Not by faith alone

BS OPINION

It's a crisis that could leap out of control, and undo all the calculations of a rosy future for the country. More than 4.5 million Indians are now living with HIV/AIDS, with over 500,000 contracting the disease in the last year alone.

According to the National Aids Control Organisation (NACO), which now ranks India second to only South Africa in the spread of the disease, India has less than 10 years before the infection rate rises to tens of millions.

Another estimate says India could have nearly 25 million adult HIV-infected people by 2006, roughly equal to the number of current infections in sub-Saharan Africa.

What is frightening is that 89 per cent of the reported cases are in the sexually active and economically productive age group of 18-40 years.

Worse, there is evidence that it is no longer concentrated among urban sex workers and their clients and drug users, but is now embedded in the general population, including women whose only risk behaviour is having sex with their husbands.

The costs for the government and for the economy could be killing. Detection itself is expensive and costs the government nearly Rs 700 per case.

Then there are the costs of treating other infections that arise from the destruction of the immune system. These include pneumonia, tuberculosis, meningitis and diarrhoea.

But the medical costs are minor compared to the potentially negative impact of AIDS on savings and productivity.

An interesting study done by YRG Care, a Chennai-based NGO, on the economic impact of AIDS shows that the proportion of affected households reporting borrowing money increased from 38 per cent to 67 per cent during the study period.

The epidemic can also push up costs of worker replacement, absenteeism, insurance expenses and healthcare expenditures for the private sector.

What's the way out? Money is no doubt pouring into the country's AIDS schemes. But as a World Bank report says, the country still lacks the resources to beat the disease.

Given the constraints, an effective way could be to encourage targeted interventions for high-risk groups, like the one tried out by an NGO in Sonagachi in Kolkata.

Sex workers were organised into informal groups and empowered with negotiating skills for promoting condom use with their clients.

Result: condom use increased from nil in 1992 to over 70 per cent in 1993-94, and these levels have been sustained thereafter. The other way the resource gap can be met is through more public-private partnerships.

Management consultancy Booz Allen Hamilton estimates that if all groups improved their cooperation, India's HIV infection rate could fall to less than 2 per cent of the population by 2010.

So, instead of making absurd suggestions like asking India's AIDS programme to focus on sexual abstinence and faith, rather than condoms, Health Minister Sushma Swaraj must welcome more initiatives like the $ 200 million committed by the Gates Foundation.