The burgeoning Indian AIDS epidemic: H. Mayer, M.D

[Guest guest]

The burgeoning Indian AIDS epidemic

H. Mayer, M.D

[ H. Mayer, M.D., is a professor of medicine and community

health at Brown Medical School and directs the Brown University AIDS

Program. He also serves as medical research director at Fenway

Community Health in Boston and as an advisor to Health Action AIDS,

a project of Physicians for Human Rights]

India, home to one-sixth of the human race, has an AIDS epidemic.

Five million Indians are living with HIV infection. The stakes are

high; the government is racing against time.

In Mumbai, India, there are close to half a million HIV-infected

people, making it the greatest urban epidemic on earth. On ward

rounds last week at a hospital in Mumbai, formerly Bombay, I saw

dozens of desperately ill AIDS patients receiving fine medical care,

despite the resource-constrained circumstances.

The head of the hospital's AIDS program told me she was optimistic

about the National AIDS Control Organization's plan to make life-

saving medicines and clinical care available to 100,000 people

across the country who desperately need treatment. But in the same

hospital, we saw a patient going blind because of the lack of

affordable medical treatment for cytomegalovirus retinitis, a late

complication of AIDS, and potentially toxic antifungal medications

had to be dripped in via an antiquated intravenous catheter, under

the watchful gaze of nurses, because of the unavailability of

automated pumps and monitors.

India is racing against time and needs to mobilize now. Already 5

million Indians are living with HIV, and the virus is spreading

rapidly in vulnerable urban populations. In one study, two of three

sex workers in Mumbai, a city of 16 million, were found to be HIV-

infected, and in the northeast near the Burma border, in Manipur and

Nagaland, injection drug users have high infection rates. At the

same time, over the last decade or so, as the Indian economy has

grown, truckers, laborers and businessmen in several southern states

have acquired HIV through extramarital sex and infected their wives

and infants.

The face of AIDS in India is increasingly that of young married

women who are under pressure to have children or be abused,

abandoned or worse. Outside of a few major cities, there is no

organized gay community. Homosexual male sex is not uncommon, but

since it is illegal, it is not discussed in public, limiting

effective prevention efforts.

Community-based organizations have risen to address the complex

needs posed by the epidemic, ranging from homes for AIDS orphans to

services for battered women to comprehensive care centers. One model

program, YRGCare, in Chennai, treats more than 7,000 people living

with HIV, providing services and medications on a sliding scale.

Although they now have more than 2,000 people on antiretroviral

therapy, they estimate that they follow an almost an equal number

who need treatment but lack the means to pay. Chennai's state, Tamil

Nadu, may have a half million HIV-infected people and tens of

thousands who will die soon if they do not have access to

medications.

The stakes are high. An unchecked HIV epidemic can undermine the

impressive economic gains of the world's largest democracy and lead

to a resurgence of tuberculosis and other health problems, with

consequences beyond those experienced by the HIV-infected

population. The Indian government has created several centers of

excellence, ranging from public hospitals to former TB sanitaria.

But these programs need to be replicated across this large, densely

populated and ethnically diverse nation with sufficient speed to

avert a public health disaster. The Indians have engaged a variety

of partners in their efforts, ranging from the UNAIDS Program, to

the U.S. Centers for Disease Control, to the Clinton Foundation, but

more resources are needed.

India is the home of several generic drug manufacturers, whose

combination pills and drug price cuts helped to spur the ethical

imperative to treat millions of people living with AIDs throughout

the developing world. I saw people who had started antiretroviral

therapy and were coming in for their follow-up visits. Their

vitality was a testimonial for the efficacy of the medications.

The key question is: How many others can be treated before it is too

late? When Oppenheimer, father of the atomic bomb, saw the

first atomic bomb blast, he quoted the sacred Hindu text, the

Bhagavad Gita: " I am Shiva, destroyer of worlds. " With an increased

awareness of the stakes involved, let us hope that concerted action

will prevent AIDS from becoming the most malignant incarnation of

this Shiva in the home of one sixth of humanity.

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