Re: AIDS figures, funds don't add up

[Guest guest]

Dear Moderator,

Re: /message/8195

I am intrigued at the new controversy on use of funds for National AIDS Control

Programme Phase III ( NACP III ) in India as a sequel to the " numbers

controversy " which has raged till recently.

The apparent connection seems to be that 'now that the numbers have come down by

half, why spend so much of money on AIDS,instead of on other health programmes'.

This is understandable if it relected the common man point of view, but coming

from noted public health experts of the country, it is indeed baffling.

Funds under any AIDS control programme are earmarked broadly under two

categories,prevention and treatment. NACP III is no exception There are of

course,earmarked funds for programme management etc which are independent of the

size of the epidemic.

On prevention,it should be understood that the programmes are essentially meant

to prevent uninfected persons from getting infected. That number, which

represents the vast majority of the adult population of the country has not

changed. There are of course questions on the strategy of prevention,like 'why

should we focus on sex workers, injecting drug users and men who have sex with

men who are all BAD PEOPLE'.

This controversy has been addressed many times in the past and it has now been

conclusively proved that the dynamics of the epidemic in Asia clearly point out

to the need to address these sections of population if we have to control HIV.

I do not want to go into that debate again.

Apart from the above specified communities, prevention efforts need to be

targeted at the vast army of adult men who have a propensity to go for

multipartner sex without adopting safe sexual practices like use of condoms. Why

they go for such multipartner sex can be debated ad infinitum, but it is a

problem which belied an answer for thousands of years. We can't be expected to

address it under AIDS control programmes.

But the minimum the programme can do is to make these people aware of the risks

of such sexual behavior and introduce safe sexual practices. Increasingly it is

now realized that these adult men are at the core of the epidemic in Asia and

their un suspecting wives and girl friends are the ones who acquire it from

them.

In a fast growing economy like India ( and China too ) these risk factors get

exacerbated because of high levels of mobility coupled with disposable incomes

in the hands of these mobile men.

It is sound public health logic to anticipate this problem and mount massive

prevention programmes addressing these adult men who are in millions.They can't

be just relegated to low priority by branding them as 'clients of sex workers'˜.

They are adult sexually active men who are mostly amongst us and not on a

distant planet.

The revised infection figures have nothing to do with these numbers. It is sound

investment by Government in prevention of the epidemic among this vast

population of the country instead of paying dearly in treatment costs for

millions of people at a later date.

Coming to treatment,it was also argued that with lesser number of infected

population the treatment costs would also come down. Prima facie it appears

sound logic. But if we go a little deeper into some of the assumptions made in

NACP III, we can appreciate the fallacy of this argument.

There is a normative percentage assumed for calculating the treatment load on

the total number of infected persons. It is assumed at 15 to 20 % depending upon

the longevity of the person who is infected with HIV.

NACP III target for treatment by 2011 is 300,000. This is not based on any

normative figure but on the affordability of treatment by the Government under

the national programme. It is clearly linked to availability of committed

resources from external as well as domestic funding. If the infected population

were to be 5.1 million,the persons who would be needing treatment would be about

1 million. The NACP III target is 0.3 million, much lower than the Universal

Access target. If we use the revised number of 2.5 million, the number of

persons needing treatment would be 500,000 still much more than what was

envisaged under NACP III.

So what reduction of expenditure are we talking about?

AIDS has always been a hot topic in India for public debate. The media has

played a great role in exposing the deep rooted stigma and discrimination which

society practices on infected persons , their families and friends. This is

irrespective of what number of infected persons we have in the country.

The duty of public health experts is to highlight the insurmountable obstacles

AIDS control programmes face from the perpetrators of these practices. AIDS

Control programmes need every rupee that is earmarked for them, as these funds

are meant to save lives; save uninfected people from getting infected and

infected people from dying of AIDS.

