Two decades of HIV awareness: What gained and what we lost

[Guest guest]

TWO DECADES of HIV AWARENESS: What we gained and what we lost?

This World AIDS Day is time for us to take stock of past two decades, since

1985, when PHO launched its first AIDS Awareness Campaign from Mumbai.

Though we lost hoards of lives of people to HIV/AIDS, we achieved a great

deal in making Mumbai one of the most HIV-aware cities, Mumbai finally has a

reason for us to smile as the city that earned dubious distinction of being the

country’s AIDS capital in last decade, is now AIDS Control and AIDS Management

Capital of India. While harping on the negativities attached to HIV/AIDS

problem in India, we need to consciously change the connotation attached to

Maharashtra being the state with highest HIV Infections and Mumbai being the

AIDS capital of India. The state leads in Prevention, Control and Management of

HIV/AIDS in India. Andhra Pradesh with 2.7% and Karnataka with 2.4% HIV

prevalence have long overtaken Maharashtra with 2.1% HIV prevalence.

In an annual update released on 21st Nov. 2005, in New Delhi United Nations

Joint Programme on AIDS (UNAIDS) Chief Dr. Piot has strongly emphasized

on the threat to India and the urgency to contain the epidemic. However he over

emphasised on the HIV spread through Injection Drug Use (IDU); which in reality

is a miniscule problem compared to India’s population as also IDUs share in

total HIV pool. However, he dared for the first time, in challenging Indian

Government on its earlier stand of controlling the HIV spread in a major way

with only 28,000 new infections during 2004.

In fact this stand of National AIDS Control Organisation (NACO) had made a

laughing stock for itself, making the Planning Commission review the NACO

figures and functioning that later saw the exit of its Director Dr. S Y

Qureishi. Come December 1, all the constituent agencies and units of UNAIDS and

NACO issue different statements, glossy brochures and posters, newspaper

inserts, advertisements carrying photographs and statements of beloved leaders

on what they intend to achieve vis-Ã -vis HIV/AIDS.

It would be desirable if the UNAIDS and our Government come out with concrete,

implementable action plan, incorporating changes after studying successes and

failures in past two decades of the epidemic. We must overcome lackadaisical

attitude and

Moral overtones, become pragmatic about the prevention, control and management

of

HIV/AIDS. The need for Public-Private Partnership, moving away from

donor-dependence to avert the Crisis cannot be overemphasized.

India’s booming economy and its bright future can take a plunge soon, if

efficient

steps on war footing are not taken to avert the crisis posed by the dual

epidemic of Tuberculosis and HIV/AIDS. India’s distinction of being world’s

Information-Technology and pharma-capital is under severe threat.

However, India has an incredible capacity; which is yet to be exploited

Fully through true public-private partnership and can assist less fortunate

countries.

1. Past, Present and Future of the Epidemic in INDIA and MS: India's plunge in

the third phase, as seen from rising HIV trends among housewives and children

signaled a major AIDS crisis. From a terrible disease, AIDS is now a household

topic as a chronic manageable disorder. From more a psychosocial problem prior

to anti-HIV drugs, it is now more of a medical disease; where the virus needs

to be and can be contained, though it continues to have its socio-economic

ramifications. Though the official HIV estimate for India is 5.2 million, the

realistic figure could be ~ 10 millions (PHO), an average HIV rate of 1%. The

speed of HIV-spread has slowed down during last couple of years, but the

response to contain the epidemic needs to be hiked. Six states with 32%

Of country’s population have notable medico-socio-economic impact. In past

couple of years the state has been successful in containing HIV/AIDS, especially

Mumbai; which has shown plateau. Among other things, State leads in HIV

management and draws patients from all over India and other countries for

efficient HIV treatment and has ARV manufacturing units.

