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HIV law shifts focus from treatment to prevention

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A bill aims to end discrimination against HIV positive people

The HIV and AIDS (Prevention and Control) bill, tabled in 2014 in the Rajya Sabha regarding the
rights of those testing positive for HIV is due to be introduced during the ongoing winter session this year. Approved by the cabinet last month, this bill aims to end discrimination against the estimated 
2.1 million citizens living with the condition by attaching legal accountability to those seen to be discriminating against them. Alongside this the bill aims to address treatment and prevention of the disease – however, this element of the legislation has sparked controversy.

In 1999 studies indicated India had the largest population of HIV infected citizens in the world, numbering at roughly 4 million. In 2000 the UN states India had an infected population numbering 3.7 million, compared to the global 34.3 million – accounting for 9.27%. This number has dwindled in recent years to an estimated 2.1 million – partly as a result of programs such as the National AIDS Control Organisation (NACO), created in 1992 and partly because India had been forced to inflate its incidence numbers by pressure from several foundations and multilateral agencies.

Government and civil society  initiatives have aimed to both treat current cases and prevent the spread of the disease, contributing to the reduced figures 17 years later. Better education regarding the disease has also been a strategy for reduction in the spread of the disease. In 2010, NACO introduced the teachAIDS program, which aims to increase HIV/AIDS awareness in schools and youth programs.

However, NACO has cut spending by 20% which an official of the Andhra Pradesh State AIDS Control Society (APSACS) has related to the government’s lack of encouragement for donations from international organisations such as UNICEF. This has led to a two year shortage in funds with uncertainty and delays in financing for SACS. This is due to shifting funds from direct funding from NACO, to the government treasury, and again to direct funding from NACO.

The reduction in HIV cases has not been evenly distributed across India. Some states, such as the third smallest state Tripura, have shown an increase in cases, despite out-performing the national average in most areas of healthcare.

Further issues have arisen due to the new HIV bill. Many groups have criticised the bill’s wording, which has been scrutinised since the bill was released into the public domain. Since the bill was introduced in 2014, it has been amended to state that the focus will be on prevention rather than treatment – and that treatment will only be given “as far as possible”.

Some have taken this “as far as possible” comment to mean that free access to previously used anti-retroviral therapy (ART) therapy is no longer guaranteed. ART has been available for over a decade and 869,000 patients currently receive first and second line ART, as well as diagnostics services also reliant on funding. Given the number of people who depend on these services, this is discouraging news.

The new bill may be the government’s attempt at consolidating the reducing funds allocated to HIV treatment to the focus of reduction of patients in the long term. It may even prove an effective strategy in management of the disease in years to come. However, the fact remains that, for the time being, until the government further reviews this bill, close to a million people will be left in the dark as to whether or not they can continue with life-saving treatment. With this in mind, calling for an end to discrimination against HIV/AIDS patients may do little to alleviate their other concerns.

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