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PA N O S I N D I A
Antiretroviral drugs for all?
Obstacles in accessing treatment
Lessons from India
Acknowledgements
Panos wishes to thank all the contributors who have undertaken extensive research to file their
reports. Further updates were provided by Anushree Mishra,G. Mahesh and Soma Basu. A
number of stakeholders provided useful information for the study, including groups of most
affected, medical practitioners, representatives from pharmaceutical companies, national and
community based NGOs, media representatives, academics, government departments,
international NGOs and donor agencies. Panos wishes to acknowledge and thank all of them.
This project was co-ordinated by Anushree Mishra with support from Mitu Varma. Drafts were
edited by Sandhya Srinivasan, Lakshmi Nair and Mitu Varma.
Photographs
Front cover (Top): Civil society activists in Delhi campaign against the US company Gilead's
patent application for tenofovir, an AIDS drug which is preferred because it leads to fewer side
effects. If Gilead is granted this patent, the drug will become unaffordable in India.
PHOTO COURTESY, DELHI NETWORK OF POSITIVE PEOPLE.
(Lower): Antiretroviral drugs. © GARY HAMPTON
Back cover: Pharmacists dispensing ART drugs. © GARY HAMPTON
Contents page: © NILAYAN DUTTA/DRIK, PANOS STOP-TB FELLOW, 2005
All photographs in this publication have been taken with informed consent of the subjects.
Design
BRINDA DATTA/SEAPIA GRAPHICS
© Panos, March 2007
This report is part of the activities conducted by Panos (India) under the
Panos Global AIDS Programme.
Panos (India) was set up in 1998 in New Delhi to oversee and manage Panos programmes and
activities geared towards renegotiating power through the media by enabling diverse opinions,
ideas and theories to be included in the debate on governance and development. Panos India is
a country office for Panos South Asia that is a member of the global body of Panos Institutes
working on common principles. Besides New Delhi, Panos now also has offices in Chennai and
Guwahati.
Panos Global AIDS Programme is a network of Panos offices in West Africa, East Africa,
Southern Africa, the Caribbean, South Asia, North America and Europe, which work together to
increase participation, ownership and accountability in the response to the HIV and AIDS
pandemic. Coordinated from Lusaka, Zambia, the programme informs and challenges the way in
which the HIV and AIDS pandemic is addressed at the national, regional and global level.
This publication is available free of charge to everyone in developing countries. For further
details and copies please contact:
Panos India
IInd Floor, D-302, Defence Colony
New Delhi 110024, India
Tel: 0091-11-24615217/24615219
Fax: 0091-11-24615218
Email: [email protected]
Web Site: www.panossouthasia.org/india
This document can be freely quoted, reproduced or translated, in part or in full, provided the
source is acknowledged.
PA N O S I N D I A
C O N T E N T S
Introduction 3
Maharashtra 20
Andhra Pradesh 33
Karnataka 44
Manipur and Nagaland 55
Uttar Pradesh 66
Goa 71
Gujarat 80
West Bengal 86
Punjab, Haryana, Himachal Pradesh 96
and Chandigarh
Tamil Nadu 106
Contributors 118
Other Resources 119
A NT IRET RO V IRA L D RU G S FO R A LL? LES S O NS FRO M INDIA 1
A C RO NY M S
ACT: Access to Care and Treatment MSM: Men who have sex with men
AHF: AIDS Healthcare Foundation NACO: National AIDS Control Organisation
AIDS: Acquired Immune Deficiency Syndrome NACP: National AIDS Control Programme
AP: Andhra Pradesh NCP+: Network for Chennai Positive People
