Daily News Digest 1 April 2024

Table of content

• Genetic profiling of captive elephants of Kerala to begin shortly
• Now, GST probe into big corporates, major MNCs needs a ‘written approval’
• Vaikom satyagraha
• The ART of India’s HIV/AIDS response

Genetic profiling of captive elephants of Kerala to begin shortly

Time to Read :🕑 3 Mins

Why in news?

In its efforts to create a national elephant database, the Wildlife Institute of India (WII) has equipped the Kerala Forest Department with forensic kits for elephant profiling.

About

• The genetic profiling of the 400-odd captive elephants of the State will begin shortly.
  • Photographs of individual elephants and their physical details, including height, will be entered into a database along with their genetic features, as part of the profiling carried out by Wildlife Institute of India.
• The department has entrusted assistant conservators (social forestry) in the districts with the responsibility of collecting blood and dung samples of the animals in their respective areas.
• An online training programme has also been planned for the forest officials on April 5 and 6 on sample collection, and updating the reports

Now, GST probe into big corporates, major MNCs needs a ‘written approval’

Time to Read :🕑 5 Mins

Why in news?

Guidelines for CGST field formations in maintaining ease of doing business while engaging in investigation with regular taxpayers were recently released.

About News

• The Department of Revenue has directed Central Goods and Services Tax (CGST) officials to obtain prior written approval from zonal Chief Commissioners before initiating investigations in cases involving:
  • Big industrial houses and major multinational corporations (MNCs)
  • Sensitive matters
  • Matters with national implications
• The guidelines further specify situations where the “prior written approval of the zonal (Pr.) Chief Commissioner shall be required if investigation is to be initiated and action to be taken in a case falling under four categories.
• Apart from large corporates and major MNCs, a written nod is also mandated for matters that are already before the GST Council and “of interpretation seeking to levy tax or duty” on any sector, commodity, or service for the first time, whether in Central excise or GST.
• In all these categories of cases, including “sensitive matters or matters with national implications”, the CGST field formation concerned should also collect details regarding the prevalent trade practices and nature of transactions carried out, from stakeholders. “The implications/impact of such matter should be studied so as to have adequate justification for initiating investigation and taking action,” said the guidelines.

Vaikom satyagraha

Time to Read :🕑 11 Mins

Why in news?

The Vaikom Satyagraha marked its 100th anniversary recently.

Background

• Vaikom, a temple town in the princely state of Travancore, saw the start of a non-violent agitation on March 30, 1924 — the first among temple entry movements that would soon sweep across the country.
• The satyagraha foregrounded social reform amidst the growing nationalist movement, bringing Gandhian methods of protest to the state of Travancore.

Early 20th century Travancore

• The princely state of Travancore had a “feudal, militaristic, and ruthless system of custom-ridden government,” cultural anthropologist A Aiyappan wrote in Social Revolution in a Kerala Village: A Study in Culture (1965).
• The second half of the 19th century saw several social and political developments ushering in unprecedented social change.
  • First, Christian missionaries converted large sections of lower castes seeking to escape the clutches of caste oppression.
  • Second, the reign of Maharaja Ayilyam Thirunal Rama Varma (1860-80) saw many progressive reforms, such as universal free primary education — including for the lower castes.
• By the dawn of the 20th century, “there had begun to emerge among caste Hindus, Christians and even avarna Hindus, especially Ezhavas, a significant educated elite,” historian Robin Jeffrey wrote. (‘Temple-Entry Movement in Travancore, 1860-1940’: Social Scientist, 1976)

While religion and custom remained pervasive, the absolute material and intellectual deprivations of lower castes did not continue.

• The Ezhavas, in particular, emerged as “the most educated and organised untouchable community in Travancore”, historian Mary Elizabeth King wrote in Gandhian Nonviolent Struggle and Untouchability in South India (2015).

But government jobs were still reserved for upper castes — in 1918, caste Hindus, a numerical minority, held 3,800 out of 4,000 jobs in the state’s revenue department. This meant that education itself did not act as a means of socio-economic advancement.

Also, while a small Ezhava elite had started to emerge, in many cases, the ritual discrimination, overrode material and educational progress. Take for instance the story of Aloommootil Channar, an Ezhava, and one of the few people in Travancore to own a car in the early 20th century. Whenever the automobile reached a road where the Ezhavas were not allowed to pass, Channar had to get out of his vehicle and take a detour on foot.

Road to agitation

• The issue of temple entry was first raised by Ezhava leader T K Madhavan in a 1917 editorial in his paper Deshabhimani. Inspired by the success of Gandhi’s Non-Cooperation Movement, by 1920, he began to advocate for more direct methods. That year, he himself went beyond the restrictive notice boards on a road near the Vaikom temple.
• But upper-caste counter-agitations across Travancore made any progress difficult — and the Maharaja, fearful of caste Hindu backlash, shied away from reforms.
• It was the entry of the Indian National Congress into the picture that changed the dynamics.
  • Madhavan met Gandhi in 1921, and secured the Mahatma’s support for a mass agitation to enter temples. In the 1923 session of the INC in Kakinada, a resolution was passed by the Kerala Provincial Congress Committee to take up anti-untouchability as a key issue.

