New Delhi: Strapped for funds, the health ministry is considering axing a raft of HIV/AIDS-related research projects overseen by the National AIDS Control Organisation (Naco) in a move that may undermine India’s progress in the fight against the fatal disease.
At stake are 14 operational research projects directly financed by Naco and 18 supported by donor funds and overseen by the organization. These projects play a critical role in designing the AIDS control efforts to suit the needs of people in different regions of India.
The Bharatiya Janata Party-led National Democratic Alliance government has slashed the budget for the department of AIDS control in the year starting 1 April by 22% to Rs.1,397 crore from Rs.1,785 crore in the current financial year.
The HIV/AIDS-related projects could become a casualty of the budget cut.
An internal email exchanged between Naco and health ministry officials referred to a 9 March meeting with India’s international partners in the fight against AIDS—the US Centers for Disease Control and Prevention (CDC), Unicef and the United States Agency for International Development (USAID).
The email, which was reviewed by Mint, said the meeting was to discuss “programme priorities” in the context of the “budget slash.” The meeting was called to discuss the 32 HIV/AIDS research studies.
The budget cut comes at a time when India’s AIDS programme is already stocked out
of drugs, diagnostic kits and condoms, hindering both the treatment of patients and preventive efforts.
A senior Naco official, speaking on condition of anonymity, said any move by the government to stop HIV/AIDS-related research “could hurt us very badly in the future.”
“Everybody in Naco is saying the same thing. If we stop research, prevention activities right now, we will see resurgence of HIV in time to come. And this will be in pockets so far considered low-risk. It is too early to give it up.”
Preventive measures include condom distribution, IEC (information, education and communication) measures and targeted intervention.
“Everything is resource intensive. If we stop everything, we will reduce a stellar programme to pill distribution,” said the official.
In the past 25 years, India has made impressive progress through the national AIDS programme. In fact, the anti-HIV programme—with its vocal community and activist base—is one of its best performing health initiatives. The country is on track to meet the Millennium Development Goal of halting and reversing the HIV/AIDS epidemic.
The government estimates that about 2.4 million Indians are living with HIV. According to the health ministry, recent data suggests there are signs of a decline in HIV prevalence among female sex workers in areas where focused interventions were implemented, particularly in the southern states.
When asked about the decisions taken in the 9 March meeting, Naco joint secretary K.B. Agarwal said: “This is an internal process and it will remain within the ministry. We cannot be expected to share this with the media.”
N.S. Kang, additional secretary in the health ministry, said, “Not all research activities will be stopped. Relevant programmes will continue to be funded.”
Responding to an email query, USAID spokesperson Bonnie Carlson said, “USAID, as a donor, supports what Naco chooses to fund based on the priorities they identify.”
Unlike clinical trials, operational research is aimed at improving and adapting a national programme in line with the requirements of the people who need healthcare.
“We did operational research on the incidence of sexually transmitted infections (STIs) and cervical cancer in women living with HIV. Then we adapted the prescribed regimen and tests in the programme accordingly,” said a public health activist on condition of anonymity.
“Operations research is crucial to accomplishing accelerated, large-scale and sustainable delivery of HIV/AIDS treatment and prevention services in India. Operational research allows the HIV/AIDS programme to adapt its programme as it grows,” the activist said.
According to the activist, the World Health Organization has recognized “the rapid identification and re-application of new knowledge” as one of the pillars in the effort to combat HIV/AIDS.
“Yet several hurdles stand in the way of operational research in India to advance AIDS prevention and treatment interventions. Funding cuts to Naco’s budget are now threatening to affect its research initiative aimed at improving the standards of HIV care in India,” the activist cited above said.
In 1986, following the detection of the first AIDS case in the country, a national AIDS committee was constituted by the health ministry. The panel recommended setting up an organization dedicated to steering the national programme against the disease.
Naco was set up in 1991, with a credit of $84 million from the World Bank. In the second phase, the World Bank advanced another $191 million. In 2006-07, the third phase was launched with $250 million from the World Bank.
The fourth phase (2012-17) of India’s national response to AIDS, the NACP-IV, is being funded mostly by mobilizing domestic financial support, entangling the hitherto efficient programme in bureaucratic red tape. Naco estimates the domestic contribution to be 80% of the total budget.