APSACS: Andhra Pradesh State AIDS Control Society NFHS: National Family Health Survey
ARV: Antiretroviral (drugs) NGO: Non Government Organisation
ART: Antiretroviral Therapy NIMHANS: National Institute of Mental health and Neural
BSS: Behaviour Surveillance Survey Sciences
BEST: Brihan Mumbai Electric Supply and Transport NNP+: Nagaland Network of Positive People
Undertaking NPP+: Network of Positive People, Secunderabad
BHU: Benaras Hindu University OI: Opportunistic Infections
BNP+: Bengal Network of Positive People OPD: Out Patient Department
CAHA: Children Affected by HIV or AIDS PEPFAR: President's Emergency Plan for AIDS Relief
CARES: Cutting-Edge Medicine and Advocacy Regardless PFI: Population Foundation of India
of the Ability to pay PGIMER: Post Graduate Institute of Medical Education and
CHC: Community Heaqlth Centre Research (Chandigarh)
CII : Confederation of Indian Industry PHC: Primary Health Centre
CINI : Child in Need Institute PPTCT: Prevention of Parent to Child Transmission
CNP+: Chandigarh Network of Positive People PRAMS: Physicians Responsible for AIDS Management
DAPCU: District AIDS Prevention Control Unit PSACS: Punjab State AIDS Control Society
DOTS: Directly Observerd Treatment, Short Course PWN: Positive Women's Network
FXB: Association Francois-Xavier Bagnoud RIMS: Regional Institute of Medical Sciences (Imphal)
GICA: Greater Involvement of Children Living with AIDS SAATHI: Solidarity and Action Against the HIV Infection in India
GIPA: Greater Involvement of People Living with AIDS SASO: Social Awareness Service Organisation
GMC: Goa Medical College SIAAP: South India AIDS Action Programme
GSACS: Goa State AIDS Control Society SEEDS: Social Economical and Educational Development
HIV: Human Immunodeficiency Virus Society
HPSACS: Himachal Pradesh State AIDS Control Society STD: Sexually Transmitted Disease
ICAP: India-Canada Collaborative HIV and AIDS Project STM: School of Tropical Medicine (Calcutta)
ICTCs: Integrated Counselling and Treatment Centres SVYM: Swami Vivekananda Youth Movement
IDUs: Intravenous Drug Users TAI: Tamil Nadu AIDS Initiative
IEC: Information, Education and Communication TB: Tuberculosis
INP+: Indian Network of Positive People TI: Targetted Intervention
GFATM: Global Fund to Fight AIDS, Tuberculosis and TNMSC: Tamil Nadu Medical Services Corporation
Malaria TNP+: Telugu Network of Positive People
GSNP+: Gujarat State Network of Positive People TNSACS: Tamil Nadu State AIDS Control Society
KGMC: King George Medical College (Lucknow) TRIPS: Trade-Related Aspects of Intellectual Property Rights
KHPT: Karnataka Health Promotion Trust UNAIDS: United Nations Programme on HIV and AIDS
KIMS: Karnataka Institute of Medical Sciences UNICEF: United Nations Children's Fund
KNP: Kolkata Network of Positive People UNGASS: United Nations General Assembly Special Session
KNP+: Karnataka Network of Positive People on AIDS
KSACS: Karnataka State AIDS Control Society UP: Uttar Pradesh
MACS: Manipur State AIDS Control Society UPNP+: Uttar Pradesh Network of People Living with HIV and
MDSACS: Maharashtra District AIDS Control Society AIDS
MLA: Member of Legislative Assembly UPSACS: Uttar Pradesh State AIDS Control Society
MNP+: Manipur Network of Positive People VAMP: Vaishya Anyaya Mukti Parishad
MPT: Mumbai Port Trust VCTC: Voluntary Counselling and Testing Centre
MSDR: Maharashtra State Development Report WBSACS: West Bengal State AIDS Control Society
MSF: Medecins Sans Frontieres WHO: World Health Organisation
2 A NT IRE T RO V IRA L D RU G S FO R A LL? LES S O NS FRO M INDIA
INTRODUCTION
INTRODUCTION
"The microbe is nothing, the terrain
everything."
