Sunil Sethi: Why AIDS is still a four-letter word

AL FRESCO

The well-known British journalist Peter Gill, whose excellent investigation into the international AIDS crisis The Politics of AIDS: How They Turned a Disease into a Disaster is just out as an inexpensive paperback in India (Viva Books; Rs 195), says that he was repeatedly rebuffed when he went in search of a publisher for his project. "It was very difficult to get many publishers in the West interested. 'A book on AIDS?', they said, 'there isn't really a market for it'" Despite being a familiar byline and television presenter for Thames Television, Channel 4 and the BBC (his last assignment was as head of the BBC World Service Trust to produce AIDS-related programming for Indian public radio and television) Gill had to pool in his own financial resources to fund travels in four continents to be able to research an epidemic that has, on average, claimed one million lives a year worldwide since the virus was discovered in America 25 years ago. Peter Gill was out of pocket to write a book that exposes how a combination of the Religious Right, dithering politicians and big pharma corporations with an eye on the bottom line failed to control the galloping spread of the killer disease. (Ronald Reagan refused to say the word "condom" during the long years of his presidency and former Indian I&B minister Sushma Swaraj had programmes about HIV/AIDS taken off air because AIDS is a four-letter word among ultra-conservatives.)

Despite successes in some countries, such as Brazil, where, despite the influence of the Roman Catholic church, intensified government efforts in sex education and the distribution of condoms among sex workers have brought down HIV prevalence, recent statistics from UNAIDS and WHO show an alarming rise in countries such as Uganda and Thailand.

In India, the picture is confused and contradictory. As UNAIDS and the National AIDS Control Organisation (NACO) bicker over the correct approximate figure of Indians infected""is it 5.2 million or 5.7 million?""the fact is that it remains the largest number in any country (not as per capita percentage of the population but because Indians are so numerous and their health profile so shadowy, given the hopeless state of the public health system). The real tragedy, though, is that only a tiny fraction of HIV-infected Indians know that they are infected. As always, it will be the poor and the illiterate""those who fail to understand the nature of the disease or lack access to blood-testing or retroviral drugs""who will continue to die in large numbers.

India has one of the worst records in making school-level sex education compulsory, disseminating information and condoms among sex workers, or abolishing antiquated legislation that make prostitution and homosexuality criminal offences. "The fact that people are embarrassed to talk about sex makes it difficult for government interventions to be effective," Union Health Minister Anbumani Ramadoss admitted on Worlds AIDS Day. Yet both legislators and the courts remain abject in their failure to introduce more liberal laws.

But India does have a remarkable record in producing generic drugs that can make AIDS patients live longer and withstand the onslaught of the HIV virus if detected early enough. Men like Dr Yusuf Hamied of the leading generic drug manufacturer Cipla have successfully "reverse-engineered" to produce anti-AIDS drugs like AZT and Triomune cheaply, but these do not reach the afflicted millions in time. An international battle between Big Pharma and Little Pharma, as detailed in Pete Gill's book, is a grim account of the conspiracy among the western world's pharma giants to keep the prices of anti-AIDS drugs high under the WTO patents regime and therefore out of reach of the world's poor.

Unlike many other countries more disaster-prone to the AIDS epidemic, India does have the drugs and the ability to control the spread of HIV and bring it down to sustainable levels. But it has to snap out of the mindset of regarding AIDS as a four-letter word.