This was followed by a massive public messaging campaign and a movement to open Hindu temples and all public roads to avarnas. Vaikom, with its revered Shiva temple, was chosen as the location for the very first satyagraha.

The Vaikom satyagraha

• Madhavan and other leaders took the strategic decision to initially focus on opening up the four roads around the temple — not the temple itself — to avarnas. Early morning on March 30, 1924, a Nair, an Ezhava and a Pulayu, dressed in Khaddar uniforms and garlanded, and followed by a crowd of thousands, attempted to use the roads.
  • They were promptly stopped and arrested. So, the next morning, another three men entered the forbidden roads and courted arrest. This went on every day — until the police stopped making arrests on April 10 and barricaded the whole area instead.
• From then through September, protesters sat in front of the barricades, fasting and singing patriotic songs. Leaders such as Periyar, who was arrested multiple times, and C Rajagopalachari came to Vaikom to offer support and lead the protesters. At the same time, counter-agitations raged on, and the satyagrahis often faced violence and intimidation from caste Hindus.
• In August, 1924, the Maharaja of Travancore died, following which, the young Maharani Regent, Queen Sethulakshmi Bai, released all prisoners. But when a large group of protesters marched to the royal palace in Trivandrum, she refused to allow all castes access to temples.
• In March 1925, Gandhi was finally able to iron out a compromise: three out of the four roads surrounding the temples were opened up for everyone, but the fourth (eastern) road was kept reserved for brahmins.
• This was finally implemented in November 1925, when the government completed diversionary roads that could be used by the low castes “without polluting the temple”. The last satyagrahi was recalled from Vaikom on November 23, 1925.

Legacy and aftermath

• The Vaikom satyagraha was a remarkable movement, which sustained itself for over 600 days, amidst hostile social forces, police crackdowns, and one of the worst floods in the town’s history in 1924. The satyagraha also saw previously unseen unity across caste lines, which was crucial for its continuing mobilisation.
• But the final compromise disappointed many. Famously, Periyar, who had envisioned a far more spectacular outcome, fell out with Gandhi over the issue.
• In November 1936, the Maharaja of Travancore signed the historic Temple Entry Proclamation which removed the age-old ban on the entry of marginalised castes into the temples of the state. This, along with the demonstration of Gandhian methods of civil disobedience as effective tools of protest, was the great success of the Vaikom satyagraha.

The ART of India’s HIV/AIDS response

Time to Read :🕑 11 Mins

Why in news?

On April 1, 2004, the Indian government launched a free Antiretroviral Therapy (ART) program for People Living with HIV (PLHIV). This initiative has proven to be a key and successful intervention in the fight against HIV/AIDS.

Background

• At the emergence of HIV/AIDS in the early 1980s, the disease was considered a death sentence and was met with a lot of fear, stigma and discrimination.
• Though the first antiretroviral drug, AZT (zidovudine), was approved by the US Food and Drug Administration (US FDA) in March 1987, three more drugs were approved soon after in 1988 and a new class of antiretroviral drugs, protease inhibitors were introduced in 1995.
• But access to these medicines remained limited for most of the world’s population except in some high-income countries.

The evolution to free ART

• Recognising this challenge, in 2000, at the UN General Assembly’s Millennium Summit, world leaders set a specific goal and issued the declaration to stop and reverse the spread of HIV.
• The Global Fund to Fight AIDS, Tuberculosis and Malaria was created in 2002 which advocated universal access to HIV prevention, treatment, care and support services.
• In 2004, the number of PLHIV in India was estimated to be 5.1 million, with a population prevalence of 0.4%.
  • Very few of them were on antiretroviral therapy. Even by the end of 2004, only 7,000 PLHIV were on ART.
• The key barrier to ART was high cost and unaffordability for individuals, and geographical access to treatment.
  • In fact, the so-called ‘cocktail therapy’ or HAART (highly active antiretroviral therapy), a combination of three or more anti-retroviral drugs, had become available starting in 1996, but costs were prohibitively high ($10,000 a year).
• People infected with HIV were stigmatised and lost their lives while health-care providers felt helpless due to non-availability/non affordability of ARTs.
  • Therefore, the decision to make free ART for any adult living with HIV was a path-breaking one.
• From November 2006, the free ART was made available for children as well.
• In two decades of free ART initiative, the facilities offering ART have expanded from less than 10 to around 700 ART centres — 1,264 Link ART centres have provided, and are providing, free ART drugs to approximately 1.8 million PLHIV on treatment.

