145;We work within the existing reality146;

NACO is basically concerned with public health and not mandated to bring about social reform

This is with reference to Rami Chhabra8217;s piece, 8216;The HIV/AIDS funding farce8217; IE, July 24. The broad thrust of the article is that NACO8217;s estimation process is agenda-based and flawed and the strategy of focusing on high-risk groups has resulted in wasteful expenditure of public funds. The alternative proposed is to establish a 8220;clean and caring society that ensures that sex work gets diminished through education and persuasion and strong implementation of punitive laws that also provide adequate safety nets to alleviate the suffering of sex workers8221;.

Regarding the estimation process, HIV/AIDS sentinel surveillance has been graded in the 8216;A8217; category by World Health Organisation WHO, which is the globally accepted technical agency on epidemiological estimation processes for disease control. The revised figures estimating people living with HIV/AIDS to almost half the earlier figures are thanks to the availability of better tools of analysis and methodologies and more robust data. The entire process of estimation is done in consultation with experts from within the country and outside.

Two, focusing on high-risk groups is based on the classical public health approach of working on sub-populations that are at the highest risk of infection. Therefore the strategy seeks to change behaviour among them so as to reduce transmission of infection among the general population who are at lower risks. The cost-effectiveness of this approach becomes clear from the fact that HIV prevalence levels in the general population is 0.36 per cent while among high-risk groups the average is between 10 and 20 per cent. For such interventions, allocations are Rs 1670 crores out of Rs 8023 crore over five years to cover an estimated 20 million persons.

Finally, while we need to strive for a society that has no commercial sex workers and all men and women have monogamous relationships, the reality is different. The fact is that there is a demand for sex before and outside marriage and as long as this demand exists, there will be a supply of such services. NACO is basically concerned with protection of public health and is not mandated to bring about societal reform on the lines suggested by the writer. NACO therefore strives to promote the policy of abstinence, encourages people to have value-based relationships but recognises the fact that there will always be people who may have other lifestyle preferences. Such people then need to use condoms to protect themselves and their partners from getting the infection that has no cure.

The writer is joint director, National AIDS Control Organisation NACO