Mainstreaming as a response to HIV/AIDS in India: an innovative multi-sectoral approach

[PHP Nepal Vol 3 Issue 11 December 2013] | HIV/AIDS is an epidemic spreading swiftly with its presence on global front. Although the prevalence of HIV/AIDS in India is still lower than many other countries in the world; it is the third largest HIV/AIDS inhabited country. According to National AIDS Control Organization (NACO) 2012 report, 2.39 million HIV positive people were living in the country at the end of 2009. Interestingly, the impact of HIV/ AIDS is not very noticeable due to low prevalence rate (estimated at 0.31% in 2009) of the infection and large population size of the country (NACO, 2012).

Under National AIDS Control Program Phase II, it was realized that HIV should not be treated merely as a public health issue but it should be addressed as a socio-developmental challenge. Therefore, besides addressing the reduction in the incidence and treatment of HIV/AIDS in the country, the other major focus of India’s National AIDS Control Organization has been on mainstreaming of People Living with HIV (PLHIV) in the community; making provisions for the welfare of these people and their families.

To bring PLHIV at par with the community, AIDS responses were decentralized with local/state governments and PLHIV were mainstreamed in existing government socio-legal protection schemes through a multi–sectoral engagement of key stakeholders in the high HIV prevalent states of India through capacity building, training, advocacy, increased awareness and public- private partnerships at central, state and district levels. 

However, every state has its own procedures and processes. Therefore, the time taken for the formulation, notification and implementation of schemes and policies vary accordingly. Also, different schemes within a state undergo different procedures in terms of formulation and implementation.

Realizing that PLHIV and widows affected/ living with HIV had no permanent source of income, carrying the burden of stigma and need of financial support, this population was made beneficiaries in the existing government pension schemes. Although the amount they received was petty, beneficiaries had accepted the scheme as they thought that something is better than nothing. 

Transportation cost and the distance to the ART centres often posed barrier to PLHIV to access ART & other care and support services. Reportedly, many PLHIV dropped out of the therapy as they were unable to bear the cost of travel from their homes to the ART centres. Realizing this need, HIV was included in the list of chronic illnesses available with state transport corporations, through advocacy efforts. Consequently, PLHIV were allowed to travel free or avail discount in all government and private buses in the states (e.g. Odisha, Rajasthan) in which this scheme was implemented. 

Nutrition support schemes such as Antyodaya Anna Yojana in Orissa and Rajasthan, double nutrition in Andhra Pradesh were the schemes that many of the PLHIV accessed. These provisions enabled them to maintain good health and save expenses on food. Similarly, various livelihoods, housing and self-employment schemes had been formulated and successfully implemented in various states for the welfare of PLHIV and their families. 

These provisions and schemes had helped mainstream PLHIV in the society and facilitated them to live a better and healthier life. Mainstreaming HIV is, therefore, an effective strategy to address both direct and indirect causes of HIV/AIDS and to establish workplace policies and programs based on the principles of non- discrimination, gender equity, health, work environment, non-screening for the purpose of employment, confidentiality, prevention, care and support. 

Despite these efforts community still view HIV as a social taboo and a disease of those who are perverted and sinful; rendering them vulnerable to face social stigma, discrimination and denial in different facilities including health care services, education, travel and social gatherings among others. These challenges had come in the way of implementation and access of these provisions. 

Sensitizing communities, local leaders, service providers, civil society organizations, corporate on the issues related to HIV/AIDS, improving access of PLHIV to HIV prevention, treatment, care and support services, addressing the issues of confidentiality in the designing and implementation of interventions to protect them and their families from stigma and discrimination are some of the measures which could facilitate long term sustainability of the mainstreaming efforts in the country.

Dr Himanshu Gupta is a Research Officer at Public Health Foundation of India in New Delhi, India.

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