Audit report criticises India's slow progress on AIDS
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《英国医生杂志》
An Indian government audit has said that the national AIDS control programme has achieved only limited success because of slow implementation, unachieved targets, and ineffective public education.
In a report presented to the Indian parliament last week, India抯 comptroller and auditor general said that various activities under the programme could not be conducted efficiently for lack of infrastructure, drugs, equipment, and human resources.
The report, which examined the programme抯 activities between 1999 and 2003, has listed among the deficiencies misconceptions about HIV transmission, a shortfall in the training of doctors, nurses, and technicians, and the failure of marketing of condoms. It said targeted intervention, viewed as the most effective strategy to stop the spread of HIV in high risk populations, "had not been conducted effectively."
The latest sentinel survey indicates that India now has 5.1 million people infected with HIV. Earlier this month the National AIDS Control Organisation, which manages the programme, had said there was a "visible decline" in the number of new HIV infections in India: 520 000 in 2003, compared with 610 000 in 2002. "The prevention efforts have definitely made an impact," said Meenakshi Datta Ghosh, director of the organisation.
However, the audit report has said that poor awareness of methods to prevent HIV infection is alarming, particularly among commercial sex workers and their clients. Citing an independent survey, it said that just half of the general population and two thirds of female sex workers were aware of how to prevent HIV infection and only a fifth of the general population knew that HIV could not be transmitted through mosquito bites and shared meals.
"Outreach has been poor. Messages aren抰 getting into people抯 minds," said Anand Grover, director of Lawyers Collective, an organisation involved in advocacy, research, and policy initiatives on HIV and AIDS. "Some messages are designed by wrong people." The audit also pointed out a study of 600 doctors in the southern state of Tamil Nadu showing that 22% of doctors were unwilling to treat people with HIV or AIDS, even though they had been trained in the management of AIDS.
Although the programme aimed at achieving condom use by at least 90% of commercial sex workers, the report points out that condom use in this group is 57%. Health ministry officials concede that aggressive promotion of condoms is needed. A high ranking official said that a directive from the previous government to ban condom promotion through television "might have sent the wrong message." But with the change in government earlier this year—and a new health minister in place—condoms will be back on television, the official said.
The audit report also said that the National AIDS Control Organisation had used only 46% of its approved allocation of 11.6 billion rupees ($250m; ?36m; �206m) in the first four years of the five year programme, which has received funding from the World Bank. A large number of clinics for sexually transmitted diseases could not function because of a lack of equipment and trained doctors, the audit showed.
The report also criticised the organisation for advocating a policy of not informing blood donors about infection if they were HIV positive unless they asked, ignoring public concerns that infected donors may unknowingly transmit the virus to sexual partners. The government made it mandatory for blood banks to inform donors only in July 2003.(New Delhi Ganapati Mudur)
In a report presented to the Indian parliament last week, India抯 comptroller and auditor general said that various activities under the programme could not be conducted efficiently for lack of infrastructure, drugs, equipment, and human resources.
The report, which examined the programme抯 activities between 1999 and 2003, has listed among the deficiencies misconceptions about HIV transmission, a shortfall in the training of doctors, nurses, and technicians, and the failure of marketing of condoms. It said targeted intervention, viewed as the most effective strategy to stop the spread of HIV in high risk populations, "had not been conducted effectively."
The latest sentinel survey indicates that India now has 5.1 million people infected with HIV. Earlier this month the National AIDS Control Organisation, which manages the programme, had said there was a "visible decline" in the number of new HIV infections in India: 520 000 in 2003, compared with 610 000 in 2002. "The prevention efforts have definitely made an impact," said Meenakshi Datta Ghosh, director of the organisation.
However, the audit report has said that poor awareness of methods to prevent HIV infection is alarming, particularly among commercial sex workers and their clients. Citing an independent survey, it said that just half of the general population and two thirds of female sex workers were aware of how to prevent HIV infection and only a fifth of the general population knew that HIV could not be transmitted through mosquito bites and shared meals.
"Outreach has been poor. Messages aren抰 getting into people抯 minds," said Anand Grover, director of Lawyers Collective, an organisation involved in advocacy, research, and policy initiatives on HIV and AIDS. "Some messages are designed by wrong people." The audit also pointed out a study of 600 doctors in the southern state of Tamil Nadu showing that 22% of doctors were unwilling to treat people with HIV or AIDS, even though they had been trained in the management of AIDS.
Although the programme aimed at achieving condom use by at least 90% of commercial sex workers, the report points out that condom use in this group is 57%. Health ministry officials concede that aggressive promotion of condoms is needed. A high ranking official said that a directive from the previous government to ban condom promotion through television "might have sent the wrong message." But with the change in government earlier this year—and a new health minister in place—condoms will be back on television, the official said.
The audit report also said that the National AIDS Control Organisation had used only 46% of its approved allocation of 11.6 billion rupees ($250m; ?36m; �206m) in the first four years of the five year programme, which has received funding from the World Bank. A large number of clinics for sexually transmitted diseases could not function because of a lack of equipment and trained doctors, the audit showed.
The report also criticised the organisation for advocating a policy of not informing blood donors about infection if they were HIV positive unless they asked, ignoring public concerns that infected donors may unknowingly transmit the virus to sexual partners. The government made it mandatory for blood banks to inform donors only in July 2003.(New Delhi Ganapati Mudur)