India to treat 1.5 million Positive people

[Guest guest]

New York Times article of interest

India Announces Plans to Expand Aids Therapy Programs

November 30, 2003

By AMY WALDMAN

NEW DELHI, Nov. 30 - India has decided to expand

substantially its program to provide antiretroviral therapy

to people with H.I.V. and AIDS, government officials say.

By April 2004, the government hopes to begin providing free

antiretroviral therapy to all H.I.V.-positive new parents,

all children under 15, and eventually, to all patients with

full-blown AIDS in the six states with the highest rates of

H.I.V./AIDS.

The decision amounts to a significant policy shift for

India, which has not previously attempted to offer

antiretroviral treatment on any significant scale, though

does provide drugs to try to prevent transmission from

mothers to babies in childbirth.

But several hurdles will have to be overcome by next

spring. The government must still reach a final agreement

with the country's pharmaceutical companies, who

manufacture generic versions of the medications, to lower

their prices, as the companies recently agreed to do in

Africa and the Caribbean.

The government has yet to identify " budgetary support " -

the money - to pay for drugs for up to 100,000 people, the

number it estimates would be served in the first year.

It also will have to recalibrate its weak public health

system to provide for far broader testing, and train

doctors and nurses to monitor the dosage and effects of the

therapy.

India is estimated to have at least 4.6 million people with

H.I.V. - the second-highest number in the world, after

South Africa. There were more than 600,000 new cases in

2002.

Doctors in India currently prescribe antiretroviral

therapy, but at about $1 a day, it is out of reach for most

people, with the per-capita income less than $500 a year.

Providing the drugs will also challenge India's

underfinanced health system. The government spends about $5

million a year on programs to prevent or treat H.I.V./AIDS,

with far greater resources - an estimated $95 million

annually - coming from outside donors like the World Bank

and the Bill and Melinda Gates Foundation.

Sushma Swaraj, India's minister for health and family

welfare, said she would approach the finance ministry for

money. The Global Fund to Fight AIDS, Tuberculosis, and

Malaria, based in Geneva. also has agreed to provide India

with $100 million over five years for a mix of prevention,

treatment, voluntary testing and counseling, although

technical disagreements have held up the signing of a final

agreement. Its director, Dr. Feachem, said it was

possible that more of the money could be committed to

treatment to support the new venture, but reducing the

price of the drugs will be critical.

Cipla, Ranbaxy Laboratories Ltd., and Matrix Laboratories,

now joined by a fourth Indian company, Hetero Drugs, as

well as a South African company, Aspen Pharmacare Holdings,

recently reached an agreement with the Jefferson

Clinton Foundation to provide the drug to four African and

nine Caribbean countries for 36 to 38 cents a day.

Under the agreement, the companies will increase production

in return for a guaranteed customer base. The companies

will supply at least 1.5 million patients over the next

five years, and the price of their raw materials will be

pre-negotiated. They will sell direct to the foundation or

the governments, rather than middlemen, and be paid

immediately.

But there has been no such agreement in India, where they

say past efforts to work with the government have been

frustrating. Ranbaxy on its own has quietly undertaken to

provide antiretroviral therapy directly to Indian patients

at less than 90 cents a day in AIDS-endemic states. Cipla

donates the drug used to prevent mother-to-child

transmission in the government program. But at this point,

" we are probably doing more outside the country than in the

country, " Cipla's chairman and managing director, Yusuf

Hamied, said in a recent interview.

He said the companies needed to be able to sustain the

manufacture of the drugs indefinitely, and predict in

advance how much would be required. " If the government

wants to buy, they must let us know for how many, when, and

do they have the money, " he said.

For the past two weeks, the companies and government have

been in what one participant called " back breaking "

negotiations over just those issues. Ms. Swaraj has made

clear that she would like the companies to provide lower

prices in India than those agreed to with the Clinton

Foundation.

" That's only natural because these are companies based in

India, " she said in a recent interview.

Industry representatives, in turn, say the government needs

to understand the business imperatives of companies that

have become Indian success stories and wealth creators.

The Clinton Foundation agreement, they say, left them a

small margin of profit that will allow their businesses to

keep growing and appease shareholders. To go any lower,

they say, will require concessions from the government,

such as exemptions on sales and excise tax.

Ms. Swaraj announced at a news conference today - the day

before elections in four important states - that an

agreement with the companies had been reached, but

privately both industry and government officials said

negotiations were continuing.

Still, the commitment to offer the therapy in itself is

significant in a country struggling, like many, to balance

prevention and treatment. It has been brought about,

analysts say, largely by Ms. Swaraj's personal commitment

to tackling the crisis. In the interview, she said the

government's approach to AIDS had undergone a " sea change "

in the past six months.

She has increased the supply of condoms to high-risk

populations - to 171 million this year from 114 million two

years ago - and sought to destigmatize the disease through

a campaign explaining how it is and is not spread. Over the

summer, India also convened its first parliamentary forum

on H.I.V./AIDS.

Advocates for AIDS patients, epidemiologists and donors had

criticized India, home to more than one billion people, for

being too slow and cautious in reacting to a steadily

spreading epidemic.

Some still worry, however, that another shift brought about

by Ms. Swaraj - the move away from what she called a

" condom-centric " public education campaign to a more

" holistic " one - could hurt efforts to prevent the disease.

As in many conservative societies, Indian officials have

been reluctant to engage in sexually explicit campaigns,

and Ms. Swaraj has made clear her distaste for prime-time

discussions of condoms on television. While 80 percent of

new infections in India are sexually transmitted, Ms.

Swaraj said it was important to focus on " all the routes of

transmission, " not just sex. Dr. Meenakshi Datta Ghosh, the

project director of the National AIDS Control Organization,

said an undue focus on sex could lead to an unfair

presumption that those who contracted H.I.V. had engaged in

" immoral " or " wicked " behavior.

She showed one current poster that reads: " If there is

loyalty and fidelity between husband and wife, there is no

space for H.I.V./AIDS " as an example of the government's

preferred approach.

The campaign now, she said, explains that AIDS is

transmitted through unprotected sex, and encourages people

to have protected sex, but does not explain how they should

protect themselves.

" That will come, " she added.

http://www.nytimes.com/2003/11/30/international/asia/30CND-

INDI.html?ex=1071219704 & ei=1 & en=76788941076964a6

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Message forwarded by Joya Banerjee

President Columbia Global Justice

joya.banerjee@...

212.945.8071