Can a Polio-free India effectively combat the spread and stigmatisation of HIV/AIDS?…By Akanksha Singh
With the last case of Polio reported more than three years back, World Health Organisation declared India Polio-free earlier this year. Not just the Indian government or public policy leaders, its success was attributed to a 2.3-million- strong squad of Polio volunteers and 1,50,000 supervisors who worked day and night visiting every household in the country.
The news rang in hope that a serious public health threat can be conquered by India. It also made people sit up and take notice of the hard work put in by HIV volunteers who are working tirelessly to rid the country of what is perhaps the deadliest disease in the world. The first few HIV cases in India were diagnosed among sex workers in Chennai, Tamil Nadu, in 1986 and exactly a year later, the National AIDS Control Programme, now National AIDS Control Organisation (NACO), was launched.
On the other hand, India embarked upon the Polio eradication programme 19 years ago, in 1995, when the disease was affecting more than 50,000 children every year. Today, India has successfully got rid of its polio programme but it has been more than two decades that India continues to be in the news for its ever fluctuating HIV/ AIDS graph.
The Indian minister of health and family welfare, Ghulam Nabi Azad, recognised the role of ‘resolute determination, technological innovations (like the indigenous bivalent Polio vaccine), adequate domestic financial resources and close monitoring of Polio programme’ as instrumental behind the success of the Polio programme.
So, where does India lack in combating HIV/AIDS as it continues to devastate millions of families every year? Are we not resolute enough? Are we lacking in technological knowhows? Or are there not enough resources to combat this disease? What are the factors which can help us keep the disease in check? Can awareness alone play the role or is there more than what meets the eyes?
According to Razeena Padmam, director and professor, Behavioural Science Department, Mahatma Gandhi University, Kerala, “It’s time we should move beyond HIV/AIDS awareness campaigns and begin serious considerations of providing medicines to patients. Awareness is important, but it’s useless if we cannot provide medication.”
Whilst accepting that things have significantly changed, such that many more people now receive free treatment, Prof. Padmam highlights the problems still faced by patients in getting social acceptance. “People still feel that it is a very dreadful disease. Once you will get HIV, it will cultivate into AIDS. As it is an immunity deficiency disease, all of them have a very dreadful feeling as there is no cure for it,” she says. She further adds that the dreadfulness of the disease causes a lot of fear among the people and that they do not want to take a risk. “HIV patients are not accepted in the field of education and socialising with them is a problem till date. Parents of affected children are really afraid,” she thinks. Like Polio, HIV illness in children is often more severe than in adults. HIVpositive children suffer from more prominent symptoms including respiratory infections, sepsis, intestinal illness, skin diseases and meningitis.
According to the 2011 annual report of National AIDS Control Organisation, India was estimated to have around 1.16 lakh new HIV infections among adults and around 14,500 new cases among children every year. Children less than 15 years of age account for 7 per cent of all infections.
India fought Polio on numerous fronts, with regular efforts by the government, partnerships with NGOs and the massive on-the-ground efforts from health workers. The continued commitment by the Indian government as well as its partnership with international organisations can put an end to the HIV endemic, experts feel. Sister Dolores Kannampuzha, founder of Cancer and AIDS Shelter Society (CASS), Kottayam, Kerala, exclaimed, “Similar to the misconceptions and stigma associated with HIV testing and treatment that we currently face, many families in India initially didn’t trust Polio vaccinators. They didn’t understand the link between other public health initiatives and the mission to end Polio.”
“It took close to 25 years to achieve an absolute salvation. The cases of Polio in India dropped from 1,50,000 to zero and to come this far have not been an easy job,” she further added. The National Polio Surveillance Project became India’s most extensive public-health surveillance system. In every National Pulse Polio Immunisation round, 24,00,000 vaccinators under 1,50,000 supervisors visited every household, railway station, bus stand, market area, construction site, etc. to ensure immunisation of nearly 172 million children. More than $2 billion have been spent on the Pulse Polio Programme.
The third phase of the National AIDS Control Program (NACP) got a direct budgetary support of $477 million from the government and incurred extra aid from other international organisations. A total of nearly $1.9 billion was earmarked for a third five-year phased out plan.
The total proposed budget for NACPIV (2012-17) is $2.6 billion which comprises Government Budgetary Support, Externally Aided Budgetary Support from World Bank & Global Fund and Extra Budgetary Support from other Development Partners.
The awareness and immunisation programmes for HIV and Polio were carried out at the national level, with both campaigning rigorously at every corner of the country. While Pulse Polio programme was started in 1995, HIV awareness began eight years prior to it. So what leads one to succeed whereas the other, with double the resource allocation, does not deliver the expected results?
A 2006 UNDP study (‘The Socio Economic Impact of HIV and AIDS in India’) found that 25 per cent of people living with HIV in India were denied medical treatment on the basis of their HIVpositive status. About 74 per cent of employees steered away from disclosing their HIV status to their employers for the fear of being discriminated against. Of the 26 per cent who disclosed their status, 10 per cent reportedly faced problems as a result.
“It is more pronounced among people in marginalised groups. Female sex workers, transgender and gay men are often stigmatised not only because of their HIV status but also because they belong to socially excluded groups,” said Dr Y. Annamma Varghese, facilitator at Cancer and AIDS Shelter Society (CASS).
There has been a change at the micro level but on the whole, things have not changed much. Perhaps, because of political correctness, people do express their awareness and acceptance but there have been so many instances of discrimination. One wonders if all the money spent on sensitising people has been a waste.