National Youth

Shadow Report
Progress Made on the UNGASS Declaration
of Commitment on HIV/AIDS

INDIA
Global Youth Coalition on HIV/AIDS
c/o Global Youth Action Network
211 E. 43rd St. Suite #905
New York, NY 10017, USA
Phone: +1 212 661 6111
Fax: +1 212 661 1933

[email protected]

4 Eleme Rd, Off Eleme Junction

Port Harcourt, Nigeria
+2348055340179

www.youthaidscoalition.org
 1

The Global Youth Coalition on HIV/AIDS (GYCA) is a youth-led, UNAIDS and UNFPA-
supported alliance of 1,600 youth leaders and adult allies working on HIV/AIDS worldwide. The
Coalition, based at a North Secretariat in New York City and a South Secretariat in Port
Harcourt, Nigeria, prioritizes capacity building and technical assistance, networking and sharing
of best practices, advocacy training, and preparation for international conferences.

GYCA aims to empower youth with the skills, knowledge, resources, opportunities, and
credibility they need to scale up HIV/AIDS interventions for young people, who make up over
50% of the 5 million people infected with HIV each year. Our members are working at the local,
national, regional, and international levels to ensure that young people are actively involved in
policies and programmes to halt the spread of the deadly pandemic.

For more information about GYCA or to join, please visit www.youthaidscoalition.org or write
to [email protected].

The views and findings in this report are those of the author alone.
 2

About the Author

Himakshi Piplani, 18, is a youth activist from India. Himakshi’s interest in HIV/AIDS and
Health related Human Rights of young people and children developed early last year while she
was researching for an article on Sexual Abuse and Violence against children and young people
in the war-torn Darfur region. A couple of months later she also attended the first day of the
three day long International Inter-Faith Conference on HIV/AIDS organized by National Aids
Control Organization (NACO) of India which prompted her to do further research on the
HIV/AIDS scenario in India and abroad. Through UNICEF’s Voices of Youth forum, Himakshi
got the opportunity to do an e-course with Global Youth Coalition on HIV/AIDS (GYCA) on
Political Advocacy (with a focus on UNGASS and Millennium Development Goals). It led her to
develop an advocacy campaign plan based on increasing young people’s access to HIV/AIDS
related Information, Education and Communication services in India. Himakshi hopes to further
work towards ensuring greater access of young people to HIV/AIDS relates services and towards
protecting health related human rights of children and young people in general. She will be
attending the UNGASS AIDS 2006 Review in New York, May/June 2006, at the United Nations
Secretariat.

Acknowledgements

I would like to thank the following people for their invaluable contribution to this report:
Mr. Arun Joshi for helping me out with the research on financial commitment;
Mr. Kenneth Mohanty and his team in Kolkata for their input on the ground level situation at
VCTC, schools and colleges in Kolkata;
Mrs. Usha Rajput for an insight on Adolescent Education Program in govt. schools (Delhi.);
Ms. P. Anjali Mehta for her inputs on LSBE at Amity International School, a leading public
school in Noida (U.P);
Ms. Revathi Rajaramn of ThoughtShop Foundation;
Ms. Shakuntala Biswas of NRS Medical College Sealdah, Kolkata (VCTC);
and lastly,
Mila Gorokhovich and Joya Banerjee of GYCA for their constant support and invaluable
guidance!
 3

Table of Contents

List of Abbreviations used: .......................................................................................................... 4

Preface............................................................................................................................................ 5
Methodology .............................................................................................................................. 6
Why focus on young people?.................................................................................................... 6
I. Introduction ............................................................................................................................... 8
II. Methodology for Gathering Information .......................................................................... 9
III. Key Findings and Recommendations ............................................................................... 9
IV. Results.................................................................................................................................... 10
POLITICAL COMMITMENT ............................................................................................. 10
FINANCIAL COMMITMENT ............................................................................................. 12
ACCESS TO INFORMATION AND SERVICES .............................................................. 15
YOUTH PARTICIPATION .................................................................................................. 18
VI. Major Recommendations for Action .................................................................................. 20
VII. References............................................................................................................................ 23
 4

List of Abbreviations used:

1. HIV/AIDS - Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome.
2. NACO – National AIDS Control Organization
3. STD/STI – Sexually Transmitted Disease/Infection
4. IDU – Injecting Drug User
5. MSM – Men who have Sex with Men
6. IEC – Information, Education and Communication
7. VCTC – Voluntary Counseling and Testing Centre
8. UNGASS – United Nations General Assembly Special Session on HIV/AIDS
9. SRH – Sexual and Reproductive Health
10. LSBE – Life Skills Based Education
11. MOHFW – Ministry of Health and Family Welfare
12. YPTA – Young People Talk Aids
13. UTA – Universities Talk Aids.
14. BCC – Behavior Change Communication
15. NACP – National AIDS Control Programme.
16. USD – US Dollars.
17. USAID – United States Agency for International Development.
18. UNAIDS – The Joint United Nations Program on HIV/AIDS
19. DFID – Department For International Development, UK.
20. CIDA – Canadian International Development Agency
21. AUSAID – Australian Agency for International Development
22. UNDP – United Nations Development Programme.
23. PLWHA – People Living With HIV and AIDS
24. WHO – World Health Organization
 5

Preface1

On 25–27 June 2001, heads of State and government representatives met for the United Nations
General Assembly Special Session on HIV/AIDS (UNGASS), which resulted in the issuance of
the Declaration of Commitment on HIV/AIDS (DoC). The DoC outlines what governments have
pledged to achieve– through international, regional and country-level partnerships and with the
support of civil society– to halt and begin to reverse the spread of the HIV/AIDS pandemic. The
DoC is not a legally binding document; however, it is a clear statement by governments
concerning what should be done to fight the spread of HIV/AIDS and what countries have
committed to doing, with specific time-bound targets2.