­ Louis Pasteur, 1850
S ANDHYA S RINIVAS AN and T.K.RAJALAKS HMI
The overall scenario ­ policy and perspective
More than two decades after the detection of the first AIDS case in India, the
disease is now regarded as a "development" problem and not just a public health
issue. Government policy has also moved forward, from AIDS denial to practical
acceptance. The estimated number of Positive People1 in the country has gone up
from 3.5 million in 1998 to over 5.206 million in 2005, accounting for one eighth
of HIV infections in the world. The virus has moved from a few epicentres in the
southern and north-eastern states to 163 districts in 20 Indian states, though the
overall prevalence remains low in the general population (0.9%). It is also
acknowledged that women and young people are becoming increasingly vulner- 1 People Living with HIV and
able to the infection. The 2005 sentinel surveillance showed 38.4% of infected AIDS are referred to as
persons in the country were women.2 Positive People in this
document.
In the second phase of the national programme being implemented till early 2007, 2 Strategy and Implementation
the government stepped up its advocacy, prevention, care, support and treatment Plan, Phase III (2006-
programmes. Political advocacy as an activity gained importance. The government 2011), National AIDS Control
Programme, Government of
recognised that the `ABC' ­ or Abstinence, Behavioural change and Condom use ­
India, November 30, 2006.
approach is of little effect, given the varied risk factors for infection.
3 VCTCs and PPTCT centres
The NACO policy document states, "Behaviour change will not occur without a are now re-modelled as
Integrated Counselling and
significant change in the social and political environment," This includes problems
Testing Centres. All counsell-
of gender inequality, taboos in open communication on sexual health, and stigma
ing services will now be
and discrimination at all levels. The government also realises the limitations of converged at one centre, the
adopting a "moral" approach to the problem. In the second phase of the ICTC. The ICTC will provide
programme, condoms, earlier advocated as a safe method of population control, re- entry points for men and
emerged as a non-controversial, effective method to prevent HIV transmission. women requiring different
Innovative promotion schemes and social marketing approaches were employed to services such as STD
increase the use of condoms. The number of targeted intervention (TI) programmes clinics, TB treatment and
among "most-at risk" groups such as sex workers, drug users, men who have sex women attending antenatal
with men (MSM), transgenders, street children, truck drivers and migrant workers clinics.
increased from 199 in September 1999 to 1033 by 2006. The number of voluntary 4 http://data.unaids.org/pub/
counselling and testing centres (VCTC) increased from 79 in 1998 to 2815 Report/2006/ 2006 _
integrated counselling and testing centres (ICTC) by March 2006. 3 The number of country _ progress _ report
prevention of parent to child transmission (PPCT) centres was expanded from 11 _india _ en.pdf, Strategy and
hospitals in five states to 1882 centres across the country (this number includes Implementation Plan,
National AIDS Control
502 stand alone centres and 1380 ICTCs which offer PPTCT services). Six hundred
Programme, Phase III (2006-
and seventy nine sexually transmitted diseases (STD) clinics were also set up at 2011), National AIDS Control
the district level. Another 922 STD clinics were scaled up. Though treatment was Programme, Government of
not a component of the second phase of the programme, the government initiated India, November 30, 2006.
antiretroviral treatment (ART) in six most affected states in 2004. 4
5 Kumar R. et al, Trends in
HIV-1 in young adults in
Indeed, while the efforts have seemingly been successful, as in HIV incidence South India from 2000-
reduction of more than a third in 2000-04 in women attending antenatal clinics in 2004: a prevalence
some selected states of India5, the most marginalised continue to be acutely study, The Lancet, Vol.367,
vulnerable to HIV and AIDS. No. 3517, April 8, 2006.
