A Challenge Ahead

Ignorance and prejudice are fuelling the spread of a preventable disease. World AIDS Day, 1 December is an opportunity for people worldwide to unite in the fight against HIV and AIDS…. it’s up to you, me and us to stop the spread of HIV and end prejudice.

In just three decades, over 30 million people have died of AIDS and 34 million more have been infected with HIV. The HIV epidemic has become one of the greatest public health challenges of our time. It is also a crisis of law, human rights and social justice. The legal environment—laws, enforcement and justice systems—has immense potential to better the lives of HIV-positive people and to help turn the crisis around. International law and treaties that protect equality of access to health care and prohibit discrimination— including that based on health or legal status— underpin the salutary power of national laws. But nations have squandered the potential of the legal system. On the other hand, worse, punitive laws, discriminatory and brutal policing and denial of access to justice for people with and at risk of acquiring HIV are fuelling the epidemic. These legal practices promote risky behaviour, hinder people from accessing prevention tools and treatment, and exacerbate the stigma and social inequalities that make people more vulnerable to HIV infection and illness. 

Transmission of HIV/AIDS through Body Fluids

fluids can contain high levels of HIV; blood, semen (cum), pre-seminal fluid (pre-cum), breast milk, vaginal fluids, rectal (anal) mucous and other body fluids and waste products—like faeces, nasal fluid, saliva, sweat, tears, urine, or vomit—don’t contain enough HIV to infect one, unless they have blood mixed in them and one significant and direct contact with them. HIV is transmitted through body fluids in very specific ways:

n During sexual contact: If one partner has HIV, those body fluids can deliver the virus into your bloodstream through microscopic breaks or rips in the delicate linings of vagina, vulva, penis, rectum, or mouth. It’s much easier to get HIV, if one has a sexually transmitted disease. 

n During pregnancy, childbirth, or breastfeeding: Babies have constant contact with their mother’s body fluids-including amniotic fluid and blood-throughout pregnancy and childbirth. After birth, infants can get HIV from drinking infected breast milk.

n As a result of injection drug use: Needles or drugs that are contaminated with HIV-infected blood can deliver the virus directly into the body.

n As a result of occupational exposure: Healthcare workers have the greatest risk for this type of HIV transmission. If one work in a healthcare setting, he/she can come into contact with infected blood or other fluids through needle sticks or cuts. 

n As a result of blood transfusion with infected blood or an organ transplant from an infected donor.

 Symptoms of HIV/AIDS

As early as 2-4 weeks after exposure to HIV (but up to 3 months later), people can experience an acute illness. This is called acute retroviral syndrome or primary HIV infection, and its symptoms can include: fever, chills, rash, night sweats, muscle aches, sore throat, fatigue, swollen lymph nodes, and ulcers in the mouth.

HIV/AIDS in India: A Wider Picture

HIV/AIDS is one of the biggest challenges faced by India. There are about three million people suffering from HIV/AIDS in India. 148 lakh people died of AIDS- related causes in 2011 and 7% of them were children. According to NACO, 40,000 pregnant women test positive annually, and 12,000 children are born with the infection every year. The socio-economic condition of the country coupled with the traditional outlook and the myths associated with the things has made it more vulnerable to the disease. Poor literacy level is one of the biggest causes of the spread of the disease. The vast majority of infections occur through heterosexual sex (80%), and is concentrated among high risk groups including sex workers, men who have sex with men, and injecting drug users as well as truck drivers and migrant workers. 

Historical Background of HIV/AIDS Programmes in India

At the beginning of 1986, despite over 20,000 reported AIDS cases worldwide, India had no reported cases of HIV or AIDS. Later in the year, India’s first cases of HIV were diagnosed among sex workers in Chennai, Tamil Nadu. It was noted that contact with foreign visitors had played a role in initial infections among sex workers. In 1987 a National AIDS Control Programme was launched to co-ordinate national responses. Its activities covered surveillance, blood screening, and health education. By the end of 1987, out of 52,907 who had been tested, around 135 people were found to be HIV positive and 14 had AIDS. Most of these initial cases had occurred through heterosexual sex, but at the end of the 1980s a rapid spread of HIV was observed among injecting drug users in Manipur, Mizoram and Nagaland – three north-eastern states of India bordering Myanmar.

At the beginning of the 1990s, as infection rates continued to rise, responses were strengthened. In 1992 the government set up NACO (the National AIDS Control Organisation), to oversee the formulation of policies, prevention work and control programmes relating to HIV and AIDS. In the same year, the government launched a Strategic Plan, the National AIDS Control Programme-I for HIV prevention and also set up State AIDS Control Societies in 25 states and 7 union territories. By this stage, cases of HIV infection had been reported in every state of the country. In 1999, the NACP – II came into effect with the stated aim of reducing the spread of HIV through promoting behaviour change. During this time, the prevention of mother-to-child transmission programme and the provision of free antiretroviral treatment were implemented for the first time. In 2001, the government adopted the National AIDS Prevention and Control Policy. The NACP- III began in 2006, with the highest priority placed on reaching 80 percent of high-risk groups including sex workers, men who have sex with men, and injecting drug users with targeted interventions. It also seeks to decentralise the HIV effort to the most local level, i.e. districts, and engage more non-governmental organisations in providing welfare services to those living with HIV/AIDS.

National Human Rights Instruments against HIV/AIDS

There is no comprehensive law in India to deal with menace of HIV/AIDS and protect the people infected with the disease from discrimination and the social stigma attached with this disease. Therefore, there are following national human rights instruments to protect the HIV/AIDS infected persons from any discrimination:

Constitution of India as an Instrument of Protection of Rights of PLWHAs

Article 14 guarantees the right of equality of treatment to the HIV/AIDS patients. Articles 15 and 16 protect them against discrimination. Article 16 prohibits discrimination in public employment on grounds of religion, caste, creed, sex, colour etc. Article 21 of the Constitution protects their right to life and personal liberty. Article 39 of the Constitution directs the States to ensure that all the citizens including the HIV/AIDS patients have an adequate mean of livelihood. Article 42 casts a duty upon states to make provisions for securing just and humane conditions of work. States have been entrusted with the duty to improve public health under Article 47. 

National Human Rights Commission

The Commission has taken up a number of individual cases relating to discrimination faced by persons affected or infected by HIV/AIDS with regard to employment, access to medical treatment facilities and education. 

National Aids Control Organisation

In India, the NACO carries out the country’s National AIDS Programme, which includes formulation of policy and implementation of prevention and control programmes. Besides NACO, the country also has a National AIDS Control Board, which reviews NACO policies, expedites sanctions, approve procurement and undertake and award contracts to private agencies.

State Aids Control Societies 

For the implementation and management of HIV/AIDS programmes in states, State AIDS Cells were created in 32 States and UTs of the country. To remove the bottlenecks at the State level, Ministry of Health and Family Welfare advised the State Governments/Union Territories to constitute a registered society under the chairmanship of the Secretary Health. On an experimental basis, the Tamil Nadu State AIDS Control Society was created followed by a similar society in Pondicherry. Successful functioning of these societies led to the Government of India advising other states to follow this pattern for implementation of the National AIDS Control Programme.

By LawZ Bureau,