Sankalp Rehabilitation Trust & ANR filed a writ petition on concerns with the criteria being employed by the National AIDS Control Organization (NACO) for administering second line treatment to persons suffering from HIV/AIDS. The Supreme Court had issued directives for enhancing the extent and efficacy of treatment administered to HIV/AIDS patients. NACO submitted an “Office Memorandum” in response to that public interest litigation. The writ challenged the memo’s terms.
In August 2008, the Ministry of Health and Family Welfare’s NACO developed an “Office Memorandum” in response to a public interest litigation (PIL), in which the Supreme Court reviewed the steps taken by NACO to combat HIV/AIDS and the services being provided to patients. The Supreme Court had issued directives, including those aimed at improving the sufficiency of centres distributing second line anti-retroviral therapy (ART).
Subsequently, Sankalp Rehabilitation Trust & ANR filed a writ petition challenging the criteria employed by NACO for administering ART for persons suffering from HIV/AIDS, specifically the extension of second line treatment to all patients who need it, regardless of whether they underwent first line treatment in private or government sector, and regardless of whether that first line treatment was rational. NACO consistently expressed that its ultimate goal was to have universal second line treatment. In proceedings before the Supreme Court, the parties discussed the modalities to bring about universal second line treatment to all those who need it.
On December 12, 2010, a meeting was held where several decisions regarding the steps to attain universal second line treatment were made. First, the Court ordered that all private practitioners be required to follow the ART guidelines set forth in the August 2008 Office Memorandum. Second, NACO committed to making second line treatment accessible to all those in need.
However, the Court recognized some constraints that would need to be immediately addressed. Lacking complete data on those who need second line treatment, a proposed “first phase” of initiation would start universal treatment at the four centres of excellence (JJ Hospital in Mumbai; GHTM Tambaram, Maulana Azad Medical College, New Delhi, and Calcutta School of Tropical Medicines, Kolkata). This pilot initiative would be studied for three months, after which a progress report would be submitted to the Court along with a plan for phase II.
The Court further stipulated that persons from anywhere in the country could be referred to these four centres, by first registering at the local ART centre and then being referred to the State AIDS Clinical Expert Panel in the centre of excellence. Finally, the Court concluded that the progress of each phase would depend largely on the number of individuals requiring treatment once access was provided, but that NACO should make its best to efforts to provide available universal treatment as early as possible.
On December 16th, 2010, an update was issued regarding the decision which stated that the Lawyers Collective HIV/AIDS Unite will organize a meeting in January 2011 with people living with HIV and NACO to further explain the order and any subsequent issues with the rollout program. An application was later filed challenging NACO guidelines limiting the provision of second line anti-retroviral (ARV) treatment to widows, children, those below the poverty line, and those who had been on first line ARVs in the Government Programme for two years previously. On December 2, 2013, the case came up for final disposal before the Supreme Court, and NACO submitted an affidavit stating that most of the outstanding issues had been resolved. Senior counsel for the petitioners submitted that most of outstanding issues had been taken care of, as reflected in the affidavit, however, four issues still subsisted. The Court subsequently disposed of the petition, giving liberty to the petitioners to make separate submissions on the four outstanding issues. An order to that effect was issued on December 2, 2013.
This case is an example of the Lawyers’ Collective (representing Sankalp Rehabilitation) utilizing public interest litigation as a means to monitor implementation of the National ARV Rollout Programme. While significant problems with implementation remain, this public interest litigation significantly impacted government policy and pushed to widen access to HIV/AIDS treatment.
For their contributions, special thanks to ESCR-Net member: the Program on Human Rights and the Global Economy (PHRGE) at Northeastern University.
Sahara House, Sankalp Rehabilitation Trust & Anr., Voluntary Health Association of Punjab, Common Cause