A NT IRET RO V IRA L D RU G S FO R A LL? LES S O NS FRO M INDIA 3
In a scenario of low The 2005 annual sentinel surveillance shows HIV prevalence among sex workers
is increasing in Delhi, Assam, Chandigarh, West Bengal and Kerala. 6 The govern-
spending by the ment recognizes that though condom promotion and procurement registered an
government on public improvement, condom use still remained below target. 7 Findings of the third
health in general and National Family Health Survey (NFHS-III), 2006 show that while there has been an
improvement in the general awareness levels on HIV and AIDS among women (57%
increased spending on in NFHS-III as compared to 40% in NFHS-II), the awareness level on modes of
vertical programmes prevention remained low. Only 34.7% women knew that consistent condom use can
reduce the chances of HIV and AIDS. 8 NACO's Behaviour Surveillance Survey (BSS)
like AIDS, a new
2001 found that 30% of street-based sex workers did not know that condoms
initiative by the prevent HIV infection. And in some states such as Haryana, fewer than half of sex
government, to workers (brothel-and-street based) knew that condoms prevent HIV. 9
increase access to The strategy implementation plan for the third phase of the National AIDS Control
antiretrovirals (ARV) Programme (NACP), which is to be launched in 2007, recognises that the HIV
through the public epidemic in India is heterogeneous and states cannot just be clubbed together as
high or low prevalence states. A key lesson learnt from the second phase of the
health system has programme is that marginalised groups like out-of-school youth, married adoles-
become the subject of cents and rural populations do not get any attention. The plan, therefore, classifies
a major debate in 611 districts in four categories based on their prevalence and emphasises focus-
sing on districts based on their vulnerability. To increase outreach to rural popula-
India. tions, District AIDS Prevention and Control Units (DAPCU) would be set up in the
third phase.
Whether this strategy results in success remains to be seen. Despite a
decentralised focus and emphasis on greater participation and involvement of
Positive People and other vulnerable groups in prevention and control efforts,
certain issues remain unresolved. While NACO seems to recognise the need for a
holistic, multi-sectoral approach to the problem, it is still working on ways to
translate this perspective into action. The AIDS prevention and control programme
6 HIV/AIDS Epidemiological is still largely within the Ministry of Health. Though links have been established with
Surveillance & Estimation
other ministries like social justice and empowerment and women and child develop-
Report for the Year 2005,
National AIDS Control
ment, they need to be strengthened. Further, rigid guidelines on implementing
Organisation, Ministry intervention programmes make it difficult for programme managers to meet the
of Health & Family Welfare, varying needs of vulnerable groups.
Government of India, April
2006. The programme's problems are further illustrated by its targeted intervention
7 Strategy and Implementa- strategy, which continues to be the mainstay of its third phase. The targeted
tion Plan, National AIDS intervention component has the highest allocation (19.6%) of the total funding in
Control Programme, Phase the third phase also. This calls for targeting vulnerable groups like sex workers,
III (2006-2011),National truck drivers, migrant workers and drug users, among others. Unfortunately, this
AIDS Control Programme, strategy still does not meet needs like immunising the children of sex workers and
Government of India, providing alternate employment opportunities. In analysing policy and implementa-
November 30, 2006 tion, one cannot afford to ignore the fact that AIDS does not constitute the leading
8 National Family Health cause of mortality and morbidity in the country. 10
Survey (NFHS-III), Govern-
ment of India, 2005-2006. Perhaps this is why public health experts argue that increased funding for a vertical
http://www.nfhsindia.org/ AIDS prevention programme is no solution; spending that money for a holistic
pdf/IN.pdf concept of public health and public good will help alter the landscape of morbidity
9 National Baseline General and mortality, including that caused by HIV, in the country. So, the question remains
Population Behavioural as to why should the population living below poverty line ­ with needs other than
Surveillance Survey, AIDS and at risk of ill-health in several other ways ­ neglected by the government
National AIDS Control and kept out of policy-making, take HIV and AIDS campaigns seriously?
