Threat on the doorstep
In order to successfully contain the spread of HIV/AIDS, which has such profound socio-economic implications, it is vital that preventive interventions be more effectively targeted. This is all the more pertinent since no amount of local resources and aid money seems enough for the enormous task at hand, not just at the national level but at the regional level as well.
Until recently, government officials and public health experts in India considered HIV/AIDS to be primarily a health problem that could be addressed best through medical intervention and behaviourchange However, there is now widespread recognition that HIV/AIDS is a development problem that has profound implications not just for public health, but also for the economy and society. As a result, there is strong support at the very top of the current political leadership for greater inter-ministerial and inter-sectoral collaboration in the fight against HIV/AIDS and the mainstreaming of HIV/AIDS into development programmes. There is also agreement that more expenditure is required to strike at the root causes of the spread of HIV/AIDS pandemic. These strategic priorities are reflected in the 3rd phase of the National AIDS Control Programme (NACP-III), which will be launched in early 2006. Under NACP-III, one of the main objectives is to prevent new infections by covering all high-risk groups with targeted interventions and scaling up interventions among the general population (especially women, youth, children and migrants). Another key objective is to strengthen care, support and treatment programmes for people affected by HIV/AIDS and link them to preventions activities.
In India, HIV prevalence is low compared to sub-Saharan African countries like South Africa (0.91% and 21.5%, respectively). However, this figure masks regional epidemics taking place in 6 states where HIV prevalence has surpassed the 1% threshold, indicating that the disease has spread from high-risk groups to the general population. It also does not reflect the very high levels of vulnerability to HIV infection that exist in many of Indian states and Union Territories. India is second only to South Africa in terms of the absolute number of HIV positive cases, estimated at 5.134 million infections as per the latest NACO estimates (NACO, 2004) as compared to 5.3 million in South Africa. The number of full-blown AIDS cases detected in India by 31st July 2005 as reported by NACO stood at 1,11,608 persons, of which 30% were women. The state-wise picture showed Tamil Nadu to have the largest number of AIDS cases at 52,036, followed by Maharashtra (13,747) and Andhra Pradesh (12,349). These numbers are expected to rise steadily over the coming years as the epidemic matures.
One of the biggest challenges of controlling the spread of HIV/AIDS and mitigating its impact in India is to understand who HIV/AIDS affects and how. This process is hampered by the fact that HIV/AIDS is the most underreported disease in the sub-continent. This is largely the result of stigma, which deters people from getting tested (only about 5% know their sero-status), makes doctors disinclined to record AIDS diagnoses, and discourages HIV+ people from accessing care and support services. A weak public health system combined with the size and diversity of the country compounds this problem and results in underreporting and inadequate surveillance. Greater knowledge of who is HIV+ and who is vulnerable to HIV infection is required in order to achieve the government's objective of scaling-up of prevention programmes to cover all high-risk and vulnerable members within the general population.
ICT in HIV/AIDS prevention
The key role of ICT in the prevention and mitigation efforts for HIV/AIDS in India is generating awareness and providing practical information to people to deal with such problems through the audio-visual and electronic media and also it is helping in capacity building of health functionaries towards counseling and treatment with regard to HIV/AIDS.
UNDP has set up an e-portal and user groups to foster community connectivity and disseminate information on HIV and development issues for the Asia-Pacific region as a part of its regional HIV and Development Programme that provides online counseling and treatment guidance, databases on resources, published and other information from all concerned international organisations, agencies at various levels and NGOs, an online training programme for medical and paramedical staff. UNDP is also supporting an ICT-based project that enables a consortium of Community Based Organisations and other concerned agencies in South Asia to monitor and evaluate current HIV programmes through online information sharing, assessment of programme performance at the regional and sub-regional levels.
In India, UNDP is supporting a pilot project in Orissa and Chhattisgarh (states of origin of migrant labour) and Gujarat (one of the destination states) to reduce vulnerabilities of migrant workers and their families and communities through e-Kiosks which enable access to relevant information on livelihoods, mobility, facilitating remittances and contact with families. It also includes a training module for PRIs to be used by the southern states initially to strengthen capacities of the PRIs in programme management more effectively.
SAATHII (Solidarity and Action Against The HIV Infection in India), an NGO, received funding from UNDP to set up an Electronic Resource Centre on HIV/AIDS that will include training modules, interactive e-Forums and e-Resources tailored to the needs of organisations working in this field all over India. It will also include online databases and forums that cater to knowledge sharing and the dissemination of best practices. A needs assessment survey carried out by SAATHII pointed out that ICT has the largest potential for building the capacity of organisations that are difficult to reach through conventional means.
Electronic Helpline on HIV/AIDS in Rajasthan
The objective of the project is to disseminate technically sound information on HIV/AIDS along with details of related health services, and to as many people as possible while maintaining the anonymity of the client. In its present form the software provides a client with the following options: (i) general information on what is HIV/AIDS, causal factors and prevention possibilities, (ii) symptoms, (iii) testing and treatment facilities and (iv) support to HIV positives. An additional option is for recording the personal queries and facility for hearing answer to recorded queries. Since its inception in March 2000, more than 0.2 million callers have used the service despite various operational problems from time to time. For further information contact Contact firstname.lastname@example.org
ICT and targeting interventions
ICT can play a pivotal role in the identification of vulnerability zones for focusing HIV/AIDS intervention programmes, but this hasn't received much operational focus in the Indian context. The ICT with the help of GIS tools, can be used as an effective means of not only identifying vulnerable populations and regions, but also tracking and monitoring the vulnerability profiles of the target regions.
ADB is providing technical assistance to an ICT-based HIV/AIDS preventive education project in the cross-border areas of the Greater Mekong Sub-Region (GMSR – comprising parts of Yunan province of China and the countries of Vietnam, Laos, Cambodia and Thailand), which is being implemented jointly by UNESCO and SEAMEO (South East Asian Ministers of Education Organisation). One of the components of this project is a GIS network for monitoring the interventions for vulnerable populations and direct targeted interventions for high risk groups and interstitial populations (population falling between those who have established permanent residency in a specific location/area and those that are migrant, and move from home to work constantly).