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VIEWPOINT: KAUTILYA
We Need More Aid For AIDS
As the UN meet opens, the world thinks AIDS is
a time bomb ticking in India
 For
the first time the UN General Assembly begins a special session on June
25 devoted to a public health issue-aids. Estimates are that over 35 million
people are currently infected with HIV, the virus that causes aids. Over
16 million people have already died, with more than three-fourths of the
deaths in Africa alone.
For some years, smug in our moral superiority,
we believed that India would be immune to the aids epidemic. But that
has proved to be hopelessly wrong. Currently, according to official figures,
3.8-4 million Indians carry the HIV virus. If we go by the official figures,
about 0.4 per cent of Indians have the virus. If the infection level crosses
1 per cent, we have an epidemic on our hands. In six states, the epidemic
level has already been reached. These are Manipur, Nagaland, Maharashtra,
Andhra Pradesh, Karnataka and Tamil Nadu. On account of their proximity
to Thailand and Myanmar, Manipur and Nagaland are suffering because of
rampant intravenous drug use. But what about the other four economically
advanced states? It would be tempting to say that these are sexually more
promiscuous states and that people in north India are more conservative
and have greater fidelity to their sexual partners. There is actually
no evidence to suggest this. The high-incidence states are more urbanised,
have higher literacy and better reporting systems, and have a more active
network of NGOs. More crucially, migration both within and to and from
these states is higher. This is what could well be driving the epidemic.
Gujarat and Pondicherry may soon be joining the epidemic states.
 If
the experience of the past two-three years is any guide, the number of
Indians infected with the HIV virus could increase to about 4.5-5 million
in the next couple of years, stabilise and then start declining. This,
of course, assumes that the current low rates of infection in north India
are contained. Any increase here would trigger an epidemic of gigantic
proportions. Many international experts and Indian NGOs doubt the official
numbers. But only the Government has the mechanism to collect the data
through 230 sentinel centres spread across the country. Those who claim
that India's official numbers are fudged really do not have an independent
source to base their claims on.
In 2001-2, India will be spending about $43
million on aids control, 85 per cent of which comes from foreign donors.
This is more than what we spend on malaria, tuberculosis (TB) and other
public health programmes. Judged internationally, India is certainly under-spending
on aids. The only way our expenditure can go up is if more international
funds come in. Private philanthropic foundations are one source waiting
to be tapped. The $21 billion Gates Foundation is not only supporting
anti-aids programmes but is also stepping up its support for anti-malaria
and anti-TB research and projects. TB and the TB-aids nexus is of particular
relevance to us.
The other issue we need to face relates to the
anti-retroviral drugs that stop the replication of the virus. Right now,
India does not support the treatment by these drugs in its aids-control
programme on the grounds that it is prohibitively expensive (anywhere
between $1-3 per person per day). Brazil, for example, probably spends
around $300 million a year on its free anti-aids drugs programme alone.
But just two weeks back, US multinational Pfizer announced that it would
be offering an unlimited free supply of its drug Diflucan to combat fungal
infections that strike aids patients in 50 of the world's poorest and
most badly affected countries. Earlier in April, 39 pharmaceutical companies
withdrew their case against a 1997 law of the South African government
that allows it to obtain cheaper versions of expensive branded drugs like
those that combat aids from sources other than those who hold the patent.
Ironically, the man who has completely destabilised the world's pharmaceutical
industry and single-handedly induced a change in the approach to the prices
of and patents on anti-aids drugs is an Indian-Dr Yusuf Hamied, the London-based
chairman of Cipla, India's third largest drug company. With the involvement
of people like him and by participating in the New York-based Seth Barkley's
International aids Vaccine Initiative (IAVI) that was launched in 1996,
India can give its anti-aids programme a whole new dimension.
The anti-aids campaign has been taken up in
great earnest in Tamil Nadu and Andhra Pradesh. Sonagachi, Kolkata's red-light
district, has controlled HIV infection rates. The national blood safety
programme has also been quite successful. In the past, whether it was
smallpox or polio, India has shown it can achieve remarkable results.
The world thinks that India is waiting to go Africa's way. We can and
must prove these fears wrong, sooner rather than later.
(The author is with the Congress party. These
are his personal views.)
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