Getting a grip on AIDS wide angle

[Guest guest]

Getting a grip on AIDS wide angle

BACHI KARKARIA

TIMES NEWS NETWORK [ SUNDAY, APRIL 24, 2005 12:40:53 AM ]

India's AIDS control programme behaves disturbingly like the HIV.

Just when you think you've got this slimy little virus figured out,

it knocks you down with a new manifestation. The bouncers have been

coming thick and fast this month.

In early April, an AIIMS study warned that Indians have a greater

proclivity for AIDS. This week, Feachem, director of the

Global Fund for AIDS, TB and

Malaria, pronounced that India has outpaced South Africa in the

number of HIV-infected; the director-general of Assam Rifles

disclosed that he was losing more personnel to the virus than to

militancy; and in Mumbai three HIV+ people committed suicide in as

many days, two in the same JJ Group of hospitals.

The first two warnings have expectedly been denied. The jury will

always be out on genetic predisposition aggravated by environmental

co-conspirators, but our long familiarity with the politics of

numbers should make us stop quibbling over dubious or debatable one-

upmanship. Instead we should simply work on the premise that

critical mass is a reality, and response must match this magnitude,

all gloves and masks off, though only metaphorically.

In the late '80s itself, control was in danger of being hijacked by

official prickliness on the figures of incidence — which had rudely

pulled off the veil of hypocrisy over our chaste monogamy and sexual

mores. This moral smugness, in its time, had stymied early

intervention. Feachem's math might take away our second complacency.

For long we have believed that our comparatively low prevalence

gives us the necessary elbowroom to prevent the kind of AIDS

explosion which has virtually wiped off the economically productive

generation in sub-Saharan Africa, and inflicted a social cost as

debilitating as the clinical syndrome.

The serial suicides are brutal and frontal. They permit no luxury of

theoretical debate. They force us to confront the unbearable ravages

of collapsed immunity as destructive as the stigma. The men who

plunged to death on Tuesday and Wednesday had been in a hospital, so

even if they were already in the AIDS grip, they were also within

the grasp of care. They were in an institutional setting where their

distress could be sensed, and defused.

In the past decade we have learnt — and should have taught — how

possible it is for the HIV+ to lead a normal life, provided they

take care of their bodies and observe the safe sex practices that

everyone must. The virus may not have been tamed, but the new

phrase, People Living With AIDS (PLWA) is not just a clever

communications sweetener. Infection has been carried into the home

and into the districts, but the old dread of full-blown and dead in

10 years, no longer applies.

Drugs are still prohibitively expensive and out-of-reach despite

NACO making treatment central to its programme, but individually

calibrated anti-retroviral cocktails have replaced the traumatic

AZT. Phase 1 vaccine trials are underway in Pune. Strategic

interventions are happening, though a one-size-fits-all general

awareness campaign may never be possible, and it will always be

argued that targeted interventions which revolve around commercial

sex actually aggravate ghettoisation, stigma — and hypocrisy-stoked

complacence. We need to ring the alarm bells, but there are no

longer any grounds for the early, ignorant hysteria.

The good news comes from people like the doughty 27-year-old HIV+

Mumbai woman who walked into JJ hospital thumbing her nose at the

bogeys resurrected by the suicide jumps; she proclaimed to all

present, " Look how healthy I am. " The bad news comes from the same

quarter, and the one who should have quelled it. A doctor back home

had told her merely indisposed sister-in-law that she too had caught

the AIDS virus — because she'd used the same glass. You can take the

message to the trough; but it's no use if the the horse doesn't

drink it.

http://timesofindia.indiatimes.com/articleshow/1086512.cms