Interview with S Y Quraishi, NACO project director

[Guest guest]

AIDS no more confined to small pockets

Wednesday, 12 January , 2005, 12:52 Cynics often scoff at the

hyperbole that surrounds HIV/AIDS. As they see it, it is not as if

India is new to disease. We also live in a country where people can

fall seriously ill from ingesting dubious water and food.

So, what makes AIDS so special? Two simple facts: a) it is incurable

and, it can be sexually-transmitted; in a sexually-dynamic society

like India, this most natural of vectors can spell unimaginable

consequences.

The Indian government was swift in setting up a National AIDS

Committee in 1986, the very year that the first AIDS case in the

country was detected in Chennai, and launching a National AIDS Control

Programme (NACP) in 1987.

The National AIDS Control Organisation (NACO) has had 12 years of an

eventful existence. It has been in the middle of a storm since the

2003-2004 Comptroller and Auditor General's (CAG) report questioned

its policies and accused it of squandering funds. This led to the

transfer of then NACO chief, Meenakshi Dutta Ghosh.

S Y Quraishi, former director general of Doordarshan, stepped in

amidst all this pandemonium as NACO project director in September

2004. He faces an uphill task.

The numbers of the HIV positive are increasing exponentially. Many of

the infected don't suspect they have it because they don't belong to

the so-called high-risk groups. Many others have no knowledge of the

disease.

Meanwhile, even as reports come in that the government will run out of

its stock of anti-retro viral drugs by April 2005, Quraishi said his

strategies for addressing the problem:

What is the nature of your earlier association with AIDS projects?

Although I am new to the NACO, I was associated with the AIDS

programme as undersecretary, Youth Affairs, from 1992 to 1997. At that

time, we had a much-acclaimed project on youth awareness called

" Universities Talk AIDS " , which involved 159 universities. So, by the

time I joined the NACO, I knew the basics. I also knew that the

problem was grave and that there is no time to lose.

What is the AIDS/HIV awareness level in India?

Very low, even though the problem has been around for two decades.

There's a need to move much faster. Of course, some initiatives have

helped a lot in containing the problem, in the sense that it hasn't

assumed African proportions. There are some African nations where

about 30, 35, or even 37 per cent of the population is HIV positive.

In South Africa, the figure is 23 per cent. In India, only 0.9 per

cent of the population is HIV positive.But that should not make us

complacent. In sheer numbers, [india's AIDS/HIV population] is 5.1

million, and half a million are being added every year. The NACP,

which was adopted in 2002, seeks to achieve a zero rate of new

infections by 2007. To me, that is a very tall order.

We'll have to presume the whole country is practicing safe sex, and

for this we have to presume that they are aware of safe sex. They

should be aware of HIV, how it spreads, and how it can be prevented.

We should also take care of the stigma factor — people should also

know how the virus doesn't spread. We don't want fear, but an

understanding of the problem.

What is your budget?

Rs 259 crore. This year, the government gave us another Rs 217 crore.

Each year, we ask the state AIDS Control Societies to give an annual

action plan, which we then examine. So, even after the additional

money, we have only been able to approve 80 per cent of the states'

action plans, which means that there is a need, even on the basis of

what we have, for further scaling-up. What we need, first of all, is a

massive awareness campaign. What are we doing about communication?

The AIDS problem is not just an urban phenomenon, it also affects

rural areas. In fact, it is higher (59 per cent) in the villages.

Those days are long gone when the problem was confined to high-risk

groups in urban pockets, such as sex workers, homosexuals, drug

addicts, truck drivers, street children and migrant labourers. Today,

the problem has moved to the general population. This makes our work

more difficult, because, instead of concentrating our efforts in small

pockets, we now have to focus on the mainstream population.

Earlier, we classified India's states as high prevalence (six),

moderate prevalence (three) and low prevalence (the rest). This

nomenclature is misleading. The expression " low prevalence " gives a

sense of complacency. So, the first thing I did was coin new terms:

they are " high-vulnerable " states and " vulnerable " states. We have

designated about 13 states as high-vulnerable and an equal number as

vulnerable.

We have also launched a six-month campaign (January-June 2005) to

address the urgency of the problem. We will use every possible media.

From mid-February 2005, we will start showing a daily soap opera on

Doordarshan in which stories on women's empowerment and other issues

will be incorporated.

We have also formed a partnership with the Rajiv Gandhi Foundation

(RGF). They suggested we launch the Red Ribbon Express, on the lines

of the RGF's Lifeline Express, a mobile hospital that has been running

for 14 years. Our four trains will start from Jammu, Jodhpur, Guwahati

and Kanyakumari, and will travel for six months, halting at rural

stations.

Each train will have four coaches. One will carry an exhibition, one a

hospital and two will carry performing artistes to educate the people.

About 100 young people will be involved. Each will be given a bicycle

wherever the train halts, [which they will use to] cover 20-30

villages in one or two days and then move on.

You say that initiatives have been taken to contain the problem but

the CAG report says that NACO has been somewhat careless in spending

its funds.

We have started preparing a reply to that. The CAG says that we

haven't utilised the funds given to us. I think they are making a

mistake as we never got the funds that we asked for. The final budget

estimates that got approved were 40 per cent less than what we had

asked for.

First, we sanction a budget estimate (BE), and then, as we calculate

our expenditure, we draw up a revised expenditure (RE), which can be

both more or less than the BE. The RE is what we finally got, which

was less than what we had asked for. I believe there is a

communication gap. We had just Rs 9 crore to spend on publicity and

awareness campaigns, which is peanuts if you compare the whopping

amounts that Pepsi and Coke spend on their publicities.

Many agencies don't agree with the number of HIV-affected in India.

They say it is more than 5.1 million…

This is just irresponsible criticism. All the big agencies, such as

the World Health Organisation (WHO), the United Nations Programme on

AIDS (UNAIDS), the World Bank (WB) and government agencies like the

Indian Council of Medical Research (ICMR) and the National Family

Health Survey (NFHS) have endorsed our figures and methodology.

Our methodology is certified by government agencies. Despite that, we

are still open to suggestions. And the fact is: how does it [the

number of HIV-affected] matter? Even if it is 10 million, the problem

is there, it exists.

There were reports recently that the government's stock of anti-retro

virals will last only for another three months…

Yes, but we are going to place orders soon. The problem has been taken

care of because Cipla, which had been earlier de-listed by the WHO for

not living up to its standards, has now been taken back. Even if that

had not happened, we would have floated a global tender. Even though

the international bid would have been expensive, we would still have

taken the step because the health of our patients is dearer to us.

Uttar Pradesh and Bihar have been included in the category of

" high-vulnerable " states. What makes them so vulnerable?

The conditions in both states are ripe — poverty, poor health

services, illiteracy, absence of family planning, migrant labour, and

cross-border sex traffic from Nepal.

A lot of people feel AIDS is overrated and that there are other, more

worrisome diseases…

All those who say so are cynical. If we start feeling complacent, the

consequences will be disastrous. AIDS spreads faster than other

diseases. We need to stop considering it a " foreigner's problem " .

Is the methodology of collecting estimates of ethically dubious?

People who come to antenatal clinics and blood banks aren't aware that

they are being anonymously tested for HIV/AIDS.

The fact is that the people are anonymously tested. So, they don't

know about it, but we don't either. We don't know who the HIV positive

persons are. They are just samples. This is how we get to know the

incidence rate.

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