With multiple lapses, HIV prevention and care pose big challenge in TN

A sudden surge in the number of cases, allegations of concealment of numbers, lack of testing kits, paucity of funds for education and medical care, and increased drug abuse — the current HIV scenario in Tamil Nadu is certainly cause for concern.

The state government is being accused of concealing the correct number of HIV infections over the past decade. Health Minister Ma Subramanian says the number of HIV infected persons currently is 1,57,908 in Tamil Nadu. However, only 1,41,341 people are being treated with combined drug therapy.

The difference of over 16,000 cases is raising eyebrows, with even health department officials remaining unclear on the actual case numbers.

Numbers affected

The Tamil Nadu AIDS Control Society (TANSACS) implements the HIV/AIDS control programme in Tamil Nadu under the guidelines of the National AIDS Control Programme (NACP) and the National AIDS Control Organization (NACO).

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As of March 2024, there were 1,32,301 people with HIV on antiretroviral therapy (ART) in Tamil Nadu. Though there seems to be a surge in the numbers, health officials deny any alarming rise in HIV positive cases.

The HIV Positive Network, formed by affected individuals and led by Karunanithi Govindhasamy, has accused the state government of concealing the correct number of HIV infections over the past decade. "The cases of HIV were about 2 lakh around a decade ago and, after correction of data duplication, it was about 1.32 lakh in 2024,” Govindhasamy, founder of the HIV Positive Network, told The Federal.

Sudden surge?

“There seems to be a sudden surge, given the number of infected people is 1.5 lakhs now. The surge cannot be so sudden and the data seems unclear. There needs to be more transparency. If analysed properly, the number of people with HIV would be higher than 2 lakh," Govindhasamy said.

A senior official from TANSACS, speaking to The Federal on the condition of anonymity, said that they are verifying the data and will release any revised numbers later. Tamil Nadu Health Secretary P Senthilkumar, however, denied any alarming surge and said the number of new cases each year is typically 8,000-9,000.

There were about 1.5 lakh affected people on ART treatment for the past few years. In the last six months, “we have seen about 4,000-4,500 cases, which is a usual trend,” he said.

The Federal approached R Seethalakshmi, project director of the Tamil Nadu AIDS Control Society, but she refused to comment.

Prevention programmes

Tamil Nadu faces several challenges in the prevention and control of HIV. These include unclear data on the affected people, lack of HIV testing kits, inadequate human resources and low funds for the educational and nutritional care for HIV infected people.

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Eighty-seven NGOs operate in the state with a Rs 20 crore budget for awareness programmes. HIV prevention programmes are being implemented through TANSACS via collaborations with NGOs for targeted individuals, including men who have sex with men (MSM), transgenders, sex workers, migration workers, lorry workers, at an allocation of Rs 25 lakh for each organisation.

Also, a Link Workers Scheme (LWS) is being implemented through NGOs in 17 high-priority districts to prevent STI/HIV/AIDS and TB. This scheme works toward creating awareness, increasing condom availability, promoting testing and treatment, and providing care and support services.

Govindhasamy said Trichy, Erode, Karur, Madurai, Coimbatore, Vellore, Villupuram, Salem and Namakkal are the high-prevalence districts in the state. Since they are well-connected through highways, the risk of HIV transmission among the bridge population is higher.

Paucity of kits

Sources from HIV testing facilities that The Federal spoke to raised the issue of delays in the procurement of testing kits from the National AIDS Control Organisation.

With testing targeted only for high-risk and high-priority category populations, the kits are reported to be in short supply in government hospitals, primary health centres, corporation hospitals and even dedicated Facility Integrated Counselling Testing Centres.

"The kits are mobilised from nearby districts when there is a shortage but we need additional kits for the testing of the general population who are likely to be at risk. We have raised the issue to the senior officials at TANSACS," said an official from a TANSACS testing facility in Madurai.

Missing doctors

Several ART centres, even in the high-prevalence districts, need additional human resources. The Network for Persons Living with HIV/AIDS (PLHA) has urged the Tamil Nadu government to form a welfare board for PLHAs and appoint doctors for ART centres, especially in the high-prevalence districts.

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"Over 10 ART centres in the state were functioning without doctors for more than two years, as a result of which PLHAs were struggling to get appropriate treatment," said Govindhasamy of HIV Positive Network.

"We urge the government to appoint doctors to these centres. There are about 20-25 new cases identified every month in the districts with high prevalence. The intervention is low, which has led to a surge in the prevalence. There is no proper follow-up of these programmes," he added.

Lapses in monitoring

An apparent dip in information and educational training among the affected individuals and public health campaigns is also a concern.

"The awareness activities have seen a decline in the last few years and the community engagement activities with the persons living with HIV are not being done," Noori Saleem, founder of the South Indian Positive Network, told The Federal.

She added that there are lapses in the monitoring and implementation of activities being undertaken by the Tamil Nadu State AIDS Control Society under the Health Department. "There were four executive committee meetings being organised every year but in the last few years, the meetings are not being held," she added.

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The government established the Tamil Nadu Trust for Children Affected by HIV/AIDS in 2009-10, and provided Rs 25 crore as corpus fund. This was deposited with the Tamil Nadu Power Finance Corp Ltd. From the accumulated interest, financial assistance is paid to the HIV/AIDS infected, and affected orphan and vulnerable children annually to support their nutritional and educational needs.

The budget of Rs 25 crore is not adequate for the affected children, said Saleem, adding that the funds should be increased to help them with their higher education needs.

Risk factors

K Satish Kumar, trainee manager, YRG Centre for AIDS Research and Education (CARE), said that with more people living with HIV and improved survival rates, there is a need to emphasise preventing transmission. Adequate access to information on preventive measures needs to be available, he told The Federal.

"There are educated people who know the risk factors but are not able to take the call on prevention when circumstances arise. We need to understand that even if the prevalence reduces, the activities on awareness and preventive measures should reach the public," he said.

A senior official from the Health Department, responding to the concerns, said HIV prevention and awareness activities are being organised across the state on a regular basis and there are adequate staff members at the counselling centres. “If there are any specific requests made, they will be looked into by the project director," he told The Federal.