2. Free/Subsidised treatment for PLWHA: WHO/ UNAIDS initiative of 3 x 5: Over

90% of PLWHA in developed countries have access to ART, but access is Limited

to less than 5% of those in developing countries. WHO’s ambitious plan to

treat 3 million HIV/AIDS patients by 2005, popularly called 3 by 5 Initiativeâ€

has provided a glimmer of hope to millions of PLWHAs.

India decided to join in this effort and provide free anti-HIV treatment to

100,000 people from 2004 in 6 priority states including Maharashtra for this

dole. Currently some 10,000 PLWHAs are benefiting in India. Though a daunting

task, it is not impossible, if we really have a will to achieve this goal.

Excellent planning, proper treatment guidelines, thorough orientation to

physicians and laboratory back up are needed with fullest transparency.

India has capability to cater to the entire PLWHAs with affordable medicines

including Antiretroviral, at 4% of global cost. A one-Stop shop´ model, that

provides authentic education, proper counseling, treatment of OI, tests like

CD4/CD8 and ART at affordable price, developed by Unison Medicare needs to be

replicated in India and Africa. Our pharma companies provide ART at less than

Rs.1000/- pm.

3. Moving from 'Donor-Dependence' to 'Self-reliant' National AIDS Control

Program: Support from Bill Gates, the World Bank or Global Fund on AIDS,

Tuberculosis and Malaria for our AIDS program, pleases us all. But rationally

we feel ashamed! When Indian economy is booming, its foreign reserves are 120

billion US$ and it pre-paid ADB loans, do we need the World Bank loan to stop

AIDS? Our Health budget is a just 0.37% of GDP and 2% of the Defense budget,

but the Govt. has committed to raise it to 2%. We must mobilize business

community in contributing to the healthcare. If Gates can

donate 200 million US$ for India, why can’t our business giants match it for

our

own people? It seems that now the business houses are getting mobilized to fight

AIDS. High 'political will' to contain HIV is needed beyond occasions like World

AIDS Day, transgressed into realistic action plan, even by creating a special

AIDS Ministry as in Thailand. Make AIDS societies autonomous forceful bodies

with multi-sectoral collaboration. Government should spend its own funds at all

levels, for ownership and participation in the program.

Generate local human and economic resources for capacity building to overcome

'donor-dependence’ and 'donor fatigue’, critically review liability vis-Ã

-vis benefits of foreign collaborations. Continuum of program is not guaranteed

if it’s donor-driven. Time-tested models like ‘Saheli Project’ are

replicated to avoid re-inventing the wheel.

Strengthen AIDS case reporting system using local diagnostic criteria. Training

must

Emphasize attitudinal change towards PLWHA. Expose fake cures and fraudulent

people, quacks bullying PLWHAs. State should remove taxes on tests and drugs

required for ART and pass AIDS Anti-discrimination bill. Access to information,

counselling-testing should precede access to ART.

4. Women & Children: Reduce vulnerability of women to HIV by improving

health, legal and social status. Prevent mother to child transmission as an

emergency. Spending years to assess feasibility inflates number of HIV infected

children. Project like PHO model at Wadia Hospital (1993-2002) and included in

the UNAIDS 'best practice' should be replicated, to save our next generation,

rather than relying on a redundant African model of single-dose Nevirapine at

labour.

5. Youth, Alcohol & AIDS: Nearly 70% HIV cases are in age group 20- 35.

Often HIV prevention and promotion goes hand in hand. Few public-service

spots on AIDS prevention and several exotic surrogate ads on Alcohol promotion

with brand ambassadors, and poor prohibition law, are responsible for HIV

spread.

Alcohol leads to risky behaviours as it lowers inhibition and leads to increase

in HIV spread. PHO observed that alcohol consumption and visiting sex workers

increases many fold during festivities. Hence, make Ganesh Festival and

Navratri fully dry days. Teens are vulnerable to discotheques, pubs and Wet

parties followed by Sex parties. Provide youth with Sex Education and means to

protect from HIV/STDs and condoms.

Dr.I.S.Gilada, Secretary General, PHO & AIDS Society of India

DR GILADA " <gilada@...>