As important as it is for the government to aid those who are sick, the large projections of the disease, makes prevention the priority in India’s policy to fight AIDS. When talking about prevention, India faces the task of educating a population of 1.1 billion, about a disease that carries several taboo connotations. The health officials have to take measures that will allow them to access such the large population, without exhausting all of its resources. Simultaneously, they have to work on eradicating the strong discrimination prevalent against HIV and patients who live with the virus.
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Taking lessons from South Africa, where the devastation from HIV had a crippling effect on the economy, India has to portray and understand the impacts HIV can have on its rising economy. The correlation between work participation rate and HIV shows that the work force is the major target of the disease. If the projected rates are reached or surpassed by 2010, the widespread impact of the disease will have major bearing on the economy. Realization that India is greatly affecting the work force could persuade company owners to fund HIV education
programs or even seek insurance policies. (World Bank Report 252) Community Health Insurance is another program that can be a source of funds. Community Health Insurance program such as ones there are some CHI programs in place that provide very affordable policies especially to the disadvantaged and the poor. However, most of these policies automatically block those who have chronic ailments such as TB, or HIV. Taking a lesson from such schemes, programs need to be generated that are HIV inclusive.
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Studies reveal that the most cost effective way of prevention is through focus on high risk groups. In India, the high risk group involves sex workers, truck drivers, injecting drug users, and male homosexuals. Such marginalized population can only be reached with a coordinated effort of the government and Non governmental organizations. In a mutualistic relationship, the Government could provide NGOs with the public mandate, technical information, financing, and sector coordination, resources any NGO needs to survive. At the same time, the government can benefit from the NGOs benefits of being flexible, diverse, cost – effective, and reachable to the marginalized population. (World Bank research 252) A unified public and NGO front is needed if the government wants to reach a significant amount of patients living with HIV/AIDS.
An example of coordinated governmental and NGO efforts was seen in the success of a prevention program initiated in 1992. The program called SHIP, or STD/HIV Intervention Program was a peer educator program that incorporated the Indian Government, international donors, three local NGOs and sex workers in Calcutta. The NGOs gave the sex workers training about STDs, the use of condoms, and negotiation skills. The sex workers then took on the role of educators and spread the information amongst their colleagues. The educators were successful as they had the advantage of credibility in their community, and were often regarded as trustworthy. The educators too benefited as they gained recognition and self respect due to their authoritative position. The last aspect especially complemented the program as it persuaded more workers to become peer educators. Due to this program the use of condom per month rose from 1500 at start to 6500 at the end of 1995 (confronting AIDS 256).
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Another example of a successful collaboration of government and NGOs was seen in the harm reduction program found in Nepal. In 1992, a NGO called Lifesaving and Lifegiving Society began to provide education, condoms, bleach, needle exchange, and primary health care to about 650 of Katmandu’s 1,500 injecting drug users. The group collaborated with the Ministries of Home Affairs and Health and law enforcement agencies, while offering injecting drug users confidential and nonjudgmental assistance. Among the drug users participating in the program, the mean frequency of injecting fell from 24, shortly before the start of the program to 17 injections per week (World Bank report 118) A similar needle exchange program would be especially useful in Manipur, one of the first Indian state to have a high rate of HIV prevalence, because of IDU as a mode of transmission.
However to utilize NGOs as a resource, the government has to change some policies and laws that generate animosity between the police department and NGOs working with marginalized population. Section 377 of the Indian Penal code renders homosexuality and ‘other immoral behavior’ illegal and liable for a prison sentence of up to ten years. This law recently created unwarranted animosity when the police arrested a few Naz foundation members, an NGO working with males who have sex with males. Another proposed billed will penalize the clients of the sex workers rather than the sex workers themselves. While touted as being ‘pro sexworker’ the law will ultimately force the workers into more clandestine conditions where they will have lesser negotiation power.
Another big resource that can deal with discrimination and get rid of the stigma attached with HIV is Indian Bollywood. Indian cinema has a great impact on everyday life, and movie stars are often awarded hero status. To combat discrimination, AIDS fight needs a star appeal. Basically, AIDS has to move from being a scandal to simply a tragedy. Currently, four Bollywood directors are planning short films depicting stories of people dealing with HIV. The films will be shown in theaters before full-length feature films, and will start in the autumn of 2007. (Gates foundation 1)Recently, India has proposed and committed 2.6 billion dollars for a five year program, known as NACP – III. Two thirds of this budget is allocated for prevention and one sixth for treatment. More funds can be generated if the corporations are used as a resource.