The DoC is unique because it recognized the specific vulnerability of young people to HIV and
AIDS and established time-bound targets for action:

• (Paragraph 37) By 2003, ensure the development and implementation of multi-sectoral national
strategies and financing plans for combating HIV/AIDS that (…) involve partnerships with civil society
and the business sector and the full participation of people living with HIV/AIDS, those in vulnerable
groups and people mostly at risk, particularly women and young people (…)

ƒ (Paragraph 47) By 2003, establish time-bound national targets to achieve the internationally agreed global prevention goal:
to reduce, by, 2005 HIV prevalence among young men and women aged 15 to 24 in the most affected countries by 25 per
cent.
o To reduce, by 2010, HIV prevalence among young men and women aged 15-24 globally.
o To intensify efforts to achieve these targets as well as to challenge gender stereotypes, attitudes, and inequalities in
relation to HIV/AIDS, encouraging the active involvement of men and boys.

ƒ (Paragraph 53) By 2005, ensure that at least 90 per cent, and by 2010 at least 95 per cent of young men and women aged 15
to 24 have access to the information, education, including peer education and youth-specific HIV/AIDS education, and
services necessary to develop the life skills required to reduce their vulnerability to HIV infection, in full partnership with
young persons, parents, families, educators and health-care providers.

ƒ (Paragraph 63) By 2003, develop and/or strengthen strategies, policies and programmes:
o Which recognize the importance of the family in reducing vulnerability, in educating and guiding children and take
account of cultural, religious and ethical factors,
o To reduce the vulnerability of children and young people by ensuring access of both girls and boys to primary and
secondary education, including HIV/AIDS in curricula for adolescents;
o Ensuring safe and secure environments, especially for young girls;
o Expanding good-quality, youth-friendly information and sexual health education and counseling services;
o Strengthening reproductive and sexual health programmes; and
o Involving families and young people in planning, implementing and evaluating HIV/AIDS prevention and care
programmes, to the extent possible.

As part of the monitoring process of the DoC, progress made towards attaining the targets will be
reviewed at the UN General Assembly in New York on May 31- June 2, 2006. The participation
of young people in this review process is critical and this report strives to ensure their voices are
heard.
1
Global Youth Coalition on HIV/AIDS and Global Youth Partners, “Our Voice, Our Future: Young People Report
on Progress Made on the UNGASS Declaration of Commitment on HIV/AIDS.”UNFPA, 2004.
2
DoC on HIV/AIDS. Resolution adopted by the UN General Assembly, A/RES/S-26/2. August 2001
 6

Methodology

To ensure that the voices and concerns of young people are included in the monitoring process of
the UNGASS DoC in its five year review, young people from around the world reported on the
progress made towards achieving the UNGASS targets related to young people in their countries.

To ensure that all of the country reports addressed the same issues, a guide was developed by
young people with the technical assistance of adult allies to assist youth researchers in gathering
information and reporting on their country’s progress.3 A number of questions, based on the
indicators suggested by the UNAIDS National AIDS Programmes - A guide to indicators for
monitoring and evaluating national HIV/AIDS prevention programmes for young people”,4 were
suggested to guide their research. Members of the Global Youth Partners Initiative5 actively
contributed to the development of the research tool in 2004 through an interactive e-discussion.
Data collection and analysis focused on four main indicators:
1) Political Commitment
2) Financial Commitment
3) Access to Information Services
4) Youth Participation

Young people used a range of methods to conduct their research and collect relevant
information. They gathered inputs from young people, including young people living with HIV
and AIDS (YLWHA) in their countries through focus group discussions, in-depth interviews and
workshops. Young people were asked to make recommendations for strategies to ensure that
their country would achieve the UNGASS targets for young people. This qualitative information
was supplemented by reviews of national policies, laws and documents, as well as academic
literature. Young people also consulted representatives from national and local governments and
national AIDS programmes, as well as various stakeholders such as service providers,
representatives from NGOs, international and bilateral organisations. The final reports were
reviewed and edited by GYCA staff, preserving original content.

Why focus on young people?

Over half of all new infections worldwide each year are among young people between the ages
of 15 and 24. Every day, more than 6,000 young people become infected with HIV – almost five
every minute. Yet the needs of the world’s over one billion young people are often ignored
when strategies on HIV/AIDS are drafted, policies developed, and budgets allocated. This is
especially tragic as young people are more likely than adults to adopt and maintain safe

3
The research guide is available upon request.
4
National AIDS Programmes - A guide to indicators for monitoring and evaluating national HIV/AIDS prevention
programmes for young people. UNAIDS, 2004.
5
Global Youth Partners (GYP) is a UNFPA youth-adult partnership initiative, and aims to rally partners and
stakeholders to increase investment and strengthen commitments for preventing HIV infections among young
people, especially among under-served youth. GYP is building capacity of GYP team members, learning lessons
from successful advocacy campaigns and building partnerships and collaborative networks with other youth
initiatives, including youth-adult partnerships. In the foreground of the initiative stands the development,
implementation and monitoring of national strategic advocacy action plans in seven countries.
 7

behaviours.6 Young people are vulnerable to HIV infection because they lack the crucial
information, education, and services to protect themselves.

