Prioritising health

At a rally organised by the State government in Hyderabad to mark World AIDS Day on December 1, 2003. - MOHAMMED YOUSUF

The State government's multi-pronged strategy to check the spread of HIV-AIDS yields results.

RECOGNISING the grave threat posed by the Human Immunodeficiency Virus-Acquired Immune Deficiency Syndrome (HIV/AIDS) to the State's human resource development and being conscious of its gender dimensions, policy planners in Andhra Pradesh have emphasised the importance of a strong political commitment in tackling the epidemic comprehensively and effectively.

An HIV-AIDS epidemic is capable of wiping out the gains made by the State - by way of increased life expectancy and reduced morbidity and mortality among mothers, infants and youth - and affecting the population in the most productive age group of 15-49.

Political will, it is realised, is essential to ensure that all sections of society play their parts in the struggle against HIV-AIDS, adequate resources are allocated for effective prevention programmes, that partnerships are developed within the government and with non-governmental organisations and, that people living with HIV-AIDS are not stigmatesed and discriminated against.

A State-level conference of policy-makers was held in March 2003 by Chief Minister N. Chandrababu Naidu with a view to sensitising legislators to the HIV-AIDS issue and seeking their active support for and participation in prevention programmes. One morning, MLAs walking into the Assembly were surprised to find a giant-sized condom at the entrance and literature on safe sex plastered on the walls.

Anything less bold would not do since Andhra Pradesh accounts for 1/10th of HIV infections in India. From the time the first case was detected in Hyderabad in 1987, the number of HIV positive persons has grown to four lakhs, next only to Maharashtra in sheer numbers.

Ninety per cent of HIV-AIDS infections were found to have been transmitted sexually, 3 per cent from parent to child and 1 per cent each through blood, blood products and infected syringes.

According to a study in 2002, although there has been a decline in HIV cases in recent years, the prevalence of the disease among pregnant women is quite high, at 1.62 per cent. The highest positivity rate of 6.75 per cent was recorded in Warangal followed by three per cent in Kakinada. The prevalence of the disease among pregnant women could lead to its spread among the general adult population. Equally worrisome was the finding that the prevalence of HIV among attendees at clinics offering treatment for Sexually-Transmitted Disease or STD was 23 per cent; the highest proportion of this was in Warangal (40.40 per cent) and Tirupati (39.20 per cent).

Among the major factors contributing to the spread of the epidemic in the State are the widespread prevalence of commercial sex, a network of national highways passing through the State, high incidence of STD among men and women, relatively low rates of consistent condom use and the presence of a large migrant population.

A survey done by ORG-Marg for the National AIDS Control Organisation (NACO) revealed that the percentage of men and women in Andhra Pradesh with non-regular sex partners is the highest in the country - 19 and 7. The State also has the highest incidence of STD while the use of condoms is relatively low (25 per cent) when compared to other high prevalence States and the national average (32).

According to data collected in 2002-03 from voluntary counselling and testing centres (VCTCs), nearly 50 per cent of the infected persons are aged between 15 and 29 years.

These facts made it clear that a multi-pronged strategy for prevention and control of HIV/AIDS was required. The State government worked out a strategy with five major components - prevention of HIV infection in high and low risk populations, programme strengthening through sentinel surveillance, care and support for people living with HIV-AIDS and inter-sectoral collaboration.

A key aspect of the strategy is the focus on young people. The primary objective of the AIDS Prevention Education Programme (APEP), which has been taken up in 11,464 schools and has covered 1.3 million young people in the State, is to ensure that every young person has adequate knowledge and skills to protect himself/herself from HIV-AIDS. At least 1.2 million college students have been covered under the project.

In 2002, the government tabled a unique Bill in the Assembly - the A.P. HIV and AIDS Prevention Bill - which said that either party in a marriage shall undergo medical examination for HIV-AIDS at the request of the other and they shall exchange medical certificates. Moreover, if an HIV-AIDS-afflicted person gets married with a fraudulent intention (of extracting dowry), he or she could be jailed for up to seven years. Unfortunately, the Bill has not been passed.

Concerted efforts by the government, spearheaded by the Andhra Pradesh AIDS Control Society has yielded results, albeit slowly. According to Health Minister K. Siva Prasada Rao awareness levels among urban women have gone up from 44 per cent in 1998 to 96 per cent, HIV transmission through blood tranfusion has come down from 4 per cent to 1 per cent, the number of people accessing VCTCs has increased and the use of condom has gone up.

The latest sentinel surveillance study conducted during August-October 2003 shows that there is a decline in mean HIV prevalence level among ante-natal cases or ANCs when compared to the previous years. It decreased from 2.02 per cent in 2001 to 1.62 per cent in 2002 to 1.47 per cent in 2003.

However, among ANC attendees in 18 districts it is still above 1 per cent, which means that HIV has become a generalised epidemic in most parts of the State, which has 23 districts. However, the silver lining is that HIV prevalence has come down among ANCs in 10 districts - Chittoor, East Godavari, West Godavari, Warangal, Medak, Nalgonda, Ranga Reddy, Prakasam, Krishna and Hyderabad.

At least 14 government hospitals in the State are providing drugs that can go a long way in preventing mother-to-child transmission of HIV-AIDS. While the Bill & Melinda Gates Foundation is funding the "truckers project", and Hindustan Lever takes care of the sexual health project for sex workers, other corporates are involved in capacity building programmes. With such public-private partnership, planners are confident that the battle against HIV-AIDS can be won sooner rather than later.