J.V.R Prasada Rao

Director

Regional Support Team, Asia and the Pacific

Joint United Nations Programme on HIV/AIDS (UNAIDS)

Phone number: + 66 (0) 2288 1490

Fax number: + 66 (0) 2288 1092

Internet: www.unaids.org

e-mail: <raojvrp@...>

[Guest guest]

Dear Moderator,

Re: /message/8195

It think it has been very clearly spelled out that a reduction in numbers does

not mean a proportionate cut in the budget and this was clarified by the

Hon’able Union Health Minister himself during the press conference during launch

of NACP III.

Also one should not forget the fact India is going to roll out second line

treatment also which means expensive drugs, expensive tests like viral load and

lipid profile etc.

This is bound to increase the percentage of total HIV funds being spent on Care,

Support and Treatment. Also we cannot afford to have a reduction in prevention

budget due to higher spending on treatment. Hence it is very important that

adequate funds are available for both treatment as well as prevention efforts.

Thanks

Dr B B Rewari

Dr B.B.Rewari MD,FICP,FIACM,FIMSA

Sr.Physician, Dr RML Hospital & National Programme Officer (ART)

National AIDS Control Organistion, New Delhi

Tel;23325343,23325335(O)

FAX : 011-23731746

e-mail: <drbbrewari@...>

[Guest guest]

Dear All,

Re: /message/8195

I am equally concerned with the nightmarish 'sequel'to the horror movie titled

the'Game of Numbers'.

In a dissemination workshop of the findings of the NFHS-3 ,I was shocked to find

that quite a few people had jumped to the same 'conclusions' as have been warned

against by Mr.Rao.

A lot of advocacy and sensitization would be required at different levels to

maintain the effectiveness of all the interventions.

We have to continue spending the projected amount under NACP -III on the myriad

interventions-even with the revised estimates of infection-especially for all

the preventive measures.

The use of population based studies like the path breaking ASCI-Guntur

study(Dr.Lalit Dandona et al) and the data generated by the NFHS-III have

definitely qualitatively improved our estimates.

All our earlier estimates were dependent just on the annual HIV sentinel

Surveillance (which should be considered only as an indication of the trend and

should never be exclusively used for estimation without any

supplementation/pooling and verification/triangulation of data).

The present analysis has provided closer and better estimates of the numbers as

has been agreed upon by the experts at all the levels.

Use of packages like workbook (and specially spectrum package) has provided us

data about the estimated number of new infections every year,number of estimated

deaths going to occur, number of people

needing ART,number of people needing 2nd line of ART, number of children going

to be infected,number of AIDS orphans etc. which are going to be of immense use

from the programmatic point of view.

Our earlier estimation like calculating people needing ART as 10% of the total

no. of PLHIV may probably have to be changed to 20-25% of the estimates of the

PLHIV.

This is for sure that the committed expenditure will not need any alterations

whatsoever.

May be the present scenario necessitates a separate CASM/ACSM for this also.

Best wishes,

Dr.Rajesh Gopal.

Dr. Rajesh Gopal, MD

Joint Director,

Gujarat State AIDS Control Society (GSACS),

O/1 Block, New Mental Hospital Complex,

Meghaninagar, Ahmedabad, Gujarat. PIN 380016

Phone (O) 079-22680211--12--13,22685210 Fax 079-22680214

e-mail: <dr_rajeshg@...

[Guest guest]

Dear Forum:

Re: /message/8195

Clarifications of Dr. Prasada Rao and others regarding the mismatch of

AIDS funds and figures are well taken.

Yet, such clarifications fail to explain why with a prevalence rate of 0.3

percent, 30 percent of national health budget needs to be devoted to a so called

" epidemic. "

As per NACP III, HIV/AIDS is earmarked to consume 31% of total health budget in

India, that is 100 times higher than its prevalence rate.

A clarification on this aspect by Honble.Health Ministers/ Secretaries would

probably be useful.

Regards

Subir K Kole

East West Center

1601 East West Road

Honolulu HI 96848

e-mail: <subirkole@...>