Yojana - July 2017 - Issues of Persons living with HIV

 WHAT IS HIV?
HIV stands for human immunodeficiency virus. It is the virus that can lead to acquired immunodeficiency syndrome or AIDS if not treated. Unlike some other viruses, the human body can’t get rid of HIV completely, even with treatment. So once you get HIV, you have it for life.
HIV attacks thebody’s immune system, specifically the CD4 cells (T cells), which help the immune system fight off infections. Untreated, HIV reduces the number of CD4 cells (T cells) in the body, making the person more likely to get other infections or infection-related cancers. Over time, HIV can destroy so many of these cells that the body can’t fight off infections and disease. These opportunistic infections or cancers take advantage of a very weak immune system and signal that the person has AIDS, the last stage of HIV infection.
No effective cure currently exists, but with proper medical care, HIV can be controlled. The medicine used to treat HIV is called antiretroviral therapy or ART. If taken the right way, every day, this medicine can dramatically prolong the lives of many people infected with HIV, keep them healthy, and greatly lower their chance of infecting others. Before the introduction of ART in the mid-1990s, people with HIV could progress to AIDS in just a few years. Today, someone diagnosed with HIV and treated before the disease is far advanced can live nearly as long as someone who does not have HIV.
WHAT IS AIDS?
AIDS is the most severe phase of HIV infection. People with AIDS have such badly damaged immune systems that they get an increasing number of severe illnesses, called opportunistic infections.
When people get HIV and don’t receive treatment, they will typically progress through three stages of disease. Medicine to treat HIV, known as antiretroviral therapy (ART), helps people at all stages of the disease if taken the right way, every day. Treatment can slow or prevent progression from one stage to the next. It can also dramatically reduce the chance of transmitting HIV to someone else.

HOW IS HIV SPREAD?
HIV is spread through contact with certain body fluids from a person infected with HIV. These body fluids include:
1. Blood
2. Semen
3. Pre-seminal fluid
4. Vaginal fluids
5. Rectal fluids
6. Breast milk
HIV TRANSMISSION
1. Sexual transmission - it can happen when there is contact with infected sexual fluids (rectal, genital, or oral mucous membranes). This can happen while having unprotected sex, including vaginal, oral, and anal sex.
2. Perinatal transmission - a mother can pass the infection on to her child during childbirth, pregnancy, and also through breastfeeding.
3. Blood transmission - the risk of transmitting HIV through blood transfusion is nowadays extremely low in developed countries, thanks to meticulous screening and precautions. However, among injection or IV drug users, sharing and reusing syringes contaminated with HIV-infected blood is extremely hazardous.

HIV STATUS IN INDIA
As per the recently released, India HIV Estimation 2015 report, National adult (15–49 years) HIV prevalence in India is estimated at 0.26% (0.22% – 0.32%) in 2015. In 2015, adult HIV prevalence is estimated at 0.30% among males and at 0.22% among Females.
The total number of people living with HIV (PLHIV) in India is estimated at 21.17 lakhs (17.11 lakhs–26.49 lakhs) in 2015 compared with 22.26 lakhs (18.00 lakhs-27.85 lakhs) in 2007. Children (less than 15 years) account for 6.54%, while two fifth (40.5%) of total HIV infections are among females.
India has the third-highest number of people living with HIV in the world with 2.1 million Indians accounting for about four out of 10 people infected with the deadly virus in the Asia—Pacific region, according to a UN report.
The report by UNAIDS, the United Nations programme on HIV/AIDS, said that 19 million of the 35 million people living with the virus globally do not know their HIV—positive status and so ending the AIDS epidemic by 2030 will require smart scale—up to close the gap.

PROBLEMS FACED BY HIV/AIDS PERSONS
1. Delay in medication:- Most HIV patients do not know about their infection which results in delay of medication reaching stage 2 or stage 3 of the virus.
2. Lack of support from family and friends:- They have to suffer isolation from family and friends.
3. Dismissal from job when discovered with HIV/AIDS virus:- Mostly the patients are dismissed from their job.
4. Loss of Spouses:- HIV/AIDS patients tend to lose their life partners.
5. Social Stigma:-AIDS is often seen as “someone else’s problem” – as something that affects people living on the margins of society, whose lifestyles are considered immoral.AIDS related stigma and discrimination refers to prejudice, negative attitudes, abuse and maltreatment towards people living with HIV and AIDS.
INITIATIVES TAKEN IN INDIA TO CONTROL HIV/AIDS
Various initiatives have been taken up India to curb the problem of HIV/AIDS.
Some of them are:-
• NATIONAL AIDS CONTROL ORGANISATION
NACO envisions an India where every person living with HIV has access to quality care and is treated with dignity. Effective prevention, care and support for HIV/AIDS is possible in an environment where human rights are respected and where those infected or affected by HIV/AIDS live a life without stigma and discrimination.
NACO has taken measures to ensure that people living with HIV have equal access to quality health services. By fostering close collaboration with NGOs, women’s self-help groups, faith-based organisations, positive people’s networks and communities, NACO hopes to improve access and accountability of the services. It stands committed to building an enabling environment wherein those infected and affected by HIV play a central role in all responses to the epidemic – at state, district and grassroot level.
NACO envisions:
? Building an integrated response by reaching out to diverse populations.
? A National AIDS Control Programme that is firmly rooted in evidence-based planning.
? Achievement of development objective
? Regular dissemination of transparent estimates on the spread and prevalence of HIV/AIDS
? Building an India where every person is safe from HIV/AIDS
? Building partnerships
? An India where every person has accurate knowledge about HIV and contributes towards eradicating stigma and discrimination
? An India where every pregnant woman living with HIV has the choice to bring an HIV free baby into the world
? An India where every person has access to Integrated Counselling & Testing Centres (ICTCs)
? An India where every person living with HIV is treated with dignity and has access to quality care
? An India where every person will eventually live a healthy and safe life, supported by technological advances
? An India where every person who is highly vulnerable to HIV is heard and reached out to.