The 2001 United Nations General Assembly Special Session on HIV/AIDS noted, “poverty,
under-development and illiteracy are among the principal contributing factors to the spread of
HIV/AIDS”. These factors are particularly poignant for young people who are so often voiceless
and powerless in society. Young people are in a transitional phase between childhood and
adulthood, and are rarely taken into account in official statistics, policies, and programmes.

This year, 2006, marks five years since the DoC was put into effect. The author and 60 young
leaders in HIV/AIDS will participate in the Five Year AIDS 2006 Review at the United Nations
Secretariat to advocate to decision-makers to scale-up comprehensive, evidence-based
interventions on HIV/AIDS for and with young people.

6
Young People and HIV/AIDS, Opportunity in Crisis. UNICEF, UNAIDS & WHO, 2004.
 8

I. Introduction

The face of HIV/AIDS in India today is sadly that of a young person. Poverty, low literacy
levels, inadequacy of youth-oriented information and services along with gender inequality are
making young people increasingly vulnerable to this disease. Over 35 % of new infections every
year occur in the age group of 15-24 in India.7 In 2003 alone, 184,100 young Indians in this age
group were infected with HIV.8 Moreover, the disease is now moving from high-risk populations
to general population underscoring the urgent need for scaling up of preventive measures.
India’s history with HIV is two decades old with first case having been reported in 1986 in
Chennai. Although the overall HIV prevalence in the country remains less than 1 % as opposed
to the double digit figures in parts of Africa, India now accounts for up to 10 % of the 40 million
people living with HIV/AIDS globally, with the second highest prevalence rate in the world.9

Heterosexual Transmission accounts for up to 85% of the HIV infections. Spread of HIV in
intravenous drug use settings is localized mostly to the north-eastern region of the country and
some metropolitan cities. Parent to Child Transmission of HIV is also on the rise.
The National AIDS Control Organization, Ministry of Health & Family Welfare updates the HIV
estimates for the country every year since 1998 for monitoring the trends and pattern of
HIV/AIDS epidemic in the country. The HIV burden is estimated on the basis of the HIV
prevalence observed at designated sentinel surveillance sites for different risk groups. The Data
thus compiled is used for epidemiological analysis and estimation purpose. The sentinel sites,
which have gone up from 184 in 1998 to 659 in 200410, cover both high-risk populations such as
attendees of Sexually Transmitted Diseases (STD) clinics, injecting drug users (IDUs), sex
workers and men who have sex with men (MSM) as well as highly vulnerable populations such
as women attending antenatal clinics.

The annual sentinel surveillance surveys from 1998 to 2002 have divided States and Union
territories in India into three broad categories:
- High prevalence: Maharashtra, Tamil Nadu, Manipur, Andhra Pradesh, Karnataka and
Nagaland are states which have HIV prevalence rates exceeding 5% among groups with high-
risk behavior and 1% among women attending antenatal clinics in public hospitals.
- Concentrated epidemics: Gujarat, Pondicherry and Goa where the HIV prevalence rate among
populations with high-risk behavior has been found to be 5% or more, but HIV prevalence rates
remains below 1% among women attending ante-natal clinics.
- Low prevalence: All other States and Union Territories fall into the low prevalence category
because HIV prevalence rates among high risk population is below 5 per cent and less than 1%
among women attending ante-natal clinics.

7
‘Trends and Estimates of HIV Infections’, UNAIDS,
http://www.unaids.org.in/displaymore.asp?itemid=56&chkey=76&subchkey=0&chname=HIV%20Epidemic%20i
8
‘HIV Estimates 2004’, NACO, http://www.nacoonline.org/facts_hivestimates04.htm (The figure has been arrived
at through deductive analysis of the data.)
9
‘AIDS Epidemic Update’, December 2004, UNAIDS
10
‘HIV Estimates 2004’, NACO, http://www.nacoonline.org/facts_hivestimates04.htm
 9

Of late NACO has reclassified Low Prevalence States as High Vulnerable States – an
acknowledgement of the need to address vulnerabilities in these States with as much priority as
in other more affected states.
Tracking the epidemic and implementing effective programs is compounded by the fact that
there is no one epidemic in India. Rather, there are several localized sub-epidemics reflecting the
diversity in socio-cultural patterns and multiple vulnerabilities present in the country.

II. Methodology for Gathering Information

¾ LITERATURE REVIEW: A comprehensive and thorough review, of the existing

documentation and literature on political commitment, financial commitment,
participation of youth and access to information, education and communication (IEC) and
other relevant services as well as on evaluation of programs and policies was undertaken.
The information obtained was analyzed to identify relevant achievements and gaps.
¾ INTERCATIVE RESEARCH: As a part of the interactive research, several young
volunteers evaluated the ground-level situation in their respective cities through
interviews with Youth Counselors at schools and VCTCs, chemists, consultations with
local NGOs, surveys etc.

III. Key Findings and Recommendations

FINDINGS: Over the last few years the HIV/AIDS scenario pertaining to young people has
undergone a paradigm shift.

Below is a summary of key findings.

a.) The Govt. is now recognizing the place of adolescents in India’s response to the
HIV/AIDS epidemic and has shown commitment towards greater youth
participation.11
b.) India has achieved success in reducing the rate of new HIV infections in the
South India especially among young people since 2000 due to intensive IEC
initiatives. HIV prevalence among women aged 15 to 24 years in the states of Tamil
Nadu, Maharashtra, Karnataka and Andhra Pradesh (High Prevalence states) has
fallen from 1.7 percent to 1.1 percent in a four-year period (2000-2004).12
c.) A large percentage of young people have heard about HIV/AIDS but do not have
comprehensive knowledge on it especially regarding prevention methods.
According to UNAIDS, only 17% of male and 21% of female respondents were able
to identify two prevention methods and reject three misconceptions.13 Hence
comprehensive IEC initiatives with nation-wide coverage are lacking.

