Testing for HIV in Jaipur, India

WHO/P.Viriot

[NEW DELHI] India's Health Minister Anbumani Ramadoss has described the country's National AIDS Control Organization (NACO) as "visionless" and has announced for the second time this year that it will be reassessed.

The announcement coincides with the publication of a report criticising NACO. The report was published on the eve of World AIDS Day (30 November) by the Association Francois-Xavier Bagnoud (AFXB) and the Indian Network of Positive People (INP Plus).

India, which reported its first case in 1986, now has more than 5.13 million people infected with HIV.

Yet, according to the AFXB/INP Plus report, NACO is falling behind on targets to provide free HIV therapy (known as 'antiretroviral therapy' or ART) to 100,000 patients through the public sector by the end of 2007 (see India's AIDS drug strategy gets mixed reaction).

According to health ministry officials, India is so far providing free therapy to only 15,000 patients. The World Health Organization estimates that some 770,000 people in India need ART.

Public health experts and health activists have long pointed out that in 15 years of operation, NACO's awareness and prevention strategies have failed to either contain the HIV epidemic or reduce the intense stigma infected people struggle against.

On 30 November, Ramadoss said at a press briefing that the way NACO operates needs to be reassessed. Later, the national daily Times of India quoted him explaining that the reason for the review was that the organisation lacks visionaries, creativity and professionalism.

The review was initially announced several months ago. But Ramadoss said last week that his ministry had been unable to find any single agency sufficiently competent or qualified to review NACO.

Instead, a consortium from the Indian Institutes of Management in Ahmedabad and Bangalore, the US-based Johns Hopkins University, Tata Consultancy Services and consultancy firm McKinsey & Company is now due to undertake the task.

The AFXB/ INP Plus report identified three key problems in the free ART programme — inadequate enforcement of guidelines and critical gaps in treatment guidelines; a lack of second-line drugs; and no coordination between India's tuberculosis and HIV programmes.

The report also said that India's patent laws, amended in March 2005 to comply with the World Trade Organization, are a barrier to tackling HIV/AIDS because they make it difficult to increase the production of generic drugs.