• NATIONAL AIDS CONTROL PROGRAMME
India’s AIDS Control Programme is globally acclaimed as a success story. The National AIDS Control Programme (NACP), launched in 1992, is being implemented as a comprehensive programme for prevention and control of HIV/AIDS in India. Over time, the focus has shifted from raising awareness to behavior change, from a national response to a more decentralized response and to increasing involvement of NGOs and networks of PLHIV.
In response to the evolving epidemic, the third phase of the national programme (NACPIII) was launched in July 2007 with the goal of Halting and Reversing the Epidemic by the end of project period. NACP was a scientifically well-evolved programme, grounded on a strong structure of policies, programmes, schemes, operational guidelines, rules and norms. NACP-III aimed at halting and reversing the HIV epidemic in India over its five-year period by scaling up prevention efforts among High Risk Groups (HRG) and General Population and integrating them with Care, Support & Treatment services. Thus, Prevention and Care, Support & Treatment (CST) form the two key pillars of all the AIDS control efforts in India. Strategic Information Management and Institutional Strengthening activities provide the required technical, managerial and administrative support for implementing the core activities under NACP-III at national, state and district levels. Currently NACP-IV is being implemented. Objectives of NACP-IV are:-
a. Reduce new infections by 50% (2007 Baseline of NACP III)
b. Comprehensive care, support and treatment to all persons living with HIV/AIDS

HIV/AIDS ACT 2017
This HIV/AIDS bill was first introduced by Ghulam Nabi Azad, former Minister for Health and Family welfare on 11th February, 2014. It was a first of its kind bill in the entire South Asia.The parliament passed the historic Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) (Prevention and Control) Bill, 2017 on 11th April. The bill was passed in Rajya Sabha on 21st March, 2017 and prohibits discrimination against people living with HIV (PLHIVs) on grounds of treatment, employment and workplace. It provides for complete confidentiality, helps in safeguarding patients’ rights, and also creates a proper grievance addressing mechanism.
Main Provisions of the Act are:-
1. Prohibition of discrimination against HIV positive persons: The Act lists the various grounds on which discrimination against HIV positive persons and those living with them is prohibited.
2. These include the denial, termination, discontinuation or unfair treatment with regard to: employment, educational establishments, health care services, residing or renting property, standing for public or private office, and provision of insurance.
3. The requirement for HIV testing as a pre-requisite for obtaining employment or accessing health care or education is also prohibited.
4. Every HIV infected or affected person below the age of 18 years has the right to reside in a shared household and enjoy the facilities of the household.
5. It also prohibits any individual from publishing information or advocating feelings of hatred against HIV positive persons and those living with them.
6. Informed consent and disclosure of HIV status: The Act requires that no HIV test, medical treatment, or research will be conducted on a person without his informed consent.
7. No person shall be compelled to disclose his HIV status except with his informed consent, and if required by a court order.
8. Informed consent for an HIV test will not be required in case of screening by any licensed blood bank, a court order, medical research, and epidemiological purposes where the HIV test is anonymous and not meant to determine the HIV status of a person.
9. Establishments keeping records of information of HIV positive persons shall adopt data protection measures.
10. Role of the central and state governments: The central and state governments shall take measures to:
a. prevent the spread of HIV or AIDS,
b. provide anti-retroviral therapy and infection management for persons with HIV or AIDS,
c. facilitate their access to welfare schemes especially for women and children,
d. formulate HIV or AIDS education communication programmes that are age appropriate, gender sensitive, and non-stigmatizing, and
e. Lay guidelines for the care and treatment of children with HIV or AIDS.
11. Every person in the care and custody of the state shall have right to HIV prevention, testing, treatment and counselling services.
12. Role of the Ombudsman: An ombudsman shall be appointed by each state government to inquire into complaints related to the violation of the Act and the provision of health care services.
13. The Ombudsman shall submit a report to the state government every six months stating the number and nature of complaints received, the actions taken and orders passed.
14. Guardianship: A person between the age of 12 to 18 years who has sufficient maturity in understanding and managing the affairs of his HIV or AIDS affected family shall be competent to act as a guardian of another sibling below 18 years of age.
15. The guardianship will be apply in matters relating to admission to educational establishments, operating bank accounts, managing property, care and treatment, amongst others.
16. Court proceedings: Cases relating to HIV positive persons shall be disposed off by the court on a priority basis.
17. In any legal proceeding, if an HIV infected or affected person is a party, the court may pass orders that the proceedings be conducted (a) by suppressing the identity of the person, (b) in camera, and (c) to restrain any person from publishing information that discloses the identity of the applicant.
18. When passing any order with regard to a maintenance application filed by an HIV infected or affected person, the court shall take into account the medical expenses incurred by the applicant.

WHAT IS THE WAY AHEAD?
• Access to insurance for persons with HIV is an important part of the Act, and is best handled by the government.
• Publicly funded insurance can easily bring this subset of care-seekers into the overall risk pool.
• Such a measure is also necessary to make the forward-looking provisions in the new law meaningful, and to provide opportunities for education, skill-building and employment.
• As a public health concern, HIV/AIDS has a history of active community involvement in policymaking, and a highly visible leadership in the West.
• It would be appropriate for the Centre to initiate active public consultations to draw up the many guidelines to govern the operation of the law.

By: Anupama Sharma