11
Refer to section on political commitment and youth participation for more information.
12
‘HIV infection rate down in South India’, Nirmala George (AP), http://www.washingtonpost.com/wp-
dyn/content/article/2006/03/30/AR2006033001817.html
13
‘ India – Comprehensive Indicator Report’ , HIV Insite (UCSF Centre for HIV Information) University of
California
 10

d.) Political and Financial Commitment to fight HIV/AIDS has been strengthened
over the last five years. However, young people’s vulnerability to the epidemic
persists since there is no separate budgetary allocation to address young people as a
comprehensive group.

RECOMMENDATIONS: The efforts of the Government of India to meet UNGASS targets

so far have been commendable. Based on our research we would like to suggest the following:
a.) Extend existing youth based services such as 1097 Helpline and Young People Talk
AIDS program to all cities.
b.) Scale up IEC initiatives further throughout the country including low prevalence
states and rural areas as well through comprehensive media campaigns.
c.) Introduce Adolescent Education/ Life Skills Based Education as a mandatory part of
the curriculum in all government and public schools with immediate effect.
d.) Introduce family based orientation initiatives/programs to combat stigma and
discrimination and encourage open discussions on Sexual and Reproductive Health.
e.) Greater involvement of young people for policies and programs related to young
people, at the policy-making levels through regular interaction and adequate
representation in international, national and state level bodies.

IV. Results

POLITICAL COMMITMENT

Recent years have seen a steadily rising level of awareness and action among elected
representatives on the issue of HIV/AIDS. The formation of the Parliamentary Forum is a
proof of this.
- Shri Atal Behari Vajpayee, ex-Prime Minister of India, National Convention for Elected
Representatives on HIV/AIDS, July 26, 2003

Political Commitment towards TENTH FIVE-YEAR PLAN (2002 2007) TARGETS

HIV/AIDS has increased in recent TO STOP THE SPREAD OF HIV/AIDS IN THE
years. Formation of the Inter COUNTRY
Parliamentary Forum on HIV/AIDS • 80% coverage of high risk groups through targeted
that further organized the first ever interventions
National Convention of Elected • 90% coverage of schools and colleges through
Representatives on HIV/AIDS (July education programs,
2003) and National Student and Youth • 80% awareness among the general population in
Parliament Special Session on rural areas
HIV/AIDS (November 2003; attended • Reducing transmission through blood to less than
1%;
• Establishing of at least one voluntary testing and
counseling centre in every district
• Scaling up of prevention of mother-to child
transmission activities up to the district level
 11

by over 3000 youth representatives) made this growing commitment abundantly visible. The
govt. has undertaken a multi-sectoral approach where by the Ministry of Health and Family
Welfare, Ministry of Youth Affairs and Sports, Ministry of Railways and Ministry of Education
along with other international and bilateral agencies are working together towards achieving the
UNGASS targets. The National AIDS Control Organization (NACO), a semi-autonomous
organization under the Ministry Of Health and Family Welfare, leads the national response to the
HIV/AIDS epidemic in India.

In its second phase, the National AIDS Control Program (NACP-II, 1999-2004, extended till
2006) has taken several steps to strengthen its focus on vulnerable people. Policy initiatives have
also begun to focus on care, support and treatment issues alongside prevention, in response to the
growing number of HIV infections in the country. Given below is a critical analysis of key
national policies addressing Youth and HIV/AIDS:14
National AIDS Control Policy (2000) is a crucial component of the national health strategy. While
the policy talks about programmes for adolescents like Universities Talk AIDS and Villagers
Talk AIDS implemented by Nehru Yuva Kendra Sangathan (NYKS), it does not specifically
mention adolescents. The policy does not identify adolescents as vulnerable group, particularly
15-24 years age group that accounts for 35% percent of HIV cases15. Also missing is the fact that
screening/testing before marriage needs to be promoted as a preventive measure as it has crucial
implications for the adolescent group.
The National Health Policy expresses concern for the health of special groups such as
adolescent girls, albeit only with regard to their nutritional needs. Elsewhere, adolescent girls
are grouped with pregnant women and children within maternal and child health services instead
of being treated as a distinct group with specific needs and problems.

A life cycle approach to the health needs of women is needed .Moreover a comprehensive
approach for reproductive health of adolescent and young people and while working towards
including out of school youth in larger numbers.
National Population Policy (2000) has recognized the earlier invisibility of adolescents and
views them as a section of population identifying them as ‘under-served’ population groups. The
policy calls for interventions in specific areas such as protection from unwanted pregnancies and
STDs and encouragement of delayed marriages and child bearing. The policy also targets the
education of adolescent girls and boys on reproductive health services especially in rural India.
This issue is important because adolescents and youth are becoming sexually active at an early
age resulting in higher risk of HIV infection.
The National Youth Policy 2003 provides a comprehensive overview of youth issues and
concerns. For the first time in India, this policy recognizes adolescents by dividing them into
target groups, (i) rural and tribal youth (ii) Out of school youth and (iii) adolescent, particularly
female adolescents. By distinguishing the age of adolescence, the policy facilitates advocacy
efforts for focus on adolescents in government programmes. It gives a special focus to
adolescent health, as “they are the most important segment of the population”. HIV/AIDS, STIs,