Organisation, Government of
India, 2001
Though the present government has increased allocations to the health sector by
10 http://cbhidghs.nic.in/ 21.9% to Rs 1529111 crores in the union budget for 2007-2008, it still remains
CBHI%20Book chapter4.pdf below the World Health Organisation standard for public health expenditure, which
11 USD 347 million is 5% of GDP. Moreover, majority of the amount is to be spent in vertical
(1 USD=Indian Rs. 44) programmes like polio prevention and HIV and AIDS control. Critics say, India's
4 A NT IRE T RO V IRA L D RU G S FO R A LL? LES S O NS FRO M INDIA
INTRODUCTION
health took a knock in the 1990s ­ the era of economic liberalization, when
stagnant public health budgets and decreasing government expenditure in public
health facilities were worsened by the introduction of charges at various levels in
the public health sector.
In this scenario of low spending by the government on public health in general and
increased spending on vertical programmes like AIDS, a new initiative by the
government, to increase access to antiretrovirals (ARV) through the public health
system has become the subject of a major debate in India.
The battle for access to medicines
The story of affordable antiretroviral drugs goes back some years, as new drugs
In response to global
changed the prognosis for people with AIDS. These patented drugs were out of the
reach of most people even in the developed world. So, health activists and net- advocacy efforts, the
works of Positive People launched an international campaign to force governments UN convened a special
and international organisations to recognise their right to treatment and care11.
Indian drug companies were, at that time, manufacturing and exporting cheaper
session on HIV and
generic versions of the branded drugs to Africa and Asia. Multinational drug AIDS (UNGASS) in
companies fought the `threat' of cheap generics and the challenge to their patent 2001, calling for
rights.
additional funding for
In February 2001, the Indian pharmaceutical company Cipla Ltd. check-mated the ART. Two years later,
multinationals by offering to sell the three-drug `cocktail' of first-line ARV drugs to WHO and UNAIDS
international voluntary organisations at $350 per person per year ­ a small fraction
of the US price of $10,000-$15,000 per year. Other Indian companies followed declared the lack of
Cipla's lead, bringing down prices even further. access to therapy a
"global health
In response to global advocacy efforts, the UN convened a special session on HIV
and AIDS (UNGASS) in 2001, calling for additional funding for ART. Two years later, emergency" and
WHO and UNAIDS declared the lack of access to therapy a "global health emer- launched the `3 by 5'
gency" and launched the `3 by 5' initiative to ensure that three million people living
in resource-limited settings were treated for HIV infection by the end of 2005.
initiative to ensure that
Massive funding increases made this goal potentially feasible. The US President's three million people
Emergency Plan for AIDS Relief (PEPFAR) promised US$ 15 billion over five years for living in resource-
AIDS prevention, care and treatment. The World Bank has already disbursed an
additional US$ 1 billion towards the effort, and the Global Fund to Fight AIDS, limited settings were
Tuberculosis and Malaria (GFATM) has doled out US$ 3 billion in the past two years treated for HIV
for the prevention and treatment of these three devastating diseases. infection by the end of
The final report on the `3 by 5' initiative released in March 2006 states that the 2005.
basic objective of the project was not met on time. It revealed that though around
1.3 million people in low- and middle-income countries were receiving ART at the
end of 2005, this was just 40% of the intended target. Nevertheless, the effort to
expand access to antiretroviral therapy set up structures for treatment implementa-
tion. In two years, the number of people receiving antiretroviral therapy in low-and
middle-income countries has more than tripled. 13 The `3 by 5' target has now
changed into "Universal access by 2010". In July 2005, leaders of the Group of 12 Jesani Amar et al:
Eight (G8) countries pledged to try their utmost to achieve universal access to ART Government-funded anti-
worldwide by 2010. This promise was reaffirmed by world leaders at the UN High- retroviral therapy of HIV/
level Meeting on AIDS in June 2006. AIDS: new ethical chal
lenges. Indian Journal of
Medical Ethics, July-
September 2004. http://
www.issuesinmedicalethics.
org/123ed070.html
13 http://www.who.int/hiv/
fullreport_en_highres.pdf
A NT IRET RO V IRA L D RU G S FO R A LL? LES S O NS FRO M INDIA 5
ART roll-out in India: A dramatic announcement
On November 30, 2003, the Government of India announced a plan to provide ART
through public hospitals in the country, from April 1, 2004. The programme was
initially to cover HIV-positive pregnant women who had access to government
antenatal clinics, children under the age of 15, and adults with AIDS who went to
government hospitals for treatment. The programme would offer a fixed-dose
combination of first-line drugs. The drugs would be provided by the three large
generic drug manufacturers in India.The aim was to treat 100,000 people free of
Despite the fact that charge through the public sector by 2005 end.