The success of Free ART

• ART is not merely about starting a person living with HIV on treatment.
  • It is equally important to keep the viral load down and suppressed to ensure that the transmission of diseases is also halted.
• The impact has been that in 2023, the prevalence of HIV in 15-49 years has come down to 0.20 (confidence interval 0.17%-0.25%) and the burden of disease in terms of estimated PLHIV has been coming down to 2.4 million.
• India’s share in PLHIV globally had come down to 6.3% (from around 10% two decades ago).
• As of the end of 2023, of all PLHIV, an estimated 82% knew their HIV status, 72% were on ART and 68% were virally suppressed.
• The annual new HIV infections in India have declined by 48% against the global average of 31% (the baseline year of 2010).
• The annual AIDS-related mortalities have declined by 82% against the global average of 47% (the baseline year of 2010).
• These are significant achievements considering that many of the other government-run public health programmes in India have failed to achieve or sustain good coverage.
• The free ART initiative in India succeeded, inter alia,
  • Due to the political will and constant support of successive governments.
  • Sustained and sufficient funding, regular programme reviews and field-based monitoring, a series of complementary initiatives.
  • Community and stakeholder engagements and participation.
  • People-centric modifications in the service delivery.
  • Bridging the policy intentions to implementation gaps, and continuous expansion of services to cover more people living with HIV.

Patient-centric approach to services

• It will be unfair to credit free ART alone for the success.
  • There were many complementary initiatives which have contributed to halting the HIV epidemic.
  • These include the provision of free diagnostic facilities; attention on prevention of parent to child transmission of HIV (PPTCT) services; prevention, diagnosis and management of opportunistic infections including management of co-infections such as tuberculosis (TB).
• The programme has shown agility and dynamic modifications.
  • Early initiation of ART and Treat all policy evolved over the years where the ART eligibility criteria were relaxed — from those having a CD4 count less than 200 cells/mm3 (in 2004), to that less than 350 cells/mm3 (in 2011), and then to less than 500 cells/mm3 (in 2016).
  • And, finally, there was the ‘Treat All’ approach from 2017, which ensures that ART is initiated, irrespective of CD4 count. This has been a true universalisation and has contributed to reduced virus transmission, both at the individual and the community levels. This is supplemented by free of cost viral load testing for all PLHIV on treatment.
  • The programme also adopted a patient-centric approach by providing two to three months of medicines to stable PLHIV which minimises the number of patient visits to the ART centres, reducing travel time and costs for the patients.
• This approach also increases adherence to treatment besides decongesting ART centres by reducing the average daily OPD, giving health-care workers more time to attend to other patients.
  • India continued to add newer and more potent drugs to the programme, as and when those became available. For example, Dolutegravir (DTG), a new drug with superior virological efficacy and minimal adverse effects was introduced in 2020.
  • In 2021, India adopted a policy of rapid ART initiation in which a person was started on ART within seven days of HIV diagnosis, and in some cases, even the same day.
• However, the fight against HIV/AIDS is far from over.
  • The ongoing and fifth phase of India’s National AIDS Control programme aims to (by 2025) reduce the annual new HIV infections by 80%, reduce AIDS-related mortalities by 80% and eliminate vertical transmission of HIV and syphilis.
  • To achieve this, the National AIDS Control Programme (NACP) phase 5 calls for the attainment of ambitious targets of 95-95-95 by 2025, where 95% of all people living with HIV know their HIV status; 95% of all people diagnosed with HIV infection receive sustained antiretroviral therapy (ART), and 95% of all people receiving antiretroviral therapy achieve viral suppression by 2025. These targets are aligned with global targets agreed by the UNAIDS.

Crossing the hurdles - There are a number of challenges yet to be tackled.

• First, the delayed enrolment to the ART facilities is the biggest challenge to the national programme. In India, patients presenting with CD4 count <200 to ART centres constitute almost a third of total foot fall.
• Second, after starting on ART and continuing, the patient starts feeling well. But the moment this happens, they start missing doses and miss medicines for months or completely drop out. This results in the development of resistance as well. This ‘loss to follow up’ needs to be addressed.
• Third, the sustained supply and availability of ART needs to be ensured by the national programme, in every geography of the country and more so for tough terrain, hilly and remote areas.
• Fourth, there is a need to focus on the private sector engagement in care of PLHIV.
• Fifth, there is a need for constant training and capacity building of staff as science keeps evolving and should be focused more on hands-on training.
• Sixth, there is a need to focus on strengthening integration with other programmes such as hepatitis, non-communicable diseases (diabetes and hypertension) and mental health as PLHIV are living normal but have other health conditions that need to be addressed.
• Seventh, a focused approach needs to be adopted to reduce preventable mortality that includes systematic death reviews and availability of advanced diagnostics.

Conclusion

The free ART initiative arguably paved the path for bending the HIV/AIDS epidemic curve in India. It is a testament to the point that if there is a will, the government-run public health programme can deliver quality health services free, and available and accessible to everyone. The 20 years of free ART and subsequent steps under the NACP have the potential to guide other public health programmes in the country. As an example, the learnings can and should be used to launch a nationwide free hepatitis C treatment initiative in India and accelerate progress towards hepatitis C elimination.