Re: 50% lesser people with HIV government says – who will benefit? … [Part 2]

[Guest guest]

50% lesser people with HIV government says – who will benefit? …

[Part 2]

The newspapers are resounding with " HIV epidemic is on the

wane " ; " AIDS threat recedes " ; " AIDS scare has got halved " . Now it

is also surprising how the media is also rushing on headlong into

the `numbers game' without communicating the actual reality. The

reality, as all of us know, is that this is just a revelation

purportedly based on a re-assessment of collection of data and a

combination of different sources. This is not a `reversal' of the

epidemic. Nor is it due to a fantastic equality based, user friendly,

accessible AIDS response by either NACO or a combination of NACO, and

NGOs and recently joined foundations, not to mention our forward

looking minister. Nor is there a lesser `risk' of acquiring HIV.

I say this again – standing to risk stating the obvious – BECAUSE

this is lost to my next door neighbour, my chemist, the watchman at

the gate, the teacher in my old school, the intelligent professor of

economics in house in the next street. Even to the GP who treats the

long line of people with sniffing noses in my middle class colony, or

the mechanic who lives in the unauthorized colony or basti nearby.

And this is only in a city….

This widely publicized yet unclear message has all the potential of

turning back the wheel to where everyone believed that HIV cannot

happen to them. Because the seriousness of assessing a risk situation

is fast eroded. Even at AIIMS microbiology lab where I was yesterday –

the people waiting to get their Eliza and the technicians had a good

laugh at this yo –yo situation. And one quipped – tomorrow another

research will come along and say that there are 10 million more….

Then what will the government and UNAIDS do?

Moreover, the fact that one may be even remotely `at risk' or the

need to protect oneself is now not hitting you on the street, in the

office, in the urban slum, in the small town 30 kms away - as a knot

in the stomach.

That's for prevention, and as far as acceptance of positive people –

there is now even more danger of deaths by stoning, mostly of

powerless women, and children thrown out of schools.

The government still SAYS there is no room for complacency – but who

is going to listen and follow. Now the new figures make the whole

effort of AIDS control so far look ridiculous, at least to some of

us – imagine to the man who is not a serious AIDS person, activist

(whatever) – it `half' as dangerous. Did the government even realize

or stop to consider the interpretations possible. That is what seems

to me a gross, unfair, undermining of the work all of us have done so

far – including NACO.

As I have said before – and many have before me - HIV prevalence and

incidence data has always been debated, and in calculations, it is

said the best data can be suspect. That is the trouble with

the `suspicious serendipity' surrounding the discussions of the

almost magical minus 50% HIV estimates for India just announced.

There has been scant public debate - if at all; the tyranny of the

science of statistics keeping the lay HIV worker and common sense

questions well at bay. Why have these results not been placed in the

public arena before announcement so there can be at least a semblance

of agreement between experts and civil society? Before basing such a

critical analysis – and a final conclusion to the fate of HIV

responses in India? This is not like our election analysis - election

pollsters get caught in the end when they make mistakes; but while

they are at it, they at least provide what some would even call

puerile entertainment. HIV estimates, on the other hand, need to be

understood and acted upon by the last outreach worker in the remotest

villages and bastis of India.

For the sake of better understanding of the new numbers, we need to

place the answers of the following questions in the public domain

especially about the newly added community data from the household

survey:

• The household survey methodology has been around for a long

time. Why was it not used before if it is indeed a better methodology

for estimating HIV prevalence. Why this delay?

• What was the sampling methodology for the household survey?

The UNAIDS press release mentions that 100,000 people were surveyed

from 6 states. Not one lakh households but one lakh people! What is

NOT clear is that will this include ALL people who were found at home

in the sample area at ONE point in time – e.g if a household with 20

people is among those – then, that household may have octogenarians,

and 5, 2, 1 year old children – and would they then be part of the

number?

• It was stated at the launch that those among them who

voluntarily (?!) consented to giving their blood for an HIV test were

tested. What was the level of consent sought and received? What are

the demographics of this sample? Is there any clarity on whether one

is at risk or not at risk!

