AIDS figures, funds don’t add up

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AIDS figures, funds don't add up

By Rashme Sehgal, Sunday December 9, 12:19 AM

New Delhi, Dec. 8: The medical fraternity is questioning why the

Cabinet Committee on Economic Affairs (CCEA) has sanctioned Rs 11,585

crores for controlling HIV/AIDS after the National AIDS Control

Organisation (Naco) admitted that HIV/AIDS deaths in India have been

grossly exaggerated.

NACO had a few weeks ago stated that HIV prevalence estimates are

down from 5.5 million to 2.5 million (0.9 to 0.36 per cent) of the

population. Epidemiologists and statisticians question the

disproportionate amount of funding being spent on a " mere " 2.5

million " high risk population " .

Several global experts, including Dr Chin, former WHO

surveillance-in-chief on HIV, had backtracked on estimates, causing

30 countries across the globe to reduce HIV estimates by half.

" India has the largest number of maternal mortality deaths in the

world and a huge population of malnourished children. Crucial funds

that should have been allocated to strengthen primary health centres

and tackle mass killer diseases like tuberculosis, cholera and

malaria have been diverted for a disease whose numbers just do not

add up, " pointed out Dr D. Banerjee, professor emeritus, JNU, during

the course of the recently concluded National Consultation on the

National AIDS Control Programme (NACP), Phase 3.

Dr Banerjee wondered why it has taken Naco 16 years to admit that

their system of surveillance has been faulty, based as it was on

sentinel surveillance data collected from STD clinics and ante-natal

clinics. " If we go by the 2.5 million benchmark figure and we give

each patient a life expectancy of 10 years, there should be 2.5 lakh

deaths taking place in India every year. But the number of deaths

being recorded are only a few thousand, " said Dr Banerjee.

Dr Padam Singh, former DDG, Indian Council of Medical Research and

currently member of the National Statistical Commission, pointed out

that data from the STD clinics was taken to pertain to high risk

groups while those collected from ante-natal clinics was taken as a

benchmark for the general population.

" Following the National Family Health Survey 3 and the International

Institute of Population Studies' community-level survey, it was found

that the assumption on which Naco and UNAIDS had based their figures

were incorrect, " said Dr Singh. With this major downsizing in

numbers, Dr Singh also emphasised the need for slashing the budgetary

allocation for the HIV/AIDS programme.

Ms Rami Chabra, a health expert, expressed surprise at the CCEA

hurriedly clearing a $500 million loan in May 2007 to NACP 3 given by

the World Bank and other international donors. " The ministry of

health has committed Rs 2,860 crores as direct government of India

contribution, amounting to nearly 25 per cent of the total

investment, despite CAG reports criticising both NACP 1 and 2, " she

said. " Several World Bank aided health projects have been suspended

on grounds of corruption. With overall declining trends in this

disease in India, the ministry of health should have adopted a much

more cautious approach, " said Ms Chabra.

Defending the Naco stand, Dr Jotna Sokhey, additional project

director, Naco, said the objective of their organisation was not only

to treat those who were infected with the disease, but also to ensure

prevention of the general population, who remain at risk. Dr Sokhey

admitted that although " the numbers have changed, Naco has always

been part of a consultative process " . " The epidemic rises and then

stabilises. We have three lakh HIV registered patients and have one

lakh currently under treatment, " she said.

S. Jana, also from Naco, stressed that his organisation was in the

process of " trying to build capacity in order to contain this

epidemic " . He pointed out that NACP 3 was not only working with

targeted groups but also working in partnership with different

ministries. " We are also targeting the youth and adolescents to get

them to practise safe sex. The major portion of NACP 3 will be

integrated with the National Rural Health Mission, " he stated.

Some health activists pointed out that public health workers were

also responsible for creating a negative image of HIV infections and

of the AIDS virus by arousing fear in their portrayal of the epidemic.

The entire HIV/AIDS programme was pharmaceutical driven, some NGOs

maintained. The condom was being projected as the only means to

control this disease. A corollary of this was the attempt to legalise

prostitution by portraying " the selling of a woman's body as being

dignified labour " .

Rebutting this move, Ms Ruchira Gupta, director, Apne Aap Worldwide,

said, " I don't believe voluntary sex is taking place in India. The

Sonagachi model has women and girls standing in line as though they

are part of a cattle market, " said Ms Gupta. " Where is the

empowerment? How is Naco going to ensure they remain risk-free? We

have reached a situation where we have to sustain HIV in order to

receive these huge funds, " Ms Gupta said.

Several epidemiologists and specialists present, including Dr Ritu

Priya, associate professor, Centre of Social Medicine and Community

Health, felt the public needed to be informed of why HIV numbers had

reduced.

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