India is a major
The initial start to the `3 by 5' initiative in India was slow. 14 As of July 2005, just
producer of cheap 10,255 people were on the programme in 25 hospitals across the country. Another
generic HIV and AIDS 9,000 people were on ART, through schemes for government employees and
workers in the organised sector. 15 The number of patients using antiretrovirals
drugs, treatment
increased to a little over 18,000 by December 2005, but accelerated implementa-
reaches just 20 per tion has taken place in the early months of 2006 (see box). By December 2006,
cent of those who approximately 95,000 people were receiving antiretroviral treatment including
people enrolled through private facilities. This means that despite the fact that
need it. India is a major producer of cheap generic HIV and AIDS drugs, treatment reaches
just 20 per cent of those who need it. 16
14 http://www.whoindia.org/
CDS/CD/HIV/Tech-Asst/ ART Roll-out through the Public Health Sector in India
hiv-tech-asst-main.htm
15 Lok Sabha unstarred
question No. 454 to be April 1, 2004: ART starts through eight hospitals in the six high
answered on July 27, prevalence states of Maharashtra, Tamil Nadu,
2005. Karnataka, Manipur, Andhra Pradesh and Nagaland, and
16 Towards universal access­ two in Delhi. 17
scaling up priority HIV and
AIDS interventions in the December 2004, ART treatment expands to a total of 25 hospitals in Tamil
health sector: progress January 2005: Nadu, Manipur, Karnataka, Andhra Pradesh and in the
report, WHO, UNICEF,
low- (or moderate-) prevalence states of Gujarat, Goa,
UNAIDS, April 2007.
Punjab, West Bengal, Rajasthan, Uttar Pradesh and in
17 Sir JJ Hospital, Mumbai, the union territory of Chandigarh. 18
Maharashtra; Institute of
Thoracic Medicine and December 2005: ART treatment centres expand to 54 centres in high and
Chest diseases,
low-prevalence states.
Tambaram, Chennai, Tamil
Nadu; Regional Institute of
Medical Sciences, Imphal, September 2006: ART expands to a total of 91 centres in high, moderate
Manipur; Bangalore and low-prevalence states.
Medical College Hospital,
Bangalore, Karnataka; December 2006: Paediatric ART initiated at all ART centres. Paediatric
Osmania Medical College referral centres (centre of excellence) to be established
Hospital, Hyderabad, in each region of the country. Fees on CD4 count tests
Andhra Pradesh; Ram waived.
Manohar Lohia Hospital,
New Delhi; LNJP Hospital,
New Delhi; District Naga
Hospital, Kohima,
Nagaland
18 Anti-retroviral treatment: a
new initiative, National AIDS
Control Organisation.
http://www.nacoonline.org/
directory_arv.htm
6 A NT IRE T RO V IRA L D RU G S FO R A LL? LES S O NS FRO M INDIA
INTRODUCTION
A look at the ART programme in 14 states:
some insights, some questions...
