WSJ article on HIV drugs in India.

[Guest guest]

Dear FORUM,

Here's an interesting article from the Wall Street Journal about the HIV

epidemic in India. It is quite clear who's tune Mr. n is dancing

for!. Please could somebody inform this ‘professor of development’, People

living with HIV/AIDS in India are not victims! Such attitudes are what if

fueling the epidemic.

How to Help India's AIDS Victims

By JULIAN MORRIS

July 9, 2004

Next week, around 10,000 people will converge on Bangkok for the biennial

conference of the International AIDS Society, which has as its theme, " Access

for All. " No doubt activists will use the occasion once again to promote their

view that access to medicines is being limited by evil pharmaceutical companies

that use patents to drive up prices. If only it were so simple.

Sadly, the patent red herring has diverted attention from the real reasons why

people in poor countries are not getting medications.

In Asia, this is a crucial issue, as AIDS sweeps through the region. And

for India in particular, which is home to 61% of all HIV-infected people in

Asia.

According to a report issued by UNAids, just over 5 million people in India

are infected with HIV. Of these, perhaps 500,000 would benefit from

anti-retroviral (ARV) therapy, but only around 30,000 people are currently

receiving treatment. Why? It's not because of patents -- India doesn't recognize

patents on pharmaceutical products. And it's not for a lack

of local production, either. India is home to around 20,000 pharmaceutical

companies, several of which produce ARVs. No, India's access problem,

like its poverty, is a function of inept, inefficient and corrupt governance.

From the local land courts to the central government, India remains bound

in red tape. Entrepreneurship is undermined by absurd restrictions on the

ownership of land and the operation of business.

Tradesmen of all kinds, from the lowliest rickshaw driver to the wealthiest

doctor, are constantly harassed by police, who use daft rules to extract

bribes. As a result, about 90% of India's population operates " informally " --

at the edge of the law. So, in spite of the rapid growth of Bangalore's IT

industry, the majority of India's population remains in abject poverty, unable

to escape from the lowest rung.

With over 600 million people living on about a dollar a day, the ability to

pay for medicine of any kind is clearly limited.

Even more so AIDS medicines, which still cost hundreds of dollars a year -- and

must be taken day in, day out forever because, although massive advancements

have been made in treatment, there is still no cure.

Distribution is another major problem. At the border between Delhi and Uttar

Pradesh, India's largest state, trucks queue for miles, apparently aimlessly,

their drivers sitting on the roadside drinking tea. Very gradually, the front of

the queue moves forward, as another driver finally gets his border chit

processed -- a task that can take a day or more.

In this time, the contents of the truck often perish,or are stolen by bandits.

In temperatures of 90 degrees Fahrenheit or ore, medicines can

simply melt. On the other hand, transporting them in refrigerated trucks

drives up costs, making them less affordable.

But distribution does not end with the trucks transporting medicines. Far

more important is the oversight of trained medical practitioners. Yet the

country's health-care system is a shambles. The state-run system is a bad

joke, with hospitals and clinics massively understaffed and under-funded.

(Bureaucrats in New Delhi look in awe at Britain's crumbling National

Health Service.) As a result, most Indians receive their health care

from the private sector, but even that does not reach many. Meanwhile, most

of the thousands of charities that supply health-care service to the poor

cannot afford to treat more than a few people with AIDS.

Medical provision of ARVs requires not only a constant supply of medicine

but also regular monitoring to ensure that patients take the correct doses

of appropriate combinations of medicine. Adverse reactions to ARVs are

common, and it is very important to ensure that people are given appropriate

drugs and that they continue taking them. For if they stop taking them, this

can lead to resistance.

Lack of clean water poses a further substantial problem. HIV weakens the

immune system and makes patients susceptible to disease -- it is the nature

of AIDS that victims die of other illnesses. In most of India, public water

supplies are contaminated with all manner of bacteria, making them deadly

to those with weak immune systems. So, even if one were able to solve the

problem of distributing AIDS medicines, many HIV positive people would

still die from drinking the water they take them with.

These problems do not lend themselves to a simple solution. In fact simple

" solutions " may make the problem worse. Merely increasing spending on

AIDS -- as the U.N. proposes -- is unlikely to resolve the problems of

poverty or lack of clean water and, while it may pay for a few doctors for a

short period, it is highly unlikely to make much impact

on India's medical infrastructure.

Those concerned about improving AIDS treatment in India would do well to

consider these underlying issues and promote solutions that come from

empowering Indians to solve their own problems. It is far better to

create a sustainable medical infrastructure, based on private-sector

investment, than to support fly-by-night clinics built with foreign aid.

Likewise, it is far better for Indians to be able to pay for their own

health care than to be reliant on external intervention. For that, India

must improve its system of property rights and contracts and remove

layers of bureaucracy. In addition, stronger intellectual-property rules --

especially those relating to product patents -- far from acting as a

barrier to access, may actually provide the incentive for the development

of new AIDS therapies in India. As resistance to existing therapies increases,

this will become an important aspect of enhancing access.

There are no simple solutions to India's AIDS problem, but these are some of

the relatively simple things that can be done that might lead to a solution.

__________________

Mr. is director of the International Policy Network, a London-based

think tank focusing on international development issues.

Director, International Policy Network, Research Fellow, Institute of Economic

Affairs, Visiting Professor, University of Buckingham

Contact

n.morris@...