Universal free AIDS Care in India

[Guest guest]

Dear Moderator,

Readers of AIDS India might love this. I am forwarding it after

10 minutes of seeing in the paper. Regards. Ashok Pillai.

President, INP+ E-Mail:inpplus@... & inpplus@...

[Ashok, Thanks for sending the message to the forum. Moderator]

__________________

HINDU Article: Universal and free AIDS care

Universal and free AIDS care

By C. Rammanohar Reddy

INDIAN PHARMACEUTICAL firms now offer hope to the millions in the

poor countries of the world who are infected with the Human

Immunodeficiency Virus (HIV), the disease which causes the Acquired

Immune Deficiency Syndrome (AIDS). They have offered AIDS medicines

for export at $350 a year for every patient, compared to western

market prices of as much as $10,000 to $12,000. Governments in the

South can now at least contemplate providing their HIV-infected

citizens with highly active anti- retroviral therapy (HAART), the

medication which, while not a cure, helps patients lead a productive

life. The irony is that India itself has so far shown little

initiative in using the Indian drug industry's capabilities to

provide free universal care to the 3.86 million Indians now infected

with the virus.

Two reasons have been offered for why universal care is not possible

in India. One is that counselling, monitoring and compliance are as

important as affordability of drugs. The second and more vocal

argument is that even at $350 a year the AIDS cocktail is not

affordable in a country where the per capita annual income is only

$440. (The lowest retail cost of an annual dosage of drugs in India

is presently Rs. 42,000 - $900 - much higher than export prices

mainly because of taxes, packaging and retail margins.) Even for a

developing country these are not arguments but only excuses to avoid

providing care. Since 1997, Brazil has provided free care for every

HIV-infected Brazilian who seeks it.

The programme runs on active health care combined with provision of

generic versions of AIDS drugs that Brazil produces locally. The

result is that new infections have been controlled, HIV transmissions

lowered, AIDS-related deaths brought down and the HIV population is

now less than half what had been projected for 2000. India's per

capita income is only one-tenth Brazil's while its HIV population is

eight times larger, so the Brazilian experience may not seem very

relevant. But given the prices Indian industry has been able to come

up with and the experience of Indian doctors there is no reason why

India cannot administer a similar programme to cope with its AIDS

epidemic. A careful listing of costs suggests that universal and free

HIV therapy is feasible in India.

(1) Size of programme: Not all of the 3.86 million Indians infected

with HIV need HAART immediately. Health personnel such as Dr. N.

Kumarasamy of YRG Care in Chennai who have been working with HIV/AIDS

patients state that epidemiological studies point to 20 to 30 per

cent of the infected requiring therapy. That would be 800,000 to one

million people.

(2) Cost of drugs: Retail prices are now Rs. 42,000 a year. But bulk

purchases for a universal programme could save on packaging, retail

margins and perhaps even taxes. Prices should then be closer to the

rupee equivalent of $350. Dr. Y.K. Hamied, Chairman of CIPLA, the

company which has turned the spotlight on prices, is confident that

by 2003 the drug cocktail could cost as little as $200 a year. But a

conservative estimate of costs would be Rs. 16,450 ($350) for each

patient. (3) Costs of monitoring/testing: As the AIDS cocktail is

extremely powerful patients have to be monitored regularly for side-

effects. The costs of such tests are considerable. At Rs. 26,000 a

year they cost more than the medicines. (4) The total cost then is an

annual Rs. 42,450 for each patient. A universal AIDS care programme

in India would therefore cost the Government between Rs. 3,400 crores

and Rs. 4,300 crores every year.

As everyone is aware, there are other issues to consider as well.

First, administration of these medicines on a massive scale will be a

challenge in itself. Most important, compliance has to be ensured. If

patients do not stick to the complicated regime, they could develop

drug- resistant strains of HIV. But again as Brazil has demonstrated

it is possible even in a poor country to devise an innovative

compliance regime, involve community groups and motivate health

personnel to ensure adherence rates even among illiterates that are

reportedly no lower than in California.

Here in India, Dr. Kumarasamy reports rates of up to 90 per cent

among those who are buying the AIDS cocktail. Second, is it correct

to spend so much energy and money on AIDS at the expense of other

health concerns? In India the numbers in TB, malaria and diabetes are

much larger. Here again Brazil offers hope. The mass movement that

HIV therapy has become there has meant that the people's demands in

other health areas have also increased, leading to a general

improvement in the quality of public health services. There is no

reason why that cannot happen in India as well. And the unique nature

of the fatality of HIV/AIDS means that it does require special

attention. Third, can Indian industry produce drugs on the scale that

a universal programme would require?

Dr. Hamied is confident that with more and more Indian firms entering

the business this will not be a problem. Besides, Indian industry is

now already manufacturing up to 14 types of drugs. Moving from the

simplest $350 cocktail to another in order to deal with side- effects

in some patients could also mean more expensive medicines. But the

CIPLA chief predicts that these costs ($500 to $2000) should also

keep falling. Fourth, the AIDS cocktails now being produced in India

at low cost were all patented before 1994 - prior to the TRIPS

agreement of the WTO. But patents on the next and more effective

generation of drugs are likely to be protected by TRIPS, so local

production will violate the WTO agreement. The Government will then

have to overcome opposition from the patent holders among the

multinational drug firms and issue compulsory licences - provided for

in TRIPS - to Indian firms so that they can produce and sell these

drugs at affordable prices.

It all finally comes down to costs. The Government has indeed

considered a limited HAART programme. Mr. J. V. R. Prasada Rao,

Director of the National Aids Control Organisation (NACO), says that

rough estimates - assuming 10 per cent of the infected need treatment

and, of them, half use private services - point to an annual cost of

around Rs. 1,300 crores which is considered unaffordable because this

would be more than Central Government spending on all public health

programmes (Rs. 810 crores in 2001- 02). The NACO Director says there

is a need to ``prioritise'' health concerns in India. The NACO is

hoping instead that India will receive some assistance from the

proposed $7-10 billion health fund which the U.N. is proposing for

malaria, TB and AIDS, though that fund would focus on Africa. But

India does not have to wait for foreign aid.

The cost of a universal programme (Rs. 3,400 crores to Rs. 4,300

crores a year) looks large. But it is as little as 0.28 to 0.35 per

cent of India's GDP, which is not a large burden to carry. And with

falling prices this is likely to be an over-estimate. In any case, a

5 per cent surcharge on corporate and personal income taxes will

yield enough to finance this universal programme. In the absence of

such a programme, no more than 5 to 10 per cent of the HIV carriers,

those who can afford the medicines