HIV Testing

HIV Testing

The general consensus among those fighting AIDS worldwide is that HIV testing should be carried out voluntarily, with the consent of the individual concerned. This view has been supported by the Indian government and NACO, who have helped to establish hundreds of voluntary counselling and testing (VCT) centres in India. By the end of 2005 there were 873 VCT centres in India, compared to just 62 in 1997. 41 These centres tested 225,600 people for HIV during 2005. 42 In 2007 there was a dramatic scale-up - 4245 testing and counselling centres were in operation by December 2007

Although voluntary testing is officially supported in India, some states have tried to implement policies that would force people to be tested for HIV against their will. In Goa, the state government recently planned to make HIV tests compulsory before marriage, and in Punjab it has been proposed that all people wishing to obtain or retain a driver’s license should be tested for HIV. 44 Neither of these plans has come to pass, but they have concerned activists, who argue that HIV testing should never be imposed on people against their wishes.
Unfortunately, cases of people being tested without their consent or knowledge are common in Indian hospitals. In one 2002 study, it was suggested that over 95% of patients listed for surgical procedures are tested against their will, often resulting in their surgery being cancelled. 45 Hospital staff and health professionals, much like the rest of the Indian population, are often unaware of the facts about HIV. This leads to unnecessary fears and, in some cases, causes them to stigmatise HIV positive people and discriminate against them, including testing them without consent.

Treatment for people living with HIV

Antiretroviral drugs (ARVs), which can significantly delay the progression from HIV to AIDS – have been available in developed countries since 1996. Unfortunately, as in many resource-poor areas, access to this treatment is severely limited in India; an estimated 158,000 people were receiving ARVs by the end of 2007. 46 Some people manage to access the drugs through private health facilities, which dominate India’s healthcare sector, but the vast majority of people cannot afford to buy treatment privately.
While the coverage of treatment remains unacceptably low, improvements are being made. The government has started to expand access to ARVs in a number of areas, and the national number of ARV centres increased from 25 to around 70 in 2005 alone. 47 By 2007 this figure had almost doubled to 137. 48
Increasing access to ARVs also means that an increasing number of people living with HIV in India are developing drug resistance. When HIV becomes resistant to the ARVs the treatment regimen needs to be changed to 'second-line' ARVs. As with many other parts of the world, second line treatment in India is far more expensive than first line treatment.
In 2008, India’s National Aids Control Organisation (NACO) began to roll out government funded second-line antiretroviral treatment in two centres in Mumbai and Chennai. At the beginning of 2009 second-line therapy was available in a total of eight states. 49
There are also plans to improve the provision of nevirapine to pregnant mothers with HIV, which can significantly reduce the risk that they will pass infection on to their child. It has been reported that, even where treatment to prevent mother-to-child-transmission is available, some women do not request it because of the stigma surrounding HIV. 50
The large scale of India’s epidemic, the diversity of its spread, and the country’s lack of finances and resources all present barriers to India’s programme. Ironically, India is a major provider of cheap generic copies of ARVs to countries all over the world.