Kadri Am, Kumar Pradeep
Department of Community Medicine, PDU Medical College, Rajkot and Former Joint Director (Basic Services), Gujarat State AIDS Control Society, Ahmedabad, India.
Indian J Community Med. 2012 Apr;37(2):83-8. doi: 10.4103/0970-0218.96088.
In India, HIV prevention and control activities started way before the reporting of the first case of HIV infection. On reporting of evidences of HIV infection from different parts of the country and varied groups, Government launched the National AIDS Control Program (NACP). The program was launched on the foundation of early interventions and Mid-Term Plan, which evolved in three phases over the period of eighteen years. With progression of time, epidemiological situation changed and knowledge/capacity to tackle HIV improved. In the course of the evolution, NACP has moved from the centrally controlled program to district driven. Also different strategies were inducted/refined and many important institutes like Task Force, a high-powered National AIDS Committee, National AIDS Control Board, National AIDS Control Organization, State AIDS Control Societies, Project Support Units/Project Management Units, National Council on AIDS, Department of AIDS Control, Technical Support Unit, District AIDS Prevention and Control Unit (DAPCU) were created. Currently program is implemented vertically with good impetus and is able to contain the spread of HIV in India. For enhancing the effectiveness and sustainability, future of the NACP is strongly linked with the well-performing DAPCU and good synergy/integration with General Health System. HIV/AIDS epidemic in India has entered into the third decade. Evidences show that this epidemic in India is of concentrated type and characterized by the heterogeneity, following the type 4 pattern, where the epidemic shifts from the most vulnerable populations [such as female sex workers, men who have sex with men, injecting drug users to bridge populations (clients of sex workers, sexually transmitted infection patients, partners of drug users, long route truck drivers, short stay cyclical single male migrants], then to the general population and from urban centers to rural areas (ruralization of epidemic) with increasing involvement of youth and women (feminization of epidemic).
在印度，艾滋病病毒预防和控制活动早在报告首例艾滋病病毒感染病例之前就已展开。随着来自该国不同地区和不同群体的艾滋病病毒感染证据被报告，政府启动了国家艾滋病控制项目（NACP）。该项目基于早期干预措施和中期计划启动，在18年的时间里分三个阶段逐步发展。随着时间的推移，流行病学情况发生了变化，应对艾滋病病毒的知识和能力也有所提高。在这一发展过程中，NACP已从中央控制的项目转变为以地区为驱动的项目。同时，不同的策略也被引入或完善，还成立了许多重要机构，如特别工作组、一个高级别的国家艾滋病委员会、国家艾滋病控制委员会、国家艾滋病控制组织、邦艾滋病控制协会、项目支持单位/项目管理单位、国家艾滋病理事会、艾滋病控制司、技术支持单位、地区艾滋病预防和控制单位（DAPCU）。目前，该项目以强大的推动力垂直实施，能够在印度遏制艾滋病病毒的传播。为提高有效性和可持续性，NACP的未来与运作良好的DAPCU以及与一般卫生系统的良好协同/整合紧密相连。印度的艾滋病病毒/艾滋病疫情已进入第三个十年。有证据表明，印度的这一疫情属于集中型，具有异质性，遵循4型模式，即疫情从最脆弱人群（如女性性工作者、男男性行为者、注射吸毒者）转移到桥梁人群（性工作者的客户、性传播感染患者、吸毒者的伴侣、长途卡车司机、短期停留的周期性单身男性移民），然后转移到一般人群，从城市中心转移到农村地区（疫情农村化），且青年和女性的参与度不断增加（疫情女性化）。