14
Based upon similar analysis by Arindam Roy in ‘UNGASS Youth Report – The Indian Perspective (2005)’ with
added inputs.
15
‘Trends and Estimates of HIV Infections’, UNAIDS,
http://www.unaids.org.in/displaymore.asp?itemid=56&chkey=76&subchkey=0&chname=HIV%20Epidemic%20i
 12

substance abuse and population education finds place in the health component with emphasis on
Youth Participation for implementation. A note worthy feature has been the distinction between
target-groups of 13-35 years which has been sub classified into (13-19 years, 20-35 years). The
elements of participation, access and leadership building have been clearly delineated as
objectives of the policy.
In addition to these, The Declaration on Political Leadership in Combating HIV/AIDS clearly
states that the activists of political parties shall take steps to ensure that the response (to
HIV/AIDS) includes a focus on youth.16

KEY RECOMMENDATIONS:

a.) Formation of special focus group ‘GIYP – Greater Involvement of Young People’
for continued participation of young people in policy-making.
b.) Policy is needed to ensure that comprehensive Life Skills Based Education is made
part of the curriculum in all govt. and public schools.
c.) Policy is needed to protect reproductive and sexual rights of young women
especially those infected with HIV.
d.) Policy needed to combat stigma and discrimination attached with the disease
especially at the workplace.

FINANCIAL COMMITMENT
The Government of India is working jointly, with NGOs, international organizations and other
bilateral agencies to fight the scourge of HIV/AIDS in the country. The financial commitment
towards fighting HIV/AIDS has been strengthened considerably over the last five years. The
table given below highlights the annual budgetary allocation by the Union Govt. to National
AIDS Control Program over the last few years17.
\

Year Amount allocated to National AIDS Percentage of Ministry of

Control Program (in Crores of Health Budget it covers
Rupees)
2003 - 2004 205 + 20.00 9.11%
2004 - 2005 232 + 27.00 9.63%
2005 – 2006 476.50 + 57.00 13.93%

In addition to the above allocations, India has taken a loan of USD 191 million from World
Bank.18

16
‘Annex 3: Declaration on Political Leadership in Combating HIV/AIDS, Role of Political Leaders in Combating
HIV- AIDS’, UNAIDS, http://www.unaids.org.in
17
Union Budget, Ministry of Finance, http://indiabudget.nic.in
18
‘Portfolio of Grants in India’, The Global Fund to fight AIDS, Tuberculosis and Malaria,
http://www.theglobalfund.org/search/portfolio.aspx?countryID=IDA&lang=en
 13

No allocation could be found in the budget for any youth specific HIV prevention efforts. India
follows a multi-sectoral approach to respond to the challenges of the HIV/AIDS epidemic.
Funds to various NGOs and youth specific HIV prevention programs initiated by internal
ministries are routed through the govt. Hence it is difficult to obtain figures of expenditure on
youth specific programs for HIV/AIDS prevention and care.
External support totaling US$140 million was made available by the UK’s DFID (for prevention
interventions in West Bengal, Andhra Pradesh, Orissa, Kerala and Gujarat); USAID (prevention
in Tamil Nadu and Maharashtra); CIDA (capacity building for targeted interventions in
Rajasthan and Karnataka); UNICEF (for prevention of mother to child transmission); UNDP and
UNAIDS (for research, policy development and institutional strengthening). AUSAID has
provided assistance for prevention, care and support programs in the northeastern States
(Manipur, Mizoram, and Meghalaya) and Delhi. The Bill and Melinda Gates Foundation had
pledged US$ 200 million for a five-year period for the 6 high prevalence states for prevention
interventions, and a national prevention program for truck drivers. States contribute to this effort
both with their infrastructure and human resources.
ACHIEVEMENTS AND GAPS

With the second phase of the National AIDS Control Program (1999- 2004), NACO has
expanded its program. NACO provides funds to state AIDS control societies for targeted
interventions, blood safety, youth campaigns, VCT, care and support and social mobilization.19
The increase in several IEC initiatives targeted at young people such as toll free helpline, media
campaigns etc. indicate an increase in allocation to efforts for prevention of HIV in youth. The
govt. has promised to increase its budgetary allocation for NACP from $ 50 million to $ 100
million by 2006.

Below is the resource outlay plan of the govt. to fight HIV/AIDS:

RESOURCE OUTLAY PLAN BY GOVERNMENT OF INDIA TO FIGHT HIV/AIDS

In USD (Millions) 2004 2005 2006 2007 2008

Total resources available $74 $ 87 $100 $107 $111
Total need $805 $805 $805 $805 $805
Unmet need $731 $718 $705 $698 $694
The figures for “total need” were estimated by combining the costs of expanding prevention interventions,
VCTCs and introducing ART services at a realistic pace over the next five years. For costing the expansion
of VCTCs, a median annual cost of operating the current centers of US$ 500 was used and 100 newly-
established VCTCs per year. For costing of a new ART service, the University of Cape Town ART Costing
Model (February 2004) was used, with modifications for the Indian situation and a target of 15,000 people
on ART by the end of 2005 and 137,000 by the end of 2009. Source: National AIDS Control Organization,
2004

The shortage of resources to fight HIV/AIDS in India is clearly visible from the figures above.

