Global Scenario: HIV, the virus that causes AIDS, has become one of the world’s most serious health and development challenges. In 2012, there were 35.3 million people living with HIV   of which, 2.1 million were adolescents, and 9.7 million people in low- and middle-income countries were receiving antiretroviral therapy (ART). So far, more than 25 million people have died of AIDS worldwide since the first cases were reported in 1981. The HIV epidemic not only affects the health of individuals, but it also impacts household and communities, as well as the development and economic growth of nations. Many of the countries hardest hit by HIV also suffer from other infectious diseases, food insecurity, and diverse serious problems.

Despite these challenges, there has been some amount of success and promising signs. Preventive measures have helped to reduce HIV prevalence rates, and new HIV infections are on the decline. In addition, the number of people with HIV receiving treatment in resource-poor countries has increased ten-fold since 2002, reaching an estimated 4 million by 2008 

Indian Scenario: As per the NACO Annual Report 2011, the total number of people living with HIV/AIDS (PLHIV) in India is estimated at around 2.09 million. While 86% are in the age-group of 15-49 years, children less than 15 years account for 7% (0.15 million), and 39% (0.8 million) are women.  India is estimated to have around 0.12 million new HIV infections annually. Andhra Pradesh, Karnataka, Maharashtra, Tamil Nadu, Manipur and Nagaland account for 31% of new infections, whereas, some low-prevalence States (Odisha, Jharkhand, Bihar, Uttar Pradesh, West Bengal, Gujarat, Chhattisgarh, Rajasthan, Punjab & Uttarakhand) together account for around 57% of new infections. While there is reduction in new infection in the high prevalence states, rising trends of new infections are noted in some low-prevalence States. 

The National AIDS Control Programme (NACP) of India has been recognized globally as a success. The NACP has reduced annual new HIV infections by 57% in the last decade. Adult HIV prevalence has decreased from 0.40% in 2000 to 0.27% in 2011. However, the percentage of HIV infections for the age group 0-15 years has increased from 4.20% in 2008 to 4.36% in 2009, indicating increased number of HIV- infected children in 2009. As per projections, in India there will be an increase of orphans and reversal of child survival gains due to mother-to-child transmission.  Nearly five per cent of infections occurring in India are attributable to parent-to-child-transmission. It is estimated that out of 27 million pregnancies every year, nearly 49,000 occur in HIV-positive mothers. In 2009, only 11489 of an estimated 49,000 pregnant women living with HIV received anti-retroviral treatment to prevent parent-to-child transmission. 

In this context, the words of Shri Oscar Fernandes, Hon’ble Cabinet Minister for Road Transport and Highways, and President of the Parliamentarians Forum for HIV/AIDS, are significant. According to him, "We at the Forum are committed to taking the issue of HIV/AIDS to the masses by engaging with elected representatives up to the village level and creating a space for informed deliberations on the issue which enables us to contribute more effectively to the national HIV/AIDS response."

Response of the Catholic Church to HIV/AIDS, in India: The Catholic healthcare network still continues to play a major role in the field of health care in India, especially to the economically poor and vulnerable.  This network includes the Catholic Health Association of India (CHAI), with over 3,410 Member Institutions all over the country; Sister Doctors Forum of India (SDFI) with more than 1000 sister doctors; the Catholic Nurses Guild of India (CNGI) with about 50,000 nurses; St Johns National Academy of Health Sciences (SJNAHS); 166 dioceses with all its resources; the various religious congregations (CRI) with all their resources; and the countless Catholic lay professionals. The Church has responded decisively and positively to the HIV/AIDS epidemic through the involvement of the above- mentioned  networks and institutions in prevention, treatment, care and support activities since the very beginning.  

