The HIV/AIDS funding farce

[Guest guest]

The HIV/AIDS funding farce

Tuesday July 24, 02:00 AM

Health Minister Anbumani Ramadoss is quoted as having said, " We have

spent so much on the programme and finally the results are there "

('India's Aids Scare Just Got Halved', IE, July 7).

Results? Is the health minister kidding? India's HIV/AIDS re-

estimates, conceded after getting National Aids Control Programme-III

(NACP-III) approved by the Cabinet Committee on Economic Affairs for

a programme based on 5.2 million HIV-numbers, is a long overdue

correction of inaccurate estimates, arbitrarily boosted since 1998

and long challenged by many experts. Ramadoss needs to do serious

introspection on his ministry's functioning.

The large population-based blood-test sampling from the National

Health Fertility Survey and the Guntur district community study,

highlighting a 60 per cent difference from surveillance estimates put

forward by NACO, has for the past year provided incontrovertible,

large-scale evidence of inflated HIV-estimates. This was critically

documented as early as 2000 by the Independent Commission on Health

in India (ICHI) Experts Consultation in a report that was provided to

the health ministry and NACO.

The ICHI report pointed to arbitrary hikes: NACO's end-1994 estimate

of 1.75 million HIV-infected spiralled to 4 million by 1998.

Challenged, NACO temporarily downplayed the figures. Then another

NACO Expert Group (1999) developed a different estimation process

that placed HIV-infected in the range of 2.4 to 3.7 million in 1999.

Subsequently, NACO arbitrarily picked the higher end, adding a 20 per

cent variable. This base figure has steadily grown. Alongside, the

steady expansion of sentinel surveillance sites - 55(1994) to 703

(2005) - diminished scientific longitudinal tracking. The ICHI had

noted at the start of NACP-II: " Flawed estimates at the outset could

result in scams of enormous public expenditures vindicated through

notional reduction of 'infections averted' from levels not scaled in

the first place! "

The point bears repetition as NACP-III launches with a seeming

correction of the statistical parameters. The AIDS scare has halved

but the health minister's gung-ho response to the changed figures is

scary. He appears to be claiming results from large sums of money

spent in controlling numbers that did not exist in the first place.

He also promises more " vigorous funding " , despite overwhelming

evidence of mismanagement during NACP-II and even while other vital

areas of healthcare perceptibly lag.

Just as pertinent are the issues surrounding NACP-III's strategic

thrust. Two-thirds of Rs 11,585 crore are earmarked for prevention

but the bulk is for the NACP-III centrepiece: Targeted Interventions

for High-Risk Persons (TIHRP) focus on three major categories:

commercial sex workers (CSW); men having sex with men (MSM); and

injecting drug-users (IDU). It is a minimal package but is ironically

termed comprehensive. Altogether, Rs 6,000 to 7,000 crore is

allocated for the narrow " non-judgmental, non-interfering " servicing

of high-risk persons even as there is nothing to proactively reduce

high-risk exposure or promote alternative low-risk lifestyles,

despite specific directives to NACO for broadening prevention issued

by the HRD parliamentary standing committee examining immoral traffic

prevention act amendments.

The TIHRP operational targets are prime indicators for monitoring

NACP-III achievements. But how realistic are the targets set? The

NACP-III Expert Group on High Risk Persons Estimations dismisses out

of hand as " crude estimates " the " mappings " of high-risk persons

conducted by each state through expensive, extensive research

comprising major NACP-II activities.

Other financial points require scrutiny: only Rs 8023 crore are

within the national budget. Of this Rs 5162 crore is from external

aid and is concentrated on TIHRP/condom-provision/STD-services, with

just token attention being paid to care treatment, exposing India's

sleaziest aspects to outsider involvement. India's contribution - Rs

2861 crore - absorbs Rs 2,400 crore from the National Rural Health

Mission, suborning it to HIV/AIDS as primary healthcare is already to

contraception/immunisation/pulse polio. The biggest outlay - Rs 2000

crore - is for condoms, with just Rs 24 crore for clean blood

storage! Further, a government committed to downsizing provides Rs

418 crore to a manifold increase in NACO's strength of 800, with

1,371 new posts and 1,200 contractual appointments.

What are these figures really based on? The fiscal farce arising from

showering scarce resources on inflated numbers is one part of the

story. The other is the social, ethical and law and order

implications of such unprecedented and large-scale collectivisation

of high-risk individuals. The whole approach needs deeper

consideration lest the whole strategy boomerangs.

The writer has served as an advisor and additional secretary,

ministry of health & family welfare

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