Declare HIV/AIDS a National Crisis

[Guest guest]

Declare HIV-AIDS a crisis

Subir Roy / New Delhi August 24, 2005

Indians who take pride in the country being one of the largest

producers of so many things from milk to engineers, must wake up to

the fact that it has the second-highest number of AIDS- and HIV-

affected people. And as this is going up every year by half a

million, the first place will most likely come its way soon.

There are two particularly disturbing aspects about the prevalence

of HIV-AIDS in the country. One, it is most rampant in some of the

most prosperous and otherwise successful states in the country like

Andhra Pradesh, Maharashtra, Goa, Karnataka and Tamil Nadu, as also

three small north eastern states like Manipur, Mizoram and Nagaland.

These account for 80 per cent of all the victims in the country. As

the health status south of the Vindyas is ahead of the rest of the

country, the HIV-AIDS epidemic has the deadly potential of striking

where national human development has fared the best.

The future is more forbidding than the past because the yearly level

of fresh infections is not going down, as it has been even in a

country like Cambodia.

In India now the disease has spread from specific high-risk groups

to the population in general and from urban areas increasingly into

the countryside. In the states mentioned, the level of HIV infection

among women attending pre-natal care centres has crossed 1 per cent.

If India is to remain economically resurgent it will have to

recognise that it has an HIV-AIDS epidemic on its hands and fight it

on the same footing.

The Indian system has repeatedly been able to rise to the occasion

during a crisis. While controlling and getting the better of the

epidemic, there may well be a great spin-off benefit. The overall

effort will most likely take the health care delivery system on to a

higher level of capability and effectiveness.

HIV-AIDS has to be fought not at the national level but at the micro

level of dialects and in economically backward pockets, where the

message of awareness, prevention and lifestyle changes has to be

reached.

So much more than a national government directed project, a

grassroots campaign by volunteers is essential. The sheer ignorance

and prejudice even among public health care providers, going right

up to the heads of institutions, when it comes to treating HIV-AIDS

patients, makes this a task that has to be critically energised by

volunteers who care and are committed.

Other than telling poor people in their own language how to keep

away from the disease, the prevention campaign has to concentrate on

three specific groups—migrant workers, truck drivers and sex

workers.

Migrant workers who move for work to areas where they do not know

the local language nor have roots or family, turn to sex workers and

don't have the right help to turn to when afflicted. And when they

are back home they run the risk of passing on an acquired infection

to their wives and future children.

According to one statistic, 87 per cent of truck drivers go for

frequent and indiscriminate sex but only 11 per cent of them use

condoms. Both for them and sex workers, campaigning to make use of

condoms a habit remains the only effective means of prevention.

The one good news in this regard is the success that voluntary

groups have had in Kolkata's main red light district in raising the

use of condoms.

At the organised level, increasingly larger numbers of people have

to be screened to detect the HIV positive. Detection till now mostly

takes place when patients admitted for surgery are screened without

their knowledge.

And of course those detected positive are promptly thrown out. The

public healthcare system, which will have to fight most of the HIV-

AIDS battle, has the biggest role to play in treating the infected.

The bad news is that there is no sign yet of an AIDS vaccine but the

good news is that with the advent of anti-retroviral drugs, AIDS

symptoms can be kept at bay and it is possible to lead healthy

lives, turning the deadly scourge into a " remediable adversity " .

But to administer these drugs, mostly free to poor people, you need

a health service that works and enough government funding. Neither

of them is available in India. This is not for want of a successful

model, and that too in a developing country.

Brazil has led an exemplary fight against HIV-AIDS so that it has

reduced the level of infection to less than half of what was earlier

projected.

It has achieved this by not being squeamish in publicly dealing with

the subject; handed out condoms, syringes and needles freely;

educated sex workers; treated victims freely; effectively fought

drug majors and managed to buy generic versions of those drugs

cheaply; and spent a massive $1.8 billion on them over six years.

India's tragedy is that Indian companies manufacture a lot of those

drugs! But India has neither the mechanism nor the funding to give

the same medicine to its own victims.

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