Budget cuts are threatening to of India’s key health initiatives—the National AIDS Control Programme (NACP) and the Revised National Tuberculosis Control Programme (RNTCP). A total of 2·1 million people in India are HIV positive and about 1·2 million new cases of tuberculosis are diagnosed every year.
For a decade, under the NACP the government has been dispensing free antiretroviral therapy (ART) and diagnostic services through a national network of 510 ART clinics. About 869 000 HIV positive people currently receive first-line and second-line ART. Voluntary agencies are funded to run targeted interventions such as condom distribution and needle-exchange programmes for high-risk groups. However, many ART clinics are running out of stock and community-based prevention activities in some states have been curtailed. Voluntary organisations delivering targeted interventions have been told to dismiss health workers in Maharashtra, one of the states with a high prevalence of HIV. Condom supplies are running out in several states, according to data collated by the National AIDS Control Organisation (NACO) of the Ministry of Health, which runs the NACP. (However, the condom shortage is a persistent feature of anti-AIDS efforts in India. A few years ago, it became so critical that a Cabinet meeting had to be called to change government procurement policies. The shortage probably has more to do with the behaviour of quasi-monopoly state supplier, HLL, than with shortages of cash).
The combined effect of all the changes, could undo recent achievements such as the decline in new infections and AIDS-related mortality. “Slashing the budget and not ensuring timely release of funds to community-based organisations for prevention can reverse the gains of the last decade instead of reversing the HIV epidemic”, warned JVR Prasada Rao, the UN Secretary General’s Special Envoy for AIDS in Asia and the Pacific. Rao had been Secretary of Health when NACO was established and is widely hailed with taking early, effective action to bring HIV under control in India
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