• How many blood samples were collected? Where were they

tested? Then is this a test at ONE point in point in time – so will

each person in that survey be tested again?

• The house hold survey methodology has its share of severe

critics. Was an analysis done of the level of efficacy of this

methodology and its gaps? If so, this analysis should be made public.

• Was an analysis done of the efficacy or otherwise of the

sentinel surveillance method? If yes, the findings of this analysis

should be made public.

• Will the household survey for HIV estimations be done every

year? If yes, then which organisations will be contracted to do it?

If no, then at what intervals will it be done?

Civil society has not been told of any details in entirety and no

debate has been encouraged. Where is the transparency in this era of

right to information? Interestingly the NFHS and the Gates Foundation

Survey used by the government to come to this conclusion – have both

NOT been released!

Another thing that needs mention is where the financial backing came

for all this research. The NFHS survey component is purportedly said

to be funded by USAID (who now promote prevention based heavily on

abstinence and do not work with agencies who work for legalising sex

work or organise sex workers); the Bill Gates foundation is funding

the other research (which is well known for its prevention work

mainly with high risk groups only), while the world bank has

eventually underwritten the increase in surveillance and

the `linking' of the research efforts. So the backing is mainly

coming from prevention oriented agencies

Plus the future course of action is spelled out clearly as a

prevention focus with certain groups mainly. `Mainly' is just a step

or even a micro step away from `only'.

Why not think in a different way on this? Why not have an open, widely

communicated commitment (as strongly as the ones made at present in media) to

effectively use the method of prevention with the allure of treatment – using

treatment as a tool for prevention – universal access to all – without

discrimination – and therefore encourage testing.

So far the main difficulty in promoting testing was that there was no incentive

for many who may have been at risk. And use the cohort that WILL come – to

encourage prevention in engaging ways.

That's where the ad agencies being paid huge sums can amply help, can't they?

That's where Clinton Foundation can help, that's where even Gates Foundation

can place their bets, and the Gere Foundation can push more….. not to mention

NACO. But this step is but a small component of NACP 3.

For a minute even if we agree there are only 2.5 million – put the money on

treatment with a prevention push – why not? That's a creative way for using the

money which is no doubt going to become less and less. Save lives and keep

lesser people at risk.

If India is to meet its accepted commitment to universal access by

2010 it cannot afford to just focus on prevention alone - there is no

debate that the only effective response is a comprehensive one

focusing on treatment, prevention and care – all that are linked

intricately.

In communities across India where press conferences don't matter -

the reality is that millions still lack access to treatment and die

needless deaths every day, over 50% of women in rural India still

have not heard about AIDS; those most vulnerable to HIV such as sex

workers and injecting drug users still face widespread stigma and

discrimination, every day we hear reports that HIV positive women

across the country are thrown out of homes and hospitals, the poor in

India overwhelmingly denied their right to basic healthcare….

We at ActionAid call on the Indian government to publish the full

report and methodology that reveals new data indicating reduced HIV

numbers in India.

It is imperative to have them face an informed public debate on

HIV/AIDS data rather than jump to conclusions as these are a matter

of life and death to millions.

Emphatically the government must not to use this new data as an

excuse to reduce action and funding in any area to reverse the HIV

and AIDS epidemic. Either next year or the year after or any future

time. And no politician should somehow wake out of slumber and demand

a reduction of money and political importance in parliament using

these new numbers as an excuse, and gain cheap publicity. We MUST, as

any semblance of civil society, uniformly believe and say out loud

that there is NO ROOM for any tardiness or complacency.

So much seems to be behind curtains in this whole communication … so

much not debated or agreed. The jury is still out on this issue. The

HIV community who have to defend the numbers every time they go out

into the community to enrol participation of people, will need some

clear, dejargonised, plain speak from those who have been involved in

the number juggling.

Again. Ask yourself who is going to benefit from this?

Ramesh Venkataraman

Asia HIV and AIDS coordinator

ActionAid International

e-mail: <Ramesh.Venkataraman@...>