19
‘HIV and AIDS in India’, AVERT. ORG, http://www.avert.org/aidsindia.htm
 14

KEY RECOMMENDATION:

Greater Involvement of Business entities as stakeholders in the response to HIV/AIDS to further

augment resources.
 15

ACCESS TO INFORMATION AND SERVICES

Experience of AIDS control in other countries has shown that education is crucial to
the success of the struggle against this epidemic. Only education can empower young
people with the knowledge they need to protect themselves and their communities.
Only education can combat the problem of stigma and discrimination..

- Shri Atal Behari Vajpayee, ex-Prime Minister of India, National Convention for
Elected Representatives on HIV/AIDS, July 26, 2003.

¾ Avenues of Information: The avenues of

information for young people have increased
tremendously over the past few years and so has
youth access to these avenues. Electronic media is
being aggressively used to bring home the
message on HIV prevention.
Radio slots, television programs such as ‘Jasoos
Vijay’ and ‘Hath se Hath Mila’ (targeted at 200
million potential young viewers)20 along with
concerts and press activities are a part of NACO’s IEC strategy.21 NACO has also started
a toll free National AIDS Tele-counseling Helpline in with the support of NGOs at state
level to disseminate basic information on HIV/AIDS, the diverse and most common
routes of transmission, to areas of services available for any personal anxieties.22 Yet,
only 17 % males in the age group of 15 to 24 had comprehensive knowledge about
HIV/AIDS.23
¾ Health Services: India has a total of 631 VCTCs spread over 28 states and 7 Union
Territories offering integrated health services but most young people have never heard
about VCTC.24 Another trend that was observed by counselors at VCTC was that
although young people come more readily to VCTC nowadays while women are still
hesitant in visiting VCTC alone.
¾ Condom Use: Condom Use among young people is reportedly rising especially in
South India leading to lower rate of new infections. Yet, only 59 % of males in India
reported condom use at last high-risk sex.25 Moreover, use of contraception among young
married women is reported to be as low as 5% among 15-19 yrs. old and 21% among 20-

20
‘India : Hath Se Hath Mila’, BBC World Service Trust,
http://www.bbc.co.uk/worldservice/trust/developmentcommunications/story/2005/11/051125_india-haath.shtml
21
‘Information, Education, Communication and Social Mobilization’, NACO,
http://www.nacoonline.org/prog_iec.htm
22
‘Partnerships with NGOs : An Overview’, NACO, http://www.nacoonline.org/partnership_ngolist.htm
23
‘India : Statistics’, UNICEF, http://www.unicef.org/infobycountry/india_india_statistics.html
24
Our team in Kolkata carried out a short survey (due to time constraints) among students in various colleges.
25
‘India : Statistics’, UNICEF, http://www.unicef.org/infobycountry/india_india_statistics.html
 16

24 yrs old.26 This can be attributed to difficulty in negotiating condom use with partner,
low awareness about contraceptive methods etc. Very few condom vending machines
exist in the country mostly in red-light areas only. VCTC provide free condoms but
people are not aware of the services provided by VCTC. Local chemists and drugstores
provide condoms at competitive prices but most young people are hesitant in asking for
condoms over the counter. Hence condom use remains low and inconsistent especially
among young people.
¾ SRH Education: Reproductive and Sexual Health Education varies from state to state
in India. While New Delhi has over 450 govt. schools implementing Adolescent
education while the State Minister of education for Uttar Pradesh termed Sex Education
in schools as useless and against Indian culture.27 We as a part of interactive research
interviewed youth counselors from a govt. school in Delhi and a posh public school in
Noida (township on the border of Delhi and U.P) about the SRH Education in their
respective schools28. Upon comparative analysis, it was observed that although a
comprehensive LSBE program empowers students better to make healthy choices, for
students of lower economic strata attending govt. schools, adolescent education program
is more apt.

COMPARISON CHART OF SRH EDUCATION29

Institution – Name and Govt. Co-Education Senior Amity International School,

Postal Address. Secondary School, Chilla Sector 44, Noida, U.P -
Village, New Delhi.- 110091 201301
Format Adolescent Education LSBE
Description of training Attended 6 day Seminar by Attended Workshop by Dr.
undertaken by the Population Education Cell Patanjali Nayyar and team
counselor. (Delhi govt.) from WHO.
Level being taught at: From 6th std. till 12th std.30 From std. 4th onwards till std.
11th 31
Teaching Methodology - Classroom lectures - Class Discussion
- Poster making - Role Plays
- Question Box Activity etc. - Quiz and Questionnaires etc.
Grade based class. No. Yes.
Gender specific class. Yes – boys and girls are taught No – Mixed group.
separately
HIV/AIDS Discussed Yes Yes
Sexual mode of No. Yes.
transmission discussed
Abstinence discussed. Yes. No.

26
‘World Youth Datasheet 2006’, Population Reference Bureau
27
‘No Sex Education please, we are Indians – Minister’ , ExpressIndia,
http://cities.expressindia.com/fullstory.php?newsid=135011
28
See table on page 10; annex.
29
Based on interviews with youth counselors of the concerned institutions
30
12 - 18 yrs. old.
31
10 – 17 yrs old. Std. 10th is excluded from this since they have higher secondary qualifying examinations.
 17

Condom Use discussed. No Yes.

Skills for negotiating No. No.
Condom Use imparted.
Student Response. Average to Good. Excellent.
Other topics discussed. Personal hygiene. Peer – pressure, Drug Abuse
etc.
Behavior Trend observed Students have a curious mind Students pretend to be ignorant
by counselor. about SRH due to media but have incomplete
exposure coupled with lack of knowledge in actuality.
adequate avenues of information
elsewhere.

