AIDS is a problem that is seen to be linked to larger social and economic problems and issues. Thus an intersectoral approach is needed to deal with AIDS. This takes back us to a wider perspective on health (as embodied in the Alma Ata Declaration of 1978) and so, through AIDS one may realise the potential of primary health care that may take us towards the dream of health for all.

However, in the era of Structural Adjustment Policies and Health Sector Reforms there are cut backs in the social sector including public health services, introduction of user fees and privatisation in the pubilc sector. In the health budget not only have allocations decreased there is a skewing towards investment in AIDS (see graph and table 1). This is reflected in the increasing or stagnating trends in communicable diseases and morality due to them. There have been outbreaks of falciparum malaria in Rajasthan, Nagaland, Manipur and Assam; Kala Azar in Bihar and West Bengal and the plague in Surat. There have been outbreaks of dengue and Japanese Encephalitis as well (Table 2).

RE=Revised Estimate, BE=Budget Estimate

Source: Expenditure Budget 2001-2002, 2002-2003

* The funds for malaria control are also used for control programme of Japanese Encephalitis and Dengue. The NACO budget does not include all the expenditure on AIDS in the country as it comes through multiple channels.

If the public health sector does not address the urgent medical needs of the people they will stop accessing its services. The implications for AIDS would be devastating because while it may be a vertical programme it still runs through the general health services. Also patients with HIV/AIDS are even more susceptible to other communicable diseases.

Additionally the success of services depends not only on availability and accessibility but also on the attitude of the service providers. If people suffering from AIDS are socially and medically defined as being promiscuous and morally ‘deserving’ of such a disease, they will not come for medical care. The ‘fear phychosis’ generated to change people’s high risk behaviour has built up a paranoid stigma about the disease.

Thus, along with improvement of access and quality of the general health services, one of the first steps towards removing the barriers created by the stigma is through giving sensitive and caring support to those suffering from the disease.