01 Dec 2014 10:41pm IST
Peter F. Borges
Today is World AIDS Day. The global theme for World AIDS Day from 2011-2015 is “Getting to Zero.” Backed by the United Nations, the “Getting to Zero” campaign focuses on the goals of zero new infections, zero discrimination and zero AIDS related deaths. While we commemorate this day, it is important to discuss the implication of the recent decision of central government to merge NACO with NHM.
In keeping with PM Narendra Modi’s desire to shrink government, as exemplified in a slogan he popularized, “Minimum government, maximum governance”, the government recently has merged the country’s AIDS control department (NACO) with another department in the health ministry. The change will mean that India’s HIV prevention efforts will now be implemented under the National Health Mission (NHM), and not by a specific department. NACO was created in 1992 to steer the country’s fight against HIV/AIDS.
In Goa, this would mean, downsizing of workforce of the SACS (Goa State AIDS Control Society), which has already happened and also routing the funds from the central government through state treasury.
The merger effects are already felt in the state. The funds for the programmes in the state were caught in bureaucratic hurdles for such a long time, besides also drug stock outs coming to the fore. More than 250 staff working in the fight against HIV/AIDS had not received their salary for almost three-four months recently. Besides, there is no money released for actual implementation of the HIV prevention programme, even after funds being received in the state treasury.
Recently, the state grappled with the issue of stigma and discrimination against children which had caught national headlines. In NACP III phase, there was a lot of importance given to mainstreaming HIV among all sections of the society.
However, this was not taken seriously by GSACS, given that the position of mainstreaming officer remained unfilled, even after the post being advertised atleast three times. Funds for advocacy and mainstreaming remained unspent. Rivona incident arose out of such negligence where the state failed to sensitize people from all sections of the society.
Given that our infrastructure and health system is still not ready for integration, this should not be adopted across-the-board. Diseases where the burden is still very high, or where the medical procedures involved are technically complex, should continue to be tackled by dedicated organizations. The state is already finding difficult to handle TB, because of the large burden of the drug-resistant variant; similarly, HIV-AIDS is a very difficult pathogen requiring specially sensitized service providers in both the advocacy and curative domains.
Bringing AIDS control under the NHM umbrella would mean training the overburdened primary health workers to reach out to sex workers, transgenders, MSMs and injectable drug users. There is a lot of sensitization and monitoring needed.
The new government needs to keep HIV/ AIDS high on its political agenda, not just as a health issue but as a socio economic issue which impacts many sectors of development and affects social justice. Government should adopt a long term vision in a specific time frame in keeping with the global priority which will be defined in the post-2015 development agenda by United Nations General Assembly. The national AIDS control policy 2002 needs a review and update to incorporate this important national priority.