As India gears up to implement the third phase of its National AIDS Control Programme (NACP) this month, all districts will be made implementing authorities and the number of free treatments will be raised.
The goal is to "to halt and reverse the epidemic in five years" at a cost of Rs.115 billion ($2 billion), according to a draft executive summary of the National AIDS Control Organisation (NACO).
All districts are scheduled to become powerful implementing authorities. As many as 163 of India's 611-odd districts have been designated 'high prevalence' areas and 59 districts are where the epidemic is concentrated.
At least 278 districts are in group C where increased presence of vulnerable population has been noted and 111 districts have been classified as of "unknown vulnerability" still.
The NACP III programme will see several marked changes in the policy, which activists say will become more all encompassing.
In India, 5.2 million people are living with HIV/AIDS, second only to South Africa, and 86 percent of the transmission continues to be sexual, 15 years after the first countywide awareness programme began.
The government says 785,000 people need anti-retroviral treatment (ART), but till August 2006 only 24,000 got ART drugs from the state. It is estimated that NGOs provided ART to as many or more. By 2011, the government hopes to provide treatment to at least 39,000 children and 300,000 people.
NACP I began in 1992 and NACP II in 1999. There are "signs of stabilisation in some parts of the country", said a government review of the earlier initiatives.
"Tamil Nadu has been able to show a steady decline in prevalence. The effort in NACP III would be to keep the momentum going and ensure the reversal of the epidemic. At present the prevalence is 0.5 percent. Our mission is to bring it down to 0.1 percent by 2012," Supriya Sahu, the chairperson of the Tamil Nadu State Aids Control Society, told IANS.
The prevention programme will focus on "saturating the estimated four million high-risk groups" in India, the NACO review said. This includes commercial sex workers, intravenous drug users and men having sex with men.
Migrant workers and truck drivers have been shifted from high-risk to the "12 million highly vulnerable population".
Taking a cue from the last census data, the government has also included a "large number of young men and women in the general community who constitute 40 percent of the country's population" in the highly vulnerable category.
NACP III plans to access 95 percent of the country's young through the ministries of youth affairs, human resource development, women and child development and the ministry of social justice and empowerment.
There will be a huge push to testing, with services for all different categories undergoing voluntary testing being merged. "Like shutting the tap rather than mopping the floor," said Jaya Sridhar, a medical practitioner and activist.
Every year, the government wants to extend HIV/AIDS testing to at least 21 million, and expects to achieve this goal at least by 2011 and proposes to set up 5,000 new testing centres.
It wants the private sector to contribute in another 21 million tests even as 150,000 pregnant women will be extended testing and follow-up services with an allocation of Rs.80 billion.
Interventions through community-based organisations will be increased from less than five percent now to 50 percent by 2011, said the government.
The third National AIDS Programme Implementation Plan was evolved through consultations between 14 working groups, e-forums, civil society organisations, NGOs and development partners, including a World Bank pre-appraisal team.