Re: HIV Financing Bias in India !

[Guest guest]

[Editors note: A copy of the article; Devi Sridhar and J. Gómez

(2010), Health Financing in Brazil, Russia and India: What Role Does the

International Community Play? Health Policy and Planning Advance Access

published online on April 16, 2010. doi:10.1093/heapol/czq016, is available

with AIDS INDIA editor for review]

Dear members of AIDS INDIA FORUM,

Re: /message/11365

Here we start the debate again pitting HIV and AIDS against other diseases.  Let

me put this is plain and simply absurd.  We are comparing apples and oranges

here.

Each disease requires a certain amount of money to be tackled which is based on

many factors including costs of prevention, treatment and care.  Epi estimates

cannot be the sole criterion for budgetary allocations.

I have been trying to find out the cumulative budgetary allocations for the HIV

and AIDS, TB, Malaria, Maternal and Child Health since 1950.

Now of course my friends would say why compare when the disease was not there. 

But that is exactly my point let us not compare what cannot and should not be

compared.  But what is comparable for examples the reasons for efficiency of

containing certain diseases like HIV and AIDS in a short time vs issues like

polio and maternal mortality, child mortality and malnutrition that have

lingered on for times immemorial that too with huge cumulative budgets till now.

The answer lies not in comparing budget allocations of various diseases and then

fighting for a small pie but in estimating the total requirements for health

sector and learning for each other and fighting for the bigger pie collectively.

I hope my friends in academic institutions are listening and will hopefully not

spent their times and energies on arguing things that need not be argued in the

first place.

Warm Regards,

Rajiv

e-mail: <rajivdua@...>

[Guest guest]

Rajiv Dua,

Re: /message/11365

Thank you for your posting and shooting down the ridiculous comparisons between

health budgets. What scares me is that a whole set of activists and health

professionals need to be convinced that HIV/AIDS is a different cup of tea

altogether.It's the only global epidemic that selectively assaults hidden and

totally marginalised groups like MSM/TG, IDU and sex workers.

What really worries people like me who have seen the rise and rise of the HIV

epidemic is that no more is HIV being treated as a serious epidemic. It is now

among the more " endemic " (chronically occuring) among general poipulations as

it's a clearly statistical constant in the NFHS. The problem is that it's not

showing signs of being brought under control among the affected and infected

marginalised groups.

To make matters worse, there are enough rumours in Delhi that the HIV/AIDS

program being implemented by NACO will be married and piggy-backed onto the

National Rural and Urban Health Missions (NRHM and NUHM). Though this is the

natural way to mainstream it, one is afraid the HIV prevention program will lose

its focus if NACO is finally merged into the NRHM and NUHM.

Think about this anecdotally. Which Panchayat head (male or vfemale) would

consider it appropriate to take on board the issues of MSM, IDU or Sex Workers?

Who will even think of bringing these highly stigmatised groups into the

mainstream of society even as NACO programs are de-centralised into the DAPCHUs

Though radicals like Meena Seshu and Smarajit Jana have managed to bring some

focus on sex workers' issues, it is difficult to disentangle them from

trafficking issues that persist in the ITPA mess. The HIV/AIDS Bill is still

hanging fire in Parliament and the Section 377 Delhi High Court judgement is

being challenged by powerful elements in every damn religion in the world here

in India's Supreme Court.

Who wants us marginalised groups? That finally is going to be the million rupee

question.

It's time to think ahead long and hard. Activists must strategise their policies

and social mainstreaming action plans right now or be allowed by die of a plague

that is every die hard conservative's darling. The moral judgement peddlers will

rather we die and rid society of their imaginary curses.

That's how urgent is the need to rethink global strategies for HIV/AIDS

prevention.

Ashok Row Kavi

e-mail: <arowkavi@...>

[Guest guest]

Dear FORUM,

Re: /message/11365

I agree with Ashok.  There is a whole movement to integrate HIV and AIDS into

mainstream health systems. 

In principle I am not against the idea..  However, that is where we began from. 

