Combating AIDS

Schoolchildren stage a skit on AIDS awareness, in Bangalore on World Aids Day, December 1, 2003. - BY SPECIAL ARRANGEMENT

The State is planning a series of programmes to tackle the AIDS menace, which is spreading at an alarming rate.

KARNATAKA is one of the six States with a high incidence of the acquired immune deficiency syndrome (AIDS) - the others being Tamil Nadu, Maharashtra, Andhra Pradesh, Manipur and Nagaland. The number of human immunodeficiency virus (HIV)-infected cases has shown a steady increase in the past 10 years. The Sentinel Surveillance round of 2002 identified the districts of Gulbarga, Bijapur, Raichur, Bagalkot, Koppal, Bellary, Belgaum, Dharwad, Davangere, Shimoga, Udupi, Dakshin Kannada, Kodagu, Mysore and Bangalore Urban as areas with a high incidence of HIV cases. It is clear that the epidemic is distributed somewhat evenly throughout the State. The data indicate that the prevalence of HIV exceeds 1 per cent among ante-natal patients in central, southern as well as northern Karnataka.

Studies have shown that the number of HIV-infected women has also gone up, with 1 to 6 per cent of those attending ante-natal clinics (ANCs) showing signs of infection. ANC studies are an indication of HIV prevalence in the `general population' since most of the women attending them report sexual contact with a single partner - their husbands. The rate of infection among those attending clinics treating sexually transmitted diseases, or STD, is also increasing.According to Vandana Gurnani, Project Director, Karnataka State AIDS Prevention Society (KSAPS), which was established in 1999 to implement the National AIDS Control Programme (NACP), the rough estimate of infected cases up to June 2004 in the State is as follows: 221 AIDS deaths, 2,024 AIDS cases, 31,485 diagnosed HIV cases and 5,00,000 estimated HIV cases (the last piece of statistics being calculated by assuming a prevalence of 1.46 per cent in the adult population). A prevalence rate in excess of 1 per cent among the adult population and over 5 per cent among STD patients is regarded as high.

Given the state of affairs, the KSAPS has cautioned all sections of society to adopt safer sex practices; to identify and treat cases of STD and reproductive tract infections (RTIs); to provide care and support services for people with HIV infection so as to improve the quality of their lives and to also prevent transmission; and to identify and treat pregnant women with drugs like Nevripine, which can control parent-to-child transmission of the disease.

AIDS prevention and control measures were initiated in the State way back in 1987 under the technical guidance of the Indian Council of Medical Research. An AIDS Surveillance Centre was established in the Department of Microbiology, Victoria Hospital, Bangalore. An AIDS cell was established in 1992 with the financial assistance and technical cooperation of the National AIDS Control Organisation (NACO), as part of the World Bank-assisted Phase I of the NACP from 1992 to 1998.

Phase II of NACP, which was officially launched by NACO in December 1999, is supported by the World Bank for a period of five years (1999-2004). While the broad objectives of Phase II in Karnataka are to reduce the spread of HIV infection in the State and to strengthen its capacity to respond to HIV/AIDS on a long-term basis, the specific objectives are to keep the HIV prevalence rate below 3 per cent in the adult population, to reduce blood-borne transmission of HIV to less than 1 per cent, to attain an awareness level of not less than 90 per cent among the youth and others in the reproductive age group and to ensure that not less than 90 per cent among the high-risk behaviour groups use condoms.

According to Gurnani, the components of the project, which costs Rs.17 crores a year, will include intervening among high-risk groups and the general population with the help of non-governmental organisations (NGOs); providing high-quality, low-cost care and support to people living with HIV/AIDS, ensuring inter-sectoral collaborations between the government and the private sector; and training 12,000 teachers from 4,000 high schools as part of the School AIDS Education Programme.

Among the other projects currently being implemented to tackle AIDS in Karnataka are the India-Canada Collaborative HIV/AIDS Project, which is contributing Rs.4 crores a year, the United Nations-supported AIDS education and awareness programme in schools (Rs.2.5 crores a year) and the Bill and Melinda Gates Foundation's India AIDS initiative aimed at the high-risk population with special emphasis on treating sexually transmitted infections ($17 million a year). The Karnataka government has pledged Rs.3 crores for services such as more counselling centres and support and care facilities for AIDS patients.

According to Gurnani, the State government has promised to allocate to AIDS patients around 20 beds in tuberculosis and leprosy homes around the State, which are underutilised. But she cautions that they should not become dumping grounds: "NGOs will have to counsel families of AIDS patients that they have to be taken care of at home."

The KSAPS has also scaled up its target interventions (TIs) in the high-risk population from 12 in 2000 to 30 in 2004. The area of coverage, based on the Sentinel Surveillance data, has been extended to northern Karnataka. Gurnani hopes that with the help of the Bill and Melinda Gates Foundation's funding, TIs will cover all the 27 districts in the State. Explained Gurnani: "Mapping will allow us to locate high-risk groups and identify the kind of activities that is facilitating the epidemic, whether it is heterosexual or homosexual behaviour, shared intravenous needles and so on. This will help us plan our programmes."

KSAPS is also actively involved in the free distribution of condoms through reproductive and child health programmes and NGOs implementing TIs. Condoms are also to be socially marketed at subsidised prices through non-traditional outlets like fair-price shops, pan shops as well as vending machines. Social marketing organisations are being asked to ensure that all big villages have an outlet for condom sales and also that condoms are made easily available at spots associated with high-risk groups.

In a bid to sensitise the community at large about the AIDS epidemic, KSAPS has launched interactive phone-in programmes and the Information, Education and Communication (IEC) programme using the radio and folk media. It has trained over 9,000 health workers; and initiated programmes for zilla, taluk and gram panchayat members through the satellite network. College students and anganwadi workers are also being targeted for sensitisation programmes. The Society has opened 78 Voluntary Testing and Counselling Centres. These offer information, pre- and post-test counselling, and testing (which is done using three antigens). The results are not divulged immediately lest the infected person should go into a depression.

KSAPS has started the anti-retroviral treatment (ART) programme at Bangalore to counsel AIDS patients to take their daily dose of life-saving drugs. There are currently 99 persons on ART.

Said Gurnani: "We have put in place systems. Massive awareness programmes to reach out to the rural population have also been initiated. We will continue to leverage all funding sources to expand further services to reach the remote rural population and to implement highly visible and sustained IEC programmes."