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"One nation – One Resolve, We will Fight AIDS Together"
-Dr. S.Y. Quraishi, Director General National AIDS Control Organisation, India

India is witnessing a changing face of AIDS pandemic. HIV, earlier confined to high-risk-behaviour-groups has now moved to general population. Till a few years ago only six states of the country were designated as ‘high HIV prevalence’, now this tag can be affixed to the entire nation. Yet another warning sign is the swift feminisation of the epidemic.

India is now implementing phase two of the national AIDS control programme. This time the policy focus is on advocacy, decentralisation with emphasis on vulnerable groups, particularly youth. There is a tactical move to behaviour change as compared to mass awareness. The programme will now focus on care and support to people living with HIV and AIDS. The government has made a commitment to provide adequate resources as well.

AIDS control will no longer be approached as a single disease programme; it will be tackled through a multi-sectoral methodology. This paradigm shift incorporates adoption of a mission mode, reclassification of states (now 14 states of India have been classified as highly vulnerable and 12 as vulnerable to HIV) and aggressive promotion of condom programmes.

HIV hits the productive age groups most. Due to a fall in income and rise in expenses, food consumption is the first casualty in families. The programme in the country will strive to include nutritional messages in HIV communications and nutritional interventions for HIV and TB patients.
 

"If we try to identify people infected with TB and HIV using physical tests, social exclusion process begins immediately"
-Professor Amitabh Kundu, School of Social Sciences, Jawaharlall Nehru University New Delhi

We need to identify the food and nutrition linked programmes, which can be expanded and modified as we approach the people with TB and HIV affection and infection. An analysis of nutrition and food linked programmes reveals that programmes that reach targeted selection using an economic criterion have a higher degree of efficiency. Some of the examples of such programmes are Integrated Child development Services and Annpoorna Yojna. The involvement of community based organisations and NGOs also adds to the efficiency of such services.

However if we try to identify people infected with TB and HIV using physical tests, social exclusion process begins immediately. Their exclusion becomes worse because of social stigma

So how do we design nutrition programmes for people living with TB or HIV/AIDS without inviting their social exclusion?

In our country per capita calorie consumption has been consistently declining in the country and is going down even further in thirty percent population. The microenvironment of living in the country has worsened over the decades. There is lack of sanitation, number of persons living in one-room units has gone up and there is social and economic exploitation at work places.

The nutrition programmes for people living with TB or HIV/AIDS shall have a sharper focus. In view of the large target group, even the present Rupees 30,000 crore food subsidies may prove insufficient. Initially the programme may focus on critically ill patients, orphans or widows.

"HIV/AIDS demands a multipronged response"
-Dr. Stuart Gillespie, Senior Research Fellow, International Food Policy Research Institute

Food and nutrition are fundamentally intertwined with HIV transmission and the impact of AIDS. The response to HIV/AIDS is conventionally disaggregated into the four pillars of prevention, care, treatment and mitigation. Food and nutrition security are fundamentally relevant all the four strategies.

Food assistance is essential for vulnerable group well being, for strengthening human capital, as well as preserving livelihoods.
 

"Lessons for India"
-David Fletcher

HIV and TB are public health, social and economic problems. Migration is major factor in spread of HIV. The best way to check spread of HIV in the country is to increase condoms use geographically.

HIV spread leads to increase in number of tuberculosis patients, together they fuel food insecurity.

Nutritional supplementation improves quality of life these patients, slows the progress to AIDS, reduces vulnerability to opportunistic infections and increases effectiveness of anti-retroviral drugs.

Food and nutrition have an important role to play in HIV and TB control programmes.

The challenges in front of the country include incorporation of nutrition related messages in related IEC activities, community participation and development of a mechanism for distribution of food amongst the targeted groups.

Kousalya Periaswamy, Network of Positive Women, India

Women suffer poor nutritional status, which is worse in rural areas. Sudden demise of the husband creates a sense of insecurity amongst women living with HIV. They have fears about future of their children and their own physical and verbal abuse. These women need financial and economic support.

 

Manoj Pardesi, Vice President, Indian Network of Positive People
HIV is fuelling TB, poverty, school dropouts and human trafficking. All TB and HIV control programmes must have nutrition-based interventions.

 

Mike Tonsing, Delhi Network of Positive People

Most people getting anti-retroviral drugs from government clinic in Delhi cannot afford nutritious food. Our members get their food from local Gurudwaras.

Currently India has no policy on nutrition programmes for TB and HIV patients, however nutrition must be a core part of HIV care package. There is a scope for integrating existing poverty alleviation programmes with HIV care.

 

Mr. S Jayapaul, Project Manager with Indian Network of Positive People (INP+)

Out of 1.5 million people who live in Namakaal district of Tamilnadu, 95,000 people are HIV positive. Their families are faced with a falling income and reduced food consumption on one hand and rising cost of health expenses on the other. A large number of families have been pushed below the poverty line forcing children to work for cheap labour.