KEY RECOMMENDATIONS:
a. We recommend that class XI girls and boys be imparted information on condom use and
skills for negotiating condom use under the adolescent education program format since these
students are vulnerable to HIV and lack of crucial information, necessitated especially by
early marriages.
b. Also we urge that SRH education programs preferably in LSBE format for public schools
and improvised Adolescent education format for govt. schools be introduced all over the
country.
c. More aggressive and innovative media campaign focused on BCC especially in young
people should be undertaken.
 18

CASE STUDY – BALBIR PASHA MEDIA CAMPAIGN

Design and Execution: Population Services International.(PSI)
Funding: USAID (AIDSMark Funding Mechanism)
Target population: Young men aged between 18 to 40 belonging to lower socio-
economic groups in Mumbai.
Campaign Objectives:
a. To increase perception of HIV/AIDS risk from unprotected sex with non-regular
partners by personalizing the message and creating empathy through identifiable real-
life situations. (ATTITUDINAL CHANGE)
b. To generate discussion about HIV/AIDS among the target populations and opinion
leaders in order to facilitate understanding and knowledge acquisition. (CHANGING
SOCIAL NORMS)
c. To motivate people to access HIV/AIDS helpline and VCT services.
(BEHAVIORAL CHANGE)
Campaign Duration:
Phase 1- November 2002 till Feb 2003.
Phase 2-November 2004 till Feb 2005.
Impact: 250% increase in number of calls to PSI's Saadhan HIV/AIDS hotline, and
shift in types of queries from superficial to more invasive & informed.

Lesson: Innovative and integrated media campaigns designed after in-depth study of
target consumer and his/her lifestyle can bring about Behavioral Change in a short
span of time.

YOUTH PARTICIPATION

FORMAL AVENUES OF PARTICIPATION:

Two major events in India highlighted the commitment of the political leadership and civil
society organizations to involve young people in the fight against HIV/AIDS.

a. Various agencies (Government, NGOs, multilateral and bilateral agencies) working on youth
issues organized a series of State Level Consultations with young people in all regions of the
country seeking their inputs into national programs and policies on their health and development.
This series of State Level Consultations converged into a National Level Consultation with
young people. Recommendations from these consultations were shared with various ministries
and departments in Central and State Governments of India for action.
 19

b. Another event that was a cornerstone of young people’s involvement was the National Youth
Parliament. This youth parliament was convened with special focus to seek inputs from young
people on the draft legislation on HIV/AIDS.
Over 4000 young people from all districts of the country participated in this two-day event. Inter
Parliamentary Forum on HIV/AIDS, NACO and UN Agencies organized the event.

c. The Nehru Yuvak Kendra Sangathan (Nehru Youth Center Association) is a system of local
youth clubs offering vocational training, peer-to-peer awareness campaigns, and health fairs to 8
million out-of-school youth.

INFORMAL AVENUES OF PARTICIPATION:

Largely young people's involvement is in peer education program for prevention of HIV/AIDS in
India. The participation is largely in campaigns on issues rather than active planning process.

The International HIV/AIDS Alliance and Alliance India have pioneered an integrated
community and home based care and support program in the states of Tamil Nadu, Andhra
Pradesh and Delhi with support from the European Union, the Step Forward Initiative and the
Allan and Nesta Ferguson Trust. Projects in the three states encourage and advocate for the
participation of children affected by HIV/AIDS at all levels of program development,
planning and implementation. Mainstreaming the response to children and families at the
community level helps to overcome stigma and discrimination.

KEY RECOMMENDATIONS:

Formation of Greater Involvement of Young People (GIYP) to strengthen youth

participation. Young people including those living with HIV need to be involved in the
planning and implementation process of HIV interventions and policies, and their efforts need to
be recognized. This will eradicate fear, stigma and discrimination and give confidence for
positive living. Young people should not merely be regarded as a ‘target group’ – policies and
interventions should not only be for them, but framed by young people.

V. Summary of Major Achievements and Gaps

¾ A First Time
Formulation of the National Youth Policy in 2003 that addressed adolescents as a sub-
group. In addition, it called for programs addressing adolescents’ growth and
development needs, especially sexuality education, HIV/AIDS and better reproductive
health. The ICPD guidelines translated into provisions in The National Youth Policy
(2003). Provision made in The National Youth Policy for population education,
HIV/AIDS, STD’s, substance abuse to be included in health component.
¾ Five Years’ Vision
The Tenth Five Year Plan for youth has been emphasized the need for Sexuality
Education and the need for involvement of young people in the fight against
HIV/AIDS. It called for multi-sectoral response for HIV/AIDS Prevention and
Management among young people.
 20

