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Hence, either in India, AIDS/HIV is spreading in a completely sporadic manner or the numbers for AIDS/HIV prevalence are off. To substantiate my belief that the numbers presented by NACO do not reflect the true picture of AIDS in India, I checked to see India’s policy on reporting AIDS cases. In India, AIDS case reporting is voluntary, and hence only a small amount of government hospitals and an even smaller amount of private hospitals report AIDS cases. A study published in year 2006, called “Routes of HIV transmission in India: assessing the reliability of information from AIDS case surveillance” tried to assess the accuracy of information gathered from AIDS cases. They examined four high HIV-prevalence districts in southern-India and suggested changes to improve the dependability and usefulness of that information. In the process they examined forms and interviewed doctors, counselors, officials of State AIDS Control Societies, and a convenience sample of people living with HIV\AIDS. They found that the standard procedure consisted of a monthly AIDS case report, which all the hospitals have to hand in to NACO. Almost no effort has been put into training people who compile such reports. Different hospitals have varying arrangements relying on doctors, counselors, nurses and administrators. In the Civil Hospital at Sangli, the hospital’s sexually transmitted infections officer visits wards and checks the rosters. If he suspects AIDS cases he approaches the nurse to collect data. Moreover, at times a hospital’s priorities conflict with accurate reporting. For example, private hospitals are unwilling to question paying customers, or forestalled investigation, whenever blood transfusion may be the culprit. In anonymity, one chief of reporting admitted, “We sometimes get HIV cases that we cannot explain. They may be through unsafe procedures either in our hospital or elsewhere. To be honest, we do not want to investigate further, because our hospital may be implicated.” Other problems, such as vague and limited forms, inclination to assign all adult cases into the sexually transmitted category, and not distinguishing high from lower risk sexual behaviors all confirm the belief that India’s surveillance system fails on several accounts. (Correa 731-735)
Also, NACO’s HIV rates come from certain assumptions based on the HIV surveillance sites. Yet these sites fail to take into account, the increasing number of patients who seek private care. Hence, the numbers for HIV prevalence are severely underreported. “Private medical institutions and nongovernmental organizations (NGOs) provide care for a huge number of AIDS patients in India, and they have witnessed a steady increase in the number of HIV patients over the last years. Their numbers are not included in the national data published by NACO.” (Solomon 159) Another report by Sheena Asthana, “AIDS-related policies, legislation and program implementation in India”, reiterates the central theme that the doctor’s in the private sector are too detached from the central government and are often underdeveloped (Asthana 185) Till the year 1992 most of India’s resources were focused on surveillance. In 1989 there was a bill passed which mandated physicians to report AIDS/HIV cases. However, this bill was later repealed due to privacy and human rights violations in the year 1992. Conflict between the public health officials and the conservative state police departments makes it hard for those in need to seek reliable help. “On the one hand, health departments are expected to take an inclusionary approach to groups such as CSWs and IDUs. On the other, State bodies in charge of public order and law enforcement are expected to arrest them” (Asthana 196) The epitome of the dissension was displayed in July 2001, when police officials arrested agency workers from the Naz foundation, who promoted care and awareness among men who have sex with men. “On July 7, 2001, police in the city of Lucknow in Uttar Pradesh state, India, raided the offices of Bharosa Trust and Naz Foundation International, two organizations promoting sexual health among men who have sex with men. Police confiscated AIDS-education materials and arrested and detained staff of the two organizations. The arrested persons were charged with possession of obscene materials and with conspiracy to commit sodomy. Section 377 of the Indian Penal Code penalizes "Whoever voluntarily has carnal intercourse against the order of nature" with imprisonment of up to 10 years. The present case shows the devastating effects of such a law not merely on privacy but on basic rights to statement and association—as well as on the right to health of vulnerable people and communities.” (Sodom Laws) In short, lack of official policies, under estimation of HIV prevalence, and separation of doctors working in the private sector from the central government all are factors that contribute to hinder AIDS case surveillance and serve to underestimate the AIDS epidemic in India. |
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