International Cost Limits Treatment of HIV in India

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International Cost Limits Treatment of HIV in India

By Angwin 938 words 28 July 2003 The Wall Street Journal A9 English

(Copyright © 2003, Dow & Company, Inc.)

CHENNAI, India -- Munuswamy Suresh used to be a middle-class Indian. He owned a

2,000-square foot house with three bedrooms, two bathrooms and a garage. But

since last year, he has been on the verge of poverty. Mr. Suresh, his wife and

his parents have been sharing a rented three bedroom, one bathroom house with

two other families. He has sold his television, camera and all of the family's

land and jewelry. The reason for his family's financial fall: the high cost of

buying antiretroviral AIDS treatment medication to keep the one wage-earner in

the family, Mr. Suresh, alive. The plight of HIV-infected Indians such as Mr.

Suresh is of particular concern today, as it becomes increasingly clear that

this country of about one billion people has a growing AIDS problem. Last week

the Indian government disclosed that the country's number of HIV/AIDS cases had

jumped 15% in 2002, raising the total number infected to 4.58 million, or about

0.5% of the population. The absolute number is!

the second highest in the world after South Africa, where an estimated 4.8

million, or 11% of the population, is infected, according to the

Mandela/HSRC study released in December. Most experts say the Indian

government's estimate is likely to be too conservative. In June, two researchers

from the University of California, Berkeley, published a paper in the British

Medical Journal saying the AIDS epidemic in India is following the same pattern

as that of sub-Saharan Africa in the 1980s, with the potential to be just as

devastating. The researchers, Malcolm Potts and Walsh, predict that by

2010, as many as 25 million Indians could be infected with HIV. According to the

World Bank, studies in Africa have shown that when more than 8% of a country's

population is infected with HIV, the country loses about 0.8% GDP growth every

year. Researchers are divided about the best way to address India's AIDS

epidemic.

Some philanthropists, such as the Bill and Melinda Gates Foundation, are focused

entirely on preventing the epidemic from spreading. The foundation has pledged

to spend $100 million in India during the next 10 years, starting with efforts

to convince truck drivers to practice safe sex. The epidemic is nearing a

tipping point where " there is a window of time to work on prevention before the

numbers will swamp us, " says Ashok , the project's director. Others say

it is foolish to focus on prevention alone. " You cannot separate care and

prevention, " says Dr. Suniti , director of Y.R.G. Care, the private AIDS

clinic that is treating Mr. Suresh. The Global Fund to fight AIDS, Tuberculosis

and Malaria has pledged to spend $100 million for AIDS care in India, which the

government says it will use to provide antiretroviral drugs for pregnant women

and newborns.

Both sides agree, however, that much more needs to be done to prevent the

epidemic from spiraling out of control. The Indian Health Ministry's AIDS policy

division says ! its annual budget for prevention and treatment was just $50

million in the fiscal year 2002-2003. And even though Indian manufacturers make

cheap AIDS treatment drugs that they sell to the rest of the world, the Indian

government says it can't afford to buy those drugs for its people. The generic

antiretrovirals cost less than $1 per patient per day. So, for now, India's

private AIDS clinics struggle to provide treatment on an extremely limited

basis. The Swiss nonprofit Francois-Xavier Bagnoud has convinced the Indian

state of Rajasthan to buy antiretroviral drugs for 10 of its 315 patients. The

Naz Foundation in New Delhi provides drugs for six orphaned children and to

pregnant women during their last two months.

The Freedom Foundation in Bangalore provides drugs for 120 of its 3,000

patients. " It's very difficult to choose " who will get the drugs, says Dr.

Nirmula Skill, who runs the Freedom Foundation clinic. " I look at who really

needs it the most: Are there people depending on them? Have they been abandoned

by their family? " R. Ravi Kumar, 34, a soft-spoken man with an easy smile is one

of the chosen ones. When his family discovered he was sick with HIV four years

ago, they threw him out. He arrived at the Freedom Foundation clinic

semi-comatose, suffering from tuberculosis. Now, the clinic pays for his

medicine and he works as an attendant in the clinic. " Now I can work, I have no

tiredness, " he says. " If it wasn't for the drugs, I wouldn't be here today. "

Even Dr. 's clinic, Y.R.G. Care, in Chennai, which is among the best

known and best-funded in the country with a $773,000 annual budget, only doles

out the drugs to about 10% of its more than 5,000 patients. Only pregnant

mothers receive the drugs free; relatively affluent patients like Mr. Suresh can

buy the drugs at a discount rate negotiated by the clinic. But Mr. Suresh will

soon run out of money to pay for the drugs. When he is feeling well, he can earn

3,000 rupees a month ($65) as an air-conditioner repairman. The medicine costs

1,600 to 2,000 rupees per month, not including the expensive viral load tests

that are required every few months. So he doesn't always buy his medicine. " When

I have money, I will purchase some little bits of medicine, " he says.

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