Re: India's ARV treatment programme is premature

[Guest guest]

Dear FORUM,

This is in response to Abhijit Bal <bal@...> article

" More Indians are living on HIV than dying of it. BMJ 16 January

2004 " reposted on eFORUM.

http://bmj.bmjjournals.com/cgi/eletters/328/7431/70-f#47080

First of all I am really disappointed to read an article, especially

the strong negative language used in this letter and the reputed

journal has encouraged to circulate this without editng the text.

This is not just because of the fact that I am from India and the

person who has written is also an India (Remember 'Greatest critics

of India are Indians').

There are some of the agruments that I propose:

1. It is true to feel frustrated about the inappropriate use of

antibiotics in India and also its aftermath in form of resistance.

However if in the fear of creating antibiotic resistance if we had

not introduced the antibiotics we would have never achieved the

control of infectious diseases to the extent that we have it today.

2. It is good to be cautious for ARV but it is hopeless to read that

you do not want to treat based on what ever assumptions some 'so

called experts' have in their mind about Indian health systems.

3. What evidence the author has in saying that " sole purpose of many

such institutes and organisations is to hold meetings, make

guidelines, generate data, carry out meaningless research and draw

funds in the name of the third world " . This is not true in its

interity. There are definately numerous organizations that work with

a mission of making difference to the society in India. So the

statement is false and deifnately hurting (one cannot let personal

frustrations in Science).

4. I have one more question. Is it ethical to deny treatment to

patient when we know something is available. If we do not provide

treatment to the patients (even if it is pallitive) then it is acting

unethical (if we know about the discussion on medical termination of

life).

5. Medical treatment in India is really advanced and India definately

has capacity to manage ARV. I would agree with the statement that we

need to increase our infrastructure for managing HIV cases. But at

the same time, I suggest to these researchers that instead of

critisizing the country's infrastructure is there any way they can go

down and conduct research to finding out some of the less expensive

markers to monitor HIV cases ( I am an optimist).

6. I would say that Government needs to be extremly careful about

adopting ARV treatment and seek specialist support for interventions.

7. We all know that any place is made with greats and worsts.. and we

want to pick up greats. We want to be optimistic.

That was some reaction to what I read. Sorry for being little

overreactive.

Now comes the issue of preventing secondary spread of HIV. It is

known that HIV spread can be prevented in the society by treating

existing pool of HIV patients. And all research is done in the

western countries that can afford ARV. Now the time comes when the

Government of India takes a major step in providing ARV to its

citizens then why do not we support it. Why limit all comforts and

security of life in the western world. Don't you think that adherence

to treatment regimen is also the issue with the western world? Don't

you think that is also causing a problem here in US.

But they are still willing to continue support the program of ARV,

because each and every researcher and scientist supports the

government initiative and provides best available solution. India

needs to learn from them, in sense that we need to dilligently apply

science and seek solution.

It is easy to sit and critize. Dont you think that accesibility to

ARV is a problem in western world? Yes it is a problem. Disorganized

management in instituting ARV is also a problem.. but everyone works

with a common mission 'to do the best for humanity'. Let us learn and

think to support the Government. We may have to be forceful to

advocate scientific interventions.. but we need to do.. I guess I am

making my opinion clear.

Please come out of synistic attitude and support the move to be the

best on this earth. Let us be a leading example in managing HIV in

resource restricted setups.

Thanks

Arun Karpur

E-mail: jaideva76@...