Overview of National Policies in HIV/AIDS Research India

1. Overview of National Policies in HIV/AIDS ResearchIndia Dr. Vasantha Muthuswamy Sr. Deputy Director General Indian Council of Medical Research New Delhi -110029 muthuswamyv@icmr.org.in

2. HIV/AIDS – An epidemic • 1st case in sex workers in Chennai, 1986 • > 5.3 million people infected • 6 High prevalence States: Maharashtra, Karnataka, Tamil Nadu, Andhra Pradesh, Manipur, Nagaland • India- world’s 2nd largest burden of HIV-infected persons. • One of every six new HIV infections • two Indians become HIV-infected every minute • Majority due to sexual transmission followed by IV drug use and Mother-to-child transmission • HIV epidemic is spreading from urban to rural populations

5. Known modes of transmission, 2002

8. Actions Taken • After 1986, Government took a series of measures • Realized that AIDS had epidemic proportion in Africa and was spreading rapidly • Govt of India started pilot screening of high risk population

9. National AIDS Committee • National AIDS Committee in Year 1986 • To formulate strategy & plan for implementation of prevention & control of HIV/AIDS in the country, • to bring together various ministries, NGOs and private institutions for effective co-ordination in implementing the programme • The committee acts as the highest-level deliberation body • to oversee the performance of the programme • to provide overall policy directions, • to forge multisectoral collaborations. • Created public awareness, introduction of blood screening for transfusion and surveillance activities • NACP -1987

10. Medium Term Plan for HIV/AIDS Control • 1989, with WHO support, a medium term plan with US $10 million budget • Implemented in 5 affected states & UTs (Maharashtra, Tamil Nadu, West Bengal, Manipur, and Delhi). • Focus on reinforcement of program management capacities & targeted IEC and Surveillance • Preventive activities like implementation of education and awareness program, blood safety measures, control of hospital infection, condom promotion, strengthening clinical services gained momentum in 1992

11. The National AIDS Control Project Key objectives • To reduce the spread of HIV infection in India • Strengthen India ’s capacity to respond to HIV/AIDS on a long term basis.

12. National AIDS Control Program (1999-2004) • Implemented in 32 States/UTs & 3 Municipal Corporations namely Ahmedabad, Chennai & Mumbai through AIDS Control Societies • The 3 new states (Chattisgarh, Uttaranchal,Jharkhand) establishing their State AIDS Control Societies • Access to highly active antiretroviral drugs • Pharma industry instrumental in providing lower cost, generic, fixed dose combinations for HIV-infected patients

13. Components • Priority targeted interventions for populations at high risk • Preventive interventions for the general population • Low Cost care for people living with HIV/AIDS • Institutional strengthening • Inter-sectoral collaboration

14. Policy on Antiretroviral therapy • Efforts to exempt customs duty on drugs to reduce cost • The ART is not provided under National Program • However, in training for doctors rationale use of ART emphasized. • ART drugs provided in cases of post-exposure prophylaxis to health care providers and the feasibility study project on prevention of mother to child transmission.

15. 3 by 5 Initiative • The WHO declared lack of access to ART as a ‘global health emergency’ in September 2003 • Joint WHO/UNAIDS emergency plan to scale up access to treatment for at least 3 million by 2005. • Government of India has issued guidelines for phased scale up of access to antiretroviral therapy for people living with HIV/AIDS.

16. Initiatives in India • 1 million people in 6 high prevalent states will receive antiretroviral (ARV) drugs free of cost from 1st April 2004 targeted to 3 vulnerable groups • mothers who participated in the Prevention of Parent to Child Transmission (PPTCT) program as seropositive antenatal cases • seropositive children below the age of 15 years • people with AIDS who seek treatment in selected government hospitals • Govt of India in dialogue with pharma to optimize additional potential reduction in cost of ARV drugs

17. State Level Srengthening • Strengthen program management at state level • Established organizations as per the guidelines of the strategic plan • State AIDS control societies (State AIDS cells), • Technical advisory committees • Empowered committees State AIDS Control Societies • takes the policy decisions for implementation of the HIV/AIDS control program • administrative and financial actions

18. Recent Initiatives • In Dec 1998, Prime Minister, Mr Atal Bihari Vajpayee acknowledged that HIV/AIDS was a serious public health problem • In July 2003, the Prime Minister gave call to elected representatives to display political courage to address HIV/AIDS issues • Momentum in political advocacy continued strongly • Parliamentary forum of elected representatives (Members of Parliament) was established for HIV/AIDS research that comprised members from all major political parties

19. contd • Feasibility study to reduce mother-to-child transmission initiated by NACO in Mar 2000 in 11 maternity hospitals with little experience in HIV/AIDS research • Decision to scale up services to reduce mother-to-child transmission in six Indian states • Rapid change from non - recognition to acceptance as a public health problem • Decision to provide free ART to persons having advanced HIV disease was taken

20. Course of Events • IAVI undertook an effective campaign for HIV vaccine trials • The President of India, Mr. Abdul Kalam supported conduct of HIV vaccine trial • In Feb 2005, the first Phase I HIV vaccine trial was initiated in the National AIDS Research Institute (NARI), Pune. • Another HIV vaccine trial using an indigenously developed vaccine is expected to be initiated in Tuberculosis Research Centre, Chennai by the end of 2005.

21. HIV/AIDS Trial • NACO, ICMR entered into a Memorandum of Understanding (MOU) with global, not-for-profit International AIDS Vaccine Initiative (IAVI) in December 2000 • An extensive 2 year exercise was undertaken to prepare the site, design the study and mobilise the volunteer groups before initiating the HIV vaccine trial • Adopted a multiple AIDS vaccine candidate approach

22. Vaccine Trial Preparedness activities in India • Preparedness activities initiated in 2002 & Ph I in Feb 2005 • Effective campaign for political advocacy helped accelerate implementation of HIV prevention & treatment strategies, research responses and its implementation • Strong political support strengthened research efforts in institutions already involved in HIV/AIDS work and also those who were not adequately exposed

23. Involvement of Policy Makers • Vaccine programme initiated with a Policy Makers conference in May 2002 • brought together parliamentarians from 8 developing countries to share their perspective • Program received strong support from top political leadership • Prime Minister of India, Leader of Opposition, Hon’ President of India and Chief Ministers of high prevalence states. • Effort to keep policy makers engaged with programme • Held policy workshops, one-on-one consultations, regular briefings at national level, specific workshops with state legislators at the regional level

24. Processes • Community Involvement • Formative Community Research • Study to see willingness to participate for the Phase I Vaccine Trial • Committee of Parliamentarians • Civil Society Stakeholders Interactions • Media Orientation • National AIDS Vaccine Advisory Board (NAB)

25. Advisory Expert Panels • Expert panels were set up to address the concerns and issues that emerged from the consultations with the various stakeholders • National AIDS Vaccine Advisory Board • Informed Consent Group • NGO Working Group • National Consultation on HIV Care and Treatment • Gender Advisory Board

26. Major Achievements • HIV sentinel surveillance mapping of high risk & vulnerable grps in over 30 states and UTs • National Blood Policy, 2002 & Action Plan on Blood Safety, 2003. • Action Plan has mandated revelation of HIV status to result seeking donor, & brought in accreditation of blood banks • Care & support and introduced ART • Mobilized grants for managing the opportunistic infections and extending antiretroviral treatment for AIDS. • Awareness generation, expanding services for people with AIDS • Creating new partnerships • Initiation of the HIV/AIDs Vaccine trial

27. Thank you