STI were neglected under the mainstream Health systems and so was access to

Health Systems by marginalized groups like Sex Workers, IDU, TG and MSM.

I still remember the 1980's and early 1990's when Drug Used and Abuse was part

of Ministry of Social Justice and the whole programme based out of National

Institute of Social Defence.  Substitution therapies were ridiculed.  Needle

exchange programmes  not even thought

of.

And then HIV and AIDS came in that changed the whole thinking.  Any

attempt to integrate HIV and AIDS has to be carefully studied beforehand. 

It will require massive changes in laws and a mindset change amongst local

government institutions.  That would take years if section 377 is an example of

how things go about in Indian polity.

Till adequate changes in the Indian legal and social system are in place, Rights

of all marginalized like MSM, TG, Sex Workers and IDU guaranteed by constitution

or law - any attempt to integrate HIV and AIDS into Health Systems would be

ridiculous and to equate HIV with other diseases on the basis of epidemiology

would be detrimental.

Warm Regards,

Rajiv

Rajiv Dua

E-MAIL: <rajivdua@...>

[Guest guest]

Dear Forum,

Re: /message/11365

There is definite possibility of HIV AIDS programs are being integrated as a

whole with NRHM and other programs in the near future.

Ideally it may sound to be the right move but we should remember that HIV

program was one of the rare successful programs we ever had .

What we should try is to replicate the success in other programs by re drafting

those programs with sound social, economic and scientific basis probably.

The issues of GIPA, main streaming,human rights,stigma, resurse management ....

etc are relevant in other diseases as well . It is important to reorient health

system to meet these issues in general.

This will avoid notion that HIV is a blue eyed boy getting special

consideration.

Also it is important to see that the limited amount of money is being spent to

archive the best possible return and it balances with other programs. (this is

going to be more relevant in the coming years)

So in short we may have to re orient every health care program

and implementation plans is such a way that we can replicate the HIV modal for

the rest of the health care system and finally have many similar programs than

integrating everything into one .

The success of India is that it acknowledges the plurality. It should be true

regarding health acre programs too.

Dr Ajithkumar.K

Trichur

--

Dr Ajithkumar.K

Asst Professor In Dermatology and Venereology

Medical college Chest Hospital

MG Kav,Trichur, Kerala ,India

Ph 04872333322 (res)9447226012

e-mail: <ajisudha@...>

[Guest guest]

Dear Ajit and forum,

Re: /message/11365

Did I read correctly in your posting " that HIV program was one of the rare

successful programs we ever had. "

What makes you say/claim that.

And a little below in the same posting you say - " This will avoid notion that

HIV is a blue eyed boy getting special consideration. " ? Sounds like internal

contradiction.

HIV/AIDS programme in has been a wasted, fragmented, directionless, sporadic,

jerky, mislead by UN, Donors and Foundation gang. It has been a costly, non

synergistic, and agenda pushing platform for international agencies and

Foundations.

I would urge the forum to take this topic as a separate discussion. Can the

editor of this FORUM start a new topic on that?

I would like to see an honest and open debate on the so wrongly called success

of HIV/AIDS programme in India.

People work hard and sometimes much harder and harsher conditions in other

health programmes and they go unsung even if they serve much greater and larger

populations who are marginalized and vulnerable.

There has hardly been accountability, transparency and good governance in HIV

programme in India.

Thanks

Dr Sanjeev Kumar

New Delhi India

e-maiol: <sanjeevbcc@...>

[Guest guest]

Dear Forum,

Re: /message/11365

I would agree with the thought expressed here that the medical system needs to

learn from what has been achieved by HIV programs and why rather than have it

blindly mainstreamed.

What we would like to understand is that the HIV program is the first to look at

a disease (after a long struggle) from the patients' viewpoint rather than that

of the doctor and see the disease in its entire complexity, medical, social,

spiritual, and economic.

Other programs like TB, malaria, leprosy, polio etc should look at the learning

and see how to take the good from this and introduce them into their programs.

A serious advocacy effort which is evidence based should bee started before it

is too late.

Regards

Sasi Kumar

email: <sasiontheweb@...>