Dissatisfied with the way the Indian government has been implementing its National AIDS Control Policy? Unhappy that perhaps adequate and useful information has not been made available to the public or that certain groups are targeted or stigmatized in the fight against HIV/AIDS? Frustrated that proper counselling and treatment facilities are not readily accessible or affordable?
Well, now is the time to voice such concerns: The government, in an unprecedented move, has thrown open the doors to its citizens to critique the flaws of India's existing National AIDS Control Policy (NACP) and offer suggestions to strengthen the third phase of the plan, NACP-III, slated for launch in April 2006.
This initiative - jointly launched by the National AIDS Control Organization (NACO) and UNAIDS on July 19 - by way of an 'e-consultation' or electronic discussion forum invites civil society to register through the UNAIDS India website and send their ideas and recommendations. The e-consultation has already received an overwhelming response. "The week from August 3 to 9 saw 27 contributions on various subjects, bringing the total number of contributions in just 20 days to 99," says Dr E Mohamed Rafique, moderator of the NACP-III e-consultation.
The process has brought in a range of comments. There are those who write in about the 'failures' of NACP-II, such as limited community involvement, lack of support systems for people living with HIV/AIDS (PLWHA), and limited focus on infected or affected children. Then there are suggestions, like scaling up specific community-based programs and integrating them into the mainstream health care services and involving civil society organizations, including networks of PLWHA, women's groups and panchayati raj institutions in all AIDS control initiatives.
Rafique says the consultation will focus on several thematic areas, such as prevention, care and support, and community mobilization. Issues emerging from the dialogue will not only stimulate discussions on NACP, but will also be used by the NACP design team commissioned by the National AIDS Control Organization (NACO).
"The objective of the e-consultation is to promote a participatory approach, as several organizations and activists have charged that in the past their views were not sought or entertained, resulting in gaps and shortcomings in the previous two phases of the NACP," he explains.
NACP-I started in 1992, while NACP-II was launched in 1999 with the aim of reducing the spread of HIV infection and strengthening the capacity of Central and state governments, civil society and the private sector to respond to AIDS prevention on a long-term basis. NACP-II will come to an end on March 31, 2006.
NACO Project Director Dr S Y Quraishi also emphasizes the inclusive nature of the project: "Over 950 Indian NGOs are already working with us in this fight. We need their inputs and experience to develop a plan that takes into consideration everyone's voice and concerns."
The electronic forum discussions have been centering around issues such as prevention of HIV in the general population, focused interventions with populations at higher risk of infections, condom programming, comprehensive care and treatment, mainstreaming and partnerships, communication and advocacy, human rights and greater involvement of PLWHA, HIV surveillance, research, decentralization and putting in place monitoring, evaluation and tracking systems.
An important critique of the existing policy that emerged through the discussions is that the special impact HIV/AIDS has on children has not been addressed. "An estimated 55,000-200,000 children are living with HIV and an additional two million have been orphaned by AIDS," says Sasi Kumar of International HIV/AIDS Alliance, India. He also says that many experts consider even this figure a significant underestimate.
"Current and emerging challenges in working with children orphaned and made vulnerable to HIV/AIDS include the need to scale up programs to address the needs of street and vulnerable children," Sasi Kumar stresses. He recommends adoption of a national plan of action for children affected by HIV/AIDS. Efforts under this should address the effective implementation and application of child-related policies and laws at the state and local levels, addressing specific issues, such as stigma and discrimination and children's access to anti-retroviral treatment and other services.
Several respondents have recommended developing coordination between different sectors, such as the social sector, the health sector, the industrial sector and establishing partnerships among them to reduce stigma and discrimination and develop a better understanding of the epidemic.
"Unless we can effectively deal with the social, legal and judicial impediments to effective and sustainable HIV/AIDS intervention, we will be unable to ensure a reduction in HIV," cautions Shivananda Khan of Naz Foundation International, Lucknow.
Observing that this is particularly the case with female sex workers, intravenous drug users and males having sex with males (MSMs), he calls for effective monitoring of harassment, abuse and violation of rights. "The National Human Rights Commission must be on board and actively involved in this effort," he points out.
There are positive comments as well. Several respondents have lauded the NACP-II on establishing condoms as one of the safest methods to prevent and control HIV and other sexually transmitted diseases. They caution, however, that there has been much condom wastage and dumping by peer educators/NGOs and other institutions. They recommend integration of contraceptive services and information into existing programs that reach a large number of youth. Proposals were also made for investing in research and promotion of female condoms.
A key failure of NACP-II, feels Shivananda, has been around ensuring that sufficient condoms of good quality are available. Another area needing urgent attention, he adds, is monitoring incidence and prevalence of HIV infections and their characteristics to track the progression of the HIV epidemic among different population groups across the country. "There are only three sites in the country that conduct sero-surveillance on MSMs. This needs to be rapidly scaled up and linked with specific intervention areas, so that impact assessments can be conducted," he urges.
Meanwhile, as suggestions and deliberations continue to keep the e-consultation alive, Rafique prepares and sends weekly summaries of the findings to all registered participants. The issues raised now will be considered when NACP-III is drafted, sometime in December 2005, he says.