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Between wishful thinking and evidence

The HIV response in India finds itself at a crossroad – a choice between consolidating gains and frittering them away into a resurgence of the epidemic.
The struggle began when policy makers chose to ignore evidence and voices from the ground and almost announced the end of AIDS in India. Riding on the trend of fewer new HIV infections and disregarding all feedback from civil society frontline workers, the fourth phase of the government’s National AIDS Control Programme – NACP 4 – stated that the AIDS response will be integrated within the health system of India by the time the programme ends in 2017. By inference, a dedicated AIDS programme was no longer needed; and hence a fifth phase of the AIDS programme – NACP 5 – would be ruled out.

 Not only does NACP 4 assume and affirm that it will achieve its results, but it goes a step further to declare that the entire government health system will thereafter be in complete readiness to deliver HIV prevention and care services.
Analysts fear that this naiveté may cost lives; this is a classic clash between evidence and wishful thinking.
Those who have analysed India’s ‘success’ in reducing new HIV infections will vouch for the fact that not only was the HIV programme birthed by civil society organisations, but the bulk of HIV prevention and care has been delivered outside the government’s health system. In the early days, the government acknowledged this and tailored a financial and administrative structure to harness the power of sex workers, men who have sex with men, transgenders, people who inject drugs and people living with HIV as lead actors in India’s HIV response.
Voices of protest grew louder more recently, when the Union Health Minister, on the heels of his controversial statements against sex education and condoms, said that HIV is like any other disease and hence it is only proper that it be treated as such within the Ministry.
The fallacy of the Minister’s assertion is deep. Sex workers, people who inject drugs, transgenders, and men who have sex with men are most vulnerable to HIV and most in need of support. These populations continue to live beneath the surface of society in shame and stigma. As lesser citizens in the eyes of the law, they harassed and punished into silence. To merely assume that members of these population groups will be able to access services at mainstream government facilities, just like anyone else, is facetious.
Forcing already marginalised populations to seek HIV prevention services from the mainstream health system will drive these groups underground and cause a resurgence of HIV infections. Only when marginalised populations remain equal partners in the HIV response can the gains be consolidated.
In response, the AIDS Momentum campaign was launched in Chennai recently. It is a nationwide campaign led by community-based organisations of marginalised communities bearing the brunt of the AIDS epidemic and engaged actively as leaders in providing prevention, care and support services to those at risk and living with the virus.
AIDS Momentum demands that the HIV programme continue until the job is done. In practical terms, this means a commitment to develop and implement NACP 5, extending current efforts for at least another five years after the current strategy – NACP 4 – winds up in 2017. Any move towards shrinking organisational and budget support to the AIDS response will lead to resurgence of the HIV epidemic in this country. India simply can’t afford to lose its momentum on AIDS.
First appeared in http://www.allianceindia.org/keeping-momentum-aids/ 
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AIDS Momentum is a campaign to protect and strengthen India’s HIV response. The campaign seeks to collaborate with the government to maintain and fully implement an effective and evidence-based HIV programme in India that will sustain and consolidate the gains achieved so far. A consortium of concerned stakeholder organisations, including Alliance India, are supporting this effort.

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