In this collection of articles, journalists from 14 states and union territories ABOVE
describe the Indian government's scheme to provide ART, which started in April A woman collects
2004. They report from six high-prevalence states (Tamil Nadu, Andhra Pradesh, medicines from an ART
Karnataka, Maharashtra, Manipur and Nagaland), two medium-prevalence states centre in India. Though
(Goa and Gujarat), low-prevalence but highly vulnerable states like Punjab, West figures on ART in India are
Bengal, and Uttar Pradesh and low-prevalence, but vulnerable states (Himachal still low, significant
Pradesh, Union Territory of Chandigarh and Haryana).They look at what it means to progress is being made
get ART from the government programme and outside the government's scheme. due to activism by Positive
People, international
These articles are a mix of insiders' views and journalistic insights. They contain commitments and
the voices of Positive People, vulnerable groups, health professionals, public health increased donor support.
experts, government officials, industry representatives and others involved with the © GARY HAMPTON
programme. The report begins with Maharashtra, a high prevalence state, which
highlights all issues of concern. These concerns are accentuated by voices of key
stakeholders in other states. The report ends with Tamil Nadu, another high
prevalence state, that shows ways of overcoming some of the obstacles.
These interviews were conducted between December 2004 and January 2005 when
the programme was initiated. The reports were updated through interviews and
desk reviews in December 2005, June 2006 and February 2006. To a large extent
they reflect the situation, more than two years after the programme was initiated in
April 2004. With every passing day the figures of those accessing treatment and
responses change and this report is cognisant of that. We therefore cite dates for
which the figures provided are applicable. However, the broad challenges have not
changed and will require concerted efforts by all stakeholders. As can be seen from
A NT IRET RO V IRA L D RU G S FO R A LL? LES S O NS FRO M INDIA 7
the set of articles that follow, the key issues emerging in different states on the
free ARV roll-out largely remain the same, irrespective of the prevalence and the
19 Affordable Medicines and
Treatment Campaign. A preparedness of the health system.
response to the Govern-
ment of India's Indeed, it is worth noting that the issues raised in an early critique of the
antiretroviral treatment programme19 are quite similar to those in a commentary 18 months later20, a
(ART) plan. ACCESS 1-4, report in November 200521, a presentation in March 200622, an interview with the
May 2004. project director of NACO in December 200623 and e-group discussions in January
20 Interview with K.K. 2007. The concerns expressed in the interviews in this collection of articles are
Abraham, President of the reinforced through these critiques, as well as references to official statements,
Indian Network for People press reports and study findings.
living with HIV/AIDS, AIDS-
Care-Watch Campaign,
October 6, 2005.
http://eforums.healthdev.
ART roll-out: Two years later
org/read/ messages?id Positive developments
=8153
21 Chakrapani V. et al, Two years after the ART launch in India, there seems to be a significant shift in the
Missing the Target, a attitude of the government to provide antiretroviral treatment. While treatment was
Report on HIV/AIDS not a component in Phase II of NACP, 12.5% of the total funds will be spent on ART
Treatment Access in India, (11.5% on adult ART and 1.0% on paediatric ART) in the third phase. This makes
Indian Network of Positive funding for treatment, the fourth largest allocation in NACP-III after targeted
People, International interventions (19.7%), condom usage (17.3%) and providing a package of services
Treatment Preparedness
such as STD treatment and counselling to "most-at-risk groups" (12.0%). The plan
Coalition (ITPC), India,
of NACP-III also emphasises that first-line drugs will be made available to Positive
November 28, 2005.
People referred from targeted interventions, seropositive women particularly those
22 http://www. who have participated in the PPTCT programme, infected children and those below
hivcollaborativefund.org/ the poverty line. NACO recognises that to reach a target of 300,000 by the end of
fileadmin/HIVCDocs/
2011, 250 ART centres need to be set up. NACP-III envisages building public-private
India_-Country_Report.ppt
partnerships, free of cost to prioritised sub-populations.24
23 http://www.tehelka.com/
story_main24.asp? When the programme was announced in 2003, NACO had stated that children
filename=Sp122306Drug
would be a priority for ART. Yet, for two years, ARV was only available in adult doses
_supply_p15.asp
for children under nine, leading to problems in physically administering drugs to
24 Strategy and Implementa- children and fears of drug resistance. To fill this gap, NACO launched the National
tion Plan, Phase III (2001- Paediatric HIV and AIDS Initiative that ­ for the first time in the country ­ allowed
2011), National AIDS
children under the age of 18 months t


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