The Catholic Health Association of India (CHAI), one of the world's largest non-governmental organizations (NGOs) in the health sector has been working since 1943, with an expansive base of over 3,410 Member Institutions (MIs) across the country. It includes big, medium and small hospitals, health centres and diocesan social service societies, of which 84% serve in the underserved rural and remote areas of the country. CHAI is involved in the field of HIV/AIDS since 1992, through its Member Institutions (MIs). CHAI was one of the first in the country to provide trainings to its medical professionals in the treatment and care of PLHIV. In 1994, taking into consideration the alarming increase in the incidence of HIV infection in India, CHAI had several consultations in order to formulae the CHAI Policy on AIDS. Later on, in collaboration with the Catholic Bishops’ Conference of India (CBCI), through further consultations, this policy was revised and published in 2005 by the CBCI as the HIV/AIDS policy of the Catholic Church in India with the title, “Commitment to Compassion and Care”.   

Care and support to People living with HIV/AIDS (PLHIV): The Catholic Church pioneered in providing care to PLHIV in India in the early nineties, at a crucial time when most of the doors to medical care were being closed for PLHIV due to stigma and discrimination. Later on, the government of India introduced the Community Care Centres (CCCs) by adopting from African countries in 1993. While rolling out the CCCs, recognizing the service of church to the PLHIV, the government of India, through National AIDS Control Organization (NACO) allotted almost 50% of CCCs (123 centers out of 253 CCCs) to the Member Institutions of CHAI. More than 15,00,000 PLHIV received outpatient services and approximately 500,000 PLHIV received in-patient services from these CCCs.  During the last evaluation done by NACO, in early 2013, most of these centres received A or B grade and were recognized for their excellence. 

Current Challenges: Due to various reasons, NACO decided to withdraw support to CCCs from March 31, 2013. This change in policy expects that the care of the PLHIV, including the treatment of Opportunistic Infections, will be done by the ART Centers and government district hospitals. However, in reality majority of these centers that belong to the general health care system are overloaded and underprepared to take care of this new scenario. Moreover, the general healthcare system is not yet ready to provide care to many of the terminally ill PLHIV who have been abandoned by their families, thrown out of their jobs and have nowhere else to go. Most of the Care Centers run by the Catholic Church were a ray of hope for many of such PLHIV, especially those who needed ‘palliative care’ as well as ‘end of life care’. After the closure of the CCCs, many of the PLHIV have expressed that they do not want to approach General Hospitals for treatment due to fear of stigma and discrimination. Instead, they prefer to die at home. Therefore, some of these Catholic Care Centers, even in the midst of great financial constraints still continue to provide services for the holistic well-being of PLHIV, beyond March 2013. A study done by CHAI on 8 of such centers, from June 2013 to Oct 2013, shows that these institutions have served 3396 PLHIV as out-patients and 1587 as in-patients. CHAI and CBCI Office for Health care, along with other like minded groups, have been jointly doing advocacy with government and various funding agencies, for the continuation of some quality Care Centers for PLHIV, at least in some regions of the country. There is an urgent need to work on strategies for provision of ‘palliative care’ and ‘end of life care’ for the terminally ill PLHIV.

Conclusion: By working with various public health institutions, government, NGOs and faith-based organizations(FBOs) in providing prevention, care, support and treatment services in HIV/AIDS sector, the Catholic healthcare network is striving to achieve ‘Zero new infections, Zero deaths and Zero discrimination’ in the society. The HIV/AIDS crisis is of such great magnitude that its impact on humanity cannot be tackled by any one single agency or by any single intervention. Hence co-operation, collaboration and networking among all stakeholders- government, NGOs, FBOs, CBOs and civil society – are important.  On this World AIDS Day, the Catholic Church rededicates itself  be part of the nationwide response to HIV/AIDS and continue to cooperate and collaborate with the National AIDS Control Organisation, the State AIDS Control Societies, and other international and national agencies in line with the ethical principles and values of the Church. 

May the compassionate God, protect and guide all those who strive to make “Getting to Zero” a reality! 

+ Archbishop Vincent M Concessao,

Chairman, CBCI Office for Healthcare 

President, CBCI Coalition for AIDS and Related Diseases

Ecclesiastical Advisor for CHAI and SDFI 

References:

http://www.unaids.org/en/resources/events/eventsin2013/

http://www.unaids.org/en/resources/campaigns/globalreport2013/factsheet/

http://aids.gov/federal-resources/around-the-world/global-aids-overview/

http://www.unicef.org/india/hiv_aids.html