DNA EXCLUSIVE: HIV test eludes half of expectant mothers in India

Barely half of all the pregnant mothers in India are getting tested for Human Immunodeficiency Virus (HIV), even after fifteen years since inception of government’s Prevention of Parent to Child Transmission of HIV (PPTCT) programme. 

This leaves a whopping number of new-born babies exposed to the risk of the deadly disease.

Earlier this month, Union Health Ministry’s Secretary Preeti Sudan shot a letter to chief secretaries of all states highlighting the fact that in 2016 - 17, a total of 3 crore pregnancies were estimated, out of which 2.85 crore (95%) women registered for Ante-natal care (ANC).

 DNA accessed a copy of the letter. Sudan stated that of the 2.85 registered pregnant women, only 1.68 crore (56%) were provided with free HIV testing. The rest, upto 1.17 crore women, were unable to access these services. Access to testing for Syphilis was even lesser, with barely 30% (88.6 lakhs) being able to access the services. Syphilis is a sexually-transmitted disease, and a pregnant woman stands the risk of losing her unborn baby to the infection, in case timely treatment is not meted out. 

According to statistics provided by the National AIDS Control Organisation (NACO), of the entire pregnancy pool, an estimated close to 33,000 pregnant women should be testing positive for HIV. “We have drawn estimates in international systems of modelling.

 Of an estimated 33,000, we were able to detect HIV in 15, 900 pregnant women. We are missing out on a large chunk of women for as in states like Uttar Pradesh, Bihar, Madhya Pradesh, Rajasthan and Assam, the percentage of women being screened for HIV is very low,” said a NACO official. While most babies were prevented from contracting HIV, 500 children ended up contracting HIV and have been put on life long treatment last year. 

While in states like Tamilnadu and Maharashtra, upto 95% of pregnant women are being screened for HIV, in UP the coverage is barely 40% while in Bihar it is close to 57%, said the NACO official. 

A central team from NACO visited nine districts of Bihar - Darbhanga, Gaya, Jehanabad, Katihar, Nalanda, Patna, Purnia, Samastipur and Saran between January 8 to 10 to assess the ground reality of prevention and treatment services offered under the National AIDS Control Programme. DNA accessed a copy of the report. The key findings were shocking. There is lack of space, sitting arrangements, non-availability or non-functional computers and refrigerators. Necessary registers for patients were not available to be inspected when the central team landed in the clinics. 

The cost of an HIV testing kit is not more than Rs 10 for the exchequer. However, in absence of cold chain facility it is futile to procure or distribute these kits.“HIV testing and detection kits have to be stored in a cold chain facility. There is no point meting out the kits at clinics or Primary Health Care Centres if there is no maintenance of cold chain at between two to eight degree celsius,” said the NACO official.

Due to shoddy infrastructure and lack of human resources, upto 1.17 crore pregnant women are not getting tested for HIV. On the other hand, the burden of HIV on India is huge. According to NACO’s 2016-17 annual report, there are 21.17 lakh people living with HIV in India (PLHIV). Upto 8, 57, 385 females are currently living with HIV and form 40.5% of PLHIV group. Upto 1, 38, 451 children below 15 years are currently living with HIV.

Revised estimates of NACO budget for 2017 - 18 as sanctioned by the Finance Ministry stand at Rs 2, 163 crores. While budgets expand each year,  the government of India keeps pushing ahead the global target for ‘Elimination of new HIV infections in children,’ every year. In the 2016 - 17 annual report of NACO, the target for this elimination was set at 2017, which has clearly been missed. Sudan, in her letter states that the dual target for Elimination of Mother to Child Transmission (EMTCT) of HIV and Syphilis is set at 2020. 

“An urgent need is felt to strengthen the strategies for scaling-up testing services for HIV and Syphilis at public and private health care centres in the country for early detection and treatment. It is also requested to direct Principal Secretaries of Health and Urban Development to establish HIV Counselling and Testing services on priority in all health care centres,” the letter states.