Controlling HIV/AIDS in India - an immense challenge

Controlling HIV/AIDS in India is an "immense" challenge for the country's National AIDS Control Organization -- which is preparing to launch on April 1 the third phase of its National AIDS Control Program, a new five-year, $2.6 billion program that aims to reduce the number of new HIV cases and improve access to treatment in the country -- NEJM national correspondent Robert Steinbrook writes in a perspective piece.

According to Steinbrook, two-thirds of NACP-III program's budget will go toward prevention efforts, while one-sixth will go toward providing treatment access to HIV-positive people.

He adds that although prevention efforts will "account for a smaller percentage of the total NACP resources than at present," prevention "will remain the focus of India's AIDS control strategy."

Steinbrook writes that the challenges associated with providing treatment access and preventing the spread of HIV in India include "increasing the number of patients receiving treatment, making additional medications available, improving the monitoring of therapy, training physicians and other health care workers, caring for patients with tuberculosis coinfection, and reducing stigma and discrimination."

Steinbrook adds that NACP's "immediate priorities" are "to start patients on first-line regimens, to achieve high rates of compliance through supervised therapy and intensive counseling, to build infrastructure," and -- according to NACO Director-General Sujatha Rao -- to ensure that people are not "dying for lack of access to drugs that are available and affordable."

Steinbrook concludes that the "new phase of the AIDS control program is just beginning, and the challenges remain immense" (Steinbrook [1], NEJM, 3/22).

Providing access to care to people living with HIV/TB coinfection also is a "major public health challenge" in India, Steinbrook writes in a second NEJM perspective piece.

According to Steinbrook, people with HIV/TB coinfection have "higher risks of recurrence and death," and TB is "expected to develop in more than half" of HIV-positive people in India.

Treatments for TB and HIV are "increasingly being coordinated, but the full benefits have yet to be realized," Steinbrook writes.

Steinbrook concludes that the "control of both [TB] and HIV is likely to be most successful if programs collaborate whenever possible and are closely integrated with the rest of medical care" (Steinbrook [2], NEJM, 3/22).

The first perspective piece is available online. The second perspective piece also is available online. More information about HIV/AIDS in India is available online at GlobalHealthReporting.org.