Subir Roy: Declare HIV-AIDS a crisis

VALUE FOR MONEY

Indians who take pride in the country being one of the largest producers of so many things from milk to engineers, must wake up to the fact that it has the second-highest number of AIDS- and HIV-affected people. And as this is going up every year by half a million, the first place will most likely come its way soon.

There are two particularly disturbing aspects about the prevalence of HIV-AIDS in the country. One, it is most rampant in some of the most prosperous and otherwise successful states in the country like Andhra Pradesh, Maharashtra, Goa, Karnataka and Tamil Nadu, as also three small north eastern states like Manipur, Mizoram and Nagaland.

These account for 80 per cent of all the victims in the country. As the health status south of the Vindyas is ahead of the rest of the country, the HIV-AIDS epidemic has the deadly potential of striking where national human development has fared the best.

The future is more forbidding than the past because the yearly level of fresh infections is not going down, as it has been even in a country like Cambodia.

In India now the disease has spread from specific high-risk groups to the population in general and from urban areas increasingly into the countryside. In the states mentioned, the level of HIV infection among women attending pre-natal care centres has crossed 1 per cent.

If India is to remain economically resurgent it will have to recognise that it has an HIV-AIDS epidemic on its hands and fight it on the same footing.

The Indian system has repeatedly been able to rise to the occasion during a crisis. While controlling and getting the better of the epidemic, there may well be a great spin-off benefit. The overall effort will most likely take the health care delivery system on to a higher level of capability and effectiveness.

HIV-AIDS has to be fought not at the national level but at the micro level of dialects and in economically backward pockets, where the message of awareness, prevention and lifestyle changes has to be reached.

So much more than a national government directed project, a grassroots campaign by volunteers is essential. The sheer ignorance and prejudice even among public health care providers, going right up to the heads of institutions, when it comes to treating HIV-AIDS patients, makes this a task that has to be critically energised by volunteers who care and are committed.

Other than telling poor people in their own language how to keep away from the disease, the prevention campaign has to concentrate on three specific groups""migrant workers, truck drivers and sex workers.

Migrant workers who move for work to areas where they do not know the local language nor have roots or family, turn to sex workers and don't have the right help to turn to when afflicted. And when they are back home they run the risk of passing on an acquired infection to their wives and future children.

According to one statistic, 87 per cent of truck drivers go for frequent and indiscriminate sex but only 11 per cent of them use condoms. Both for them and sex workers, campaigning to make use of condoms a habit remains the only effective means of prevention.

The one good news in this regard is the success that voluntary groups have had in Kolkata's main red light district in raising the use of condoms.

At the organised level, increasingly larger numbers of people have to be screened to detect the HIV positive. Detection till now mostly takes place when patients admitted for surgery are screened without their knowledge.

And of course those detected positive are promptly thrown out. The public healthcare system, which will have to fight most of the HIV-AIDS battle, has the biggest role to play in treating the infected.

The bad news is that there is no sign yet of an AIDS vaccine but the good news is that with the advent of anti-retroviral drugs, AIDS symptoms can be kept at bay and it is possible to lead healthy lives, turning the deadly scourge into a "remediable adversity".

But to administer these drugs, mostly free to poor people, you need a health service that works and enough government funding. Neither of them is available in India. This is not for want of a successful model, and that too in a developing country.

Brazil has led an exemplary fight against HIV-AIDS so that it has reduced the level of infection to less than half of what was earlier projected.

It has achieved this by not being squeamish in publicly dealing with the subject; handed out condoms, syringes and needles freely; educated sex workers; treated victims freely; effectively fought drug majors and managed to buy generic versions of those drugs cheaply; and spent a massive $1.8 billion on them over six years.

India's tragedy is that Indian companies manufacture a lot of those drugs! But India has neither the mechanism nor the funding to give the same medicine to its own victims.

sub@business-standard.com