HIV/AIDS in INDIA and the World Bank
The World Bank is helping India to curb the spread and mitigate the impact of HIV and AIDS in the country.
The Government of India (GOI) has embarked on the ambitious goal of halting and reversing the HIV/AIDS epidemic by 2011, ahead of the 2015 target of the 6th Millennium Development Goal.
World Bank support in the past:
Following the identification of the first case of HIV in Chennai in 1986, a small AIDS Cell was established in the Ministry of Health and Family Welfare (MOHFW), GOI.
In 1992, the GOI established the National AIDS Control Organization (NACO) as an autonomous agency charged with the task of HIV prevention and control activities. Since that time, World Bank projects (NACP I for US$84 million, and NACP II for US$191 million) have supported government efforts to develop and enhance its response to the epidemic. This sustained commitment has yielded many benefits. These include:
• Increased numbers of voluntary counseling and testing centers
• Amplified prevention programs in groups with high risk behavior through NGOs
• An augmented and more effective blood safety program
• More clinics to treat sexually transmitted diseases
• Services for preventing parent to child transmission
• Services for the care, support, and treatment for people already living with HIV
These efforts have helped keep HIV prevalence below 1 percent among the adult population in India despite fears to the contrary.
Challenges ahead:
Nevertheless, HIV and AIDS remains a serious threat. While the disease is concentrated among high risk groups, increasing HIV prevalence among women, and in the rural areas, points to a more generalized incidence in some states. Six states - Andhra Pradesh, Maharashtra, Tamil Nadu, Karnataka, Manipur, and Nagaland - account for some 70 percent of India’s HIV infections.
World Bank support going forward:
The World Bank’s Third National HIV/AIDS Control Project (NACP III) for US$250 million will support the Government of India’s efforts to achieve its goal of halting and reversing the HIV/AIDS epidemic by 2011. The World Bank’s convening capabilities have been instrumental in coordinating the support of development partners for the third phase of India’s National AIDS Control Program.
With over 99 percent of the population still uninfected, prevention is the project’s top priority. It aims to reach 80 percent of people at highest risk over a five-year period.
The World Bank’s support to the program focuses on:
• Preventing new infections among high risk groups and vulnerable populations
• Bringing care, support and treatment to larger numbers of people living with HIV/AIDS
• Monitoring and surveillance of the epidemic
• Developing and strengthening skills within the National AIDS Control Organization (NACO), the State AIDS Control Societies, and of NGOs and CBOs associated with the program.
Lessons learned from past interventions:
• Targeted interventions for the poor and marginalized groups at high risk of infection, within a broader population wide campaign, are the most effective way to reduce HIV transmission within the context of the Indian epidemic.
• Working with community-based organizations, especially peer-based groups, is one of the most effective HIV prevention strategies.
• Convergence of HIV programs with other programs that deal with health issues such as STDs, tuberculosis, and reproductive health is beneficial for the effectiveness of all programs.
• Well performing states in India show that a combination of the following factors can reduce HIV prevalence rates:
- Strong political commitment,
- Focus on high-impact interventions,
- Good management with continuity of trained staff,
- Strong surveillance and technical assistance,
- Adequate and flexible financial resources.
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