¾ Increased Political Commitment

Role of political leadership stressed at the first National Convention of Elected
Representatives on HIV/AIDS in July 2003.
Over 3000 youth leaders participated at the National Youth Parliament: Special Session
on HIV/AIDS in New Delhi in November 2004.
It aimed at training the young people as Youth Ambassadors in generating awareness
among their peers in their society about the epidemic.
Proposal for ‘The Red Ribbon Express’ for awareness on HIV/AIDS across the
country.
¾ Increasing involvement of Youth Organizations
Nehru Yuvak Kendra Sangathan (NYKS) caters to the information needs of millions of
rural youth through non-formal education and the Rajiv Gandhi National Institute of
Youth Development (RGNIYD)-designated to serve as the apex information and
research center on youth development issues - two of the autonomous organizations
under the Department of Sports and Youth Affairs
¾ Integration of Youth Friendly Services to millions of rural youth through non-
formal education and the Rajiv Gandhi
Innovative programs like integration of adolescent friendly health services to Phase – II
of the Reproductive and Child Health program will clear path for more programs to
address the marginalized young people.
1097- A toll free AIDS help- line in more than 80 cities in the country is a good
medium to know about HIV/AIDS.
¾ Mainstreaming of GIPA Remains on Paper.
Commitment to the Greater Involvement of (Young) People Living with HIV/AIDS
(GIPA) has remained merely a concept that is reflected in the National AIDS Control
Policy document but has hardly been in practice in services provided though.
¾ Absence of policy to make SRH education mandatory part of school curriculum.
There is no policy in particular at present that supports and promotes young people’s
access to information and services.
Limited channels to reach the less educated and illiterate young people exist.
‘Life skills based HIV/AIDS education’ in school curriculum is being integrated only
with a limited numbers of schools.
¾ Policies for Stigma and Discrimination
There is no policy at present to combat stigma and discrimination attached to the
epidemic. Policies relating to women like gender discrimination to access information
and services, addressed women’s need in a limited manner and with a limited scope.

VI. Major Recommendations for Action

1. Adopt an approach – through formulation of a policy and amendments to existing laws

– that respects and promotes the human rights of (young) PLWHA’s, legal protection against
stigma and discrimination and wrongful termination either from an educational institution or
a workplace.
2. Introduce mandatory SRH education country wide in all schools even in low prevalence
states.
 21

Reproductive and Sexual Health Education should be introduced immediately in all schools
country-wide including low prevalence areas as only education can empower the young
people to make healthy choices and prevent further spread of HIV/AIDS into the general
population.
3. More state governments should be encouraged to set up legislative forum on adolescents
and youth related health issues focusing on HIV/AIDS. There is a heightened need for
taking international and national level efforts to fight HIV epidemic to state levels. The
commitment shown by leaders of the world, whether they are high prevalent or low prevalent
countries, should now be synergized to local level actions at state and district levels. Except
Kerala, no other State has done work in terms of specific policies for adolescents.
4. Policy essential for young people’s access to information and services. Young
people needed to be recognized as the most significant element in the fight against
HIV/AIDS and that the existing policies and programs on HIV/AIDS should address the
needs of young people for age appropriate information and services. There is a need for a
policy that could combat stigma and discrimination that prevails in our society and allow
young people to access youth friendly services including their access to condom acquisition,
address abstinence for adolescents and age of consent.
5. Like GIPA, have GIYP. Involvement of young people in policies and programs related to
young people, at the policy-making levels through regular interaction and adequate
representation in international, national and state level bodies. Young people including those
living with HIV need to be involved in the planning and implementation process of HIV
interventions and policies, and their efforts need to be recognized. This will eradicate fear,
stigma and discrimination and give confidence for positive living. Young people should not
merely be regarded as a ‘target group’ – policies and interventions should not only be for
them, but framed by young people.
6. Strengthen Community Response. Greater efforts to undertake training and capacity
building programs for the NGO, Civil society organization and young people’s organizations
to empower them to take up innovative projects like provision of medical facilities including
home-based care, opening of community care centers, etc apart from the conventional areas
of awareness, counseling and targeted interventions among risk groups.
7. Mainstream Gender in all walks of life not merely in HIV/AIDS programs. Gender
stereotypes should be avoided; policies should focus on gender equity, which should include
males also. Policies should view young people as a homogeneous group. Role of young
males in family planning and protecting the rights of women free from trafficking and
violence need to be addressed with a greater commitment. ‘Feminization’ of the epidemic
needs to be addressed more specifically.
8. Sensitize Service Providers first. Doctors and health personnel working in hospitals should
be sensitized not to discriminate between a patient not suffering from HIV and a PLWHA
when it comes to treatment especially when conducting an operation. Every health worker
who interacts with adolescents should develop the skills to be able to encourage young
people to communicate their feelings and fears, and to guide them towards making decisions
9. Involve the Gatekeepers to Young People. Provide training to parents and teachers in
school about the various myths and misconceptions about sexuality and HIV/AIDS so that
they are comfortable when it comes to disseminating correct facts based information to their
child.
10. Encourage Condom Use among Young People.
 22

Life skills programs should teach negotiation skills in condom use, especially as adolescents
are reluctant to confess to inexperience due to stigma and shyness. Married women of 15-19
and 20-24 years of age should be encouraged towards usage of condoms. Condom Vending
Machines should be set up in all hospitals and medical institutes.
11. RH/HIV interventions with out-of-school youth should include
1. Encourage youth to stay in school or return to school
2. Providing out-of-school youth with accurate information on RH/HIV issues and services
and with communication and negotiation skill.
 23

VII. References

™ Role of Political Leadership in Combating HIV/AIDS - Report of the National Convention of

Elected Representatives of Parliamentary Forum on HIV/AIDS, Government of India. New Delhi
2003
™ National AIDS Prevention and Control Policy- NACO, Government of India. New Delhi,
http://www.nacoonline.org/
™ World Youth Datasheet – 2006.
™ India : Statistics, UNICEF
™ Planning Commission, Report of the Working Group on Adolescents for the Tenth Five-Year
Plan (2002-2007) Government of India. New Delhi 2001
™ Websites consulted:
a. http://www.nacoonline.org
b. http://www.nacoonline.org/prog_iec.htm
c. http://yas.nic.in/yasroot/policies/youth_policy_03.htm
d. http://www.unaids.org.in
e. http://mohfw.nic.in
f. http://www.avert.org
g. http://www.psi.org/where_we_work/india.html
™ Consultations with Thought Shop Foundation.