV-infected cases in India in mid-1998.
NACO Director J V R Prasad Rao was reported to have said, "This will set
at rest the kind of wild guesses and speculation which had resulted in
a highly distorted picture of AIDS in India." It was also reported that
this data was "formally submitted before and endorsed by the Monitoring
AIDS Pandemic (MAP), a meeting of leading epidemiologists of the world
in Kuala Lumpur in October."
The NACO publication Country Scenario (1998-99, page 8) reads: "India is one of the few countries round the world where surveillance activities have been started prior to the detection of the first case". (Page 9) "An intensive training programme was launched before the sentinel surveillance was started". (Page 11) "The first round of surveillance after establishment of 115 additional sentinel sites was held in 30 states/UTs in the country during February/March 1998. In this round, 154 sentinel sites participated. Another round of surveillance was organised during August-October 1998 in 180 sentinel sites representing all states/UTs in the country. The data received in this round has clearly demarcated HIV epidemic in various states/UTs in four stages."
Claims of such "clear demarcation" notwithstanding, figures on HIV-affected Indians issued by various 'experts', NGOs, and Indian and foreign institutions at public forums are vastly and shockingly conflicting:
* During the 13th International AIDS Conference at Durban, Prof Roy Anderson, an expert from Oxford University, commented on the cultural disposition of Indians and its connections with the 'fast spreading' HIV infection in India. An Indian medical 'expert' announced that one-fifth of India's population - 200 million Indians -- were HIV- positive. Ten million Indians had full-blown AIDS, of which 1 million had already died.
* On December 1, 1999, the Delhi Health Minister claimed that there are 35,000 HIV cases in Delhi. In May 2000, he said that there are 15,000 HIV cases in Delhi.
* In December 1998, a
Parliamentary Standing Committee Report spoke of 8.13 million existing
HIV/AIDS cases in India. In September 1999, UN Secretary General
Kofi Annan told the UN General Assembly that India had 8.5 million
HIV/AIDS cases.
*In the summer of 1999
a bunch of NRI students from the US said that India had "seven million
documented cases of
AIDS and an estimated
60 million".
* In late-1999 PTI London quoted the Indian High Commissioner to the UK as saying that India currently has 8.5 million AIDS cases.
* Headline in the Indian Express, June 29, 2000: "Govt disputes UN's AIDS figure for India". Disputing the UNAIDS report that 3.1 lakh people in India had died of AIDS in 1999, far exceeding the government's own "reported death figure" of 11,000, the NACO Director has been quoted as saying, "There is no basis for these projections and the UNAIDS headquarters in Geneva could not explain how they reached these estimates. We have asked them to correct their mistake".
* The Telegraph, July 30, 2000: "The fluctuating figures from global and national agencies may finally converge next month. NACO is hopeful experts at the August meeting will arrive at a consensus on an estimated figure for India".
* News reports on July 31, 2000: Indian Express: "NACO admits its HIV figures are wrong". The Hindu: "Centre objects to AIDS figure of UN agencies" and The Statesman: "NACO O y z { P T | O 8 p } 8 ~ 8 P O P 4 O P l P O P h O 0 L P O h h h P H O , P d O H H H P ( O P D O ( ` ( | ( P O P $ x O @ \ P O x x x P X O < P t O X X X P 8 O P T O 8 p 8 8 P O P 4 O P l P O P h O 0 L P O h h h P H O , P d O H H H P ( O P D O ( ` ( | ( P O P $ x O @ \ P O x x x P X O < P t O X X X P 8 O P T O 8 p 8 8 P O P 4 O P l P O P p O 8 T P O p p p P P O 4 P l O P P P P 0 O P L ! O 0 h " 0 # 0 $ P % O & ' ( P , ) O H * d + , P - O . / 0 P ` 1 O ( 2 D 3 4 P | 5 O ` 6 ` 7 ` 8 P @ 9 O : $ ; < P \ = O @ x > @ ? @ @ P A O B C D P < E O X F t G H P I O J K L P p M O 8 N T O P P Q O p R p S p T P P U O V 4 W X P l Y O P Z P [ P \ P 0 ] O ^ _ ` P L a O 0 h b 0 c 0 d P e O f g h P , i O H j d k l P m O n o p P ` q O ( r D s t P | u O ` v ` w ` x P @ y O z $ { | P \ } O @ x ~ @ @ P O P < O X t P O P p O 8 T P O p p p P P O 4 P l O P P P P 8 O P T O 8 p 8 8 P ! O P 4! ! O ! P! ! l! ! P ! ! O ! ! ! ! ! P " h" O ! 0" ! L" ! P " " O h" " h" " h" P " H# O " # " ,# " P d# # O H# # H# # H# P # ($ O # # # $ # P D$ $ O ($ `$ ($ |$ ($ P $ % O $ $ $ $ $ P $% x% O % @% % \% % P % % O x% % x% % x% P & X& O % & % <& % P t& & O X& & X& & X& P & 8' O & ' & ' & P T' ' O 8' p' 8' ' 8' P ' ( O ' ' ' ' ' P 4( ( O ( P( ( l( ( P ( ( O ( ( ( ( ( P ) h) O ( 0) ( L) ( P ) ) O h) ) h) ) h) P ) H* O ) * ) ,* ) P d* * O H* * H* * H* P * (+ O * * * + * P D+ + O (+ `+ (+ |+ (+ P + ,
