Re: India’s ARV treatment programme is premature

January 30, 2004

More Indians are living on HIV than dying of it. BMJ 16 January 2004

The Indian Government's decision to supply antiretroviral drugs free

of cost is dubious to say the least. What worries me more than the

lack of infrastructure is the potential misuse of these medications.

While working as a doctor in India, I had come across several

patients who were prescribed a month's or even a week's course of

zidovudine often by qualified physicians. Many of these patients

could actually afford an appropriate and complete course of treatment

based on CD4 counts, plasma viral load and clinical parameters. While

this could be due to lack of knowledge among doctors, there is also

an utter disregard for dignity of human life- a malaise affecting the

entire society and not just limited to doctors. Availability of free

drugs will only result in overprescribing and inappropriate

prescribing leading to 'antibioticisation' of antivirals.

Mechanisms to develop stringent controls over prescriptions and

procurement of drugs will remain a part of another set of guidelines

that will never be adhered to. Some of the biggest culprits in this

regard are the Governmental and Non-Governmental organisations

involved in research on HIV and treatment of HIV infected

individuals. The 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. To me it appears that more people in India are living on

HIV than dying of it.

Abhijit Bal,

Specialist Registrar, Dept. of Microbiology, The General Infirmary,

Leeds LS1 3EX, UK, Send response to BMJ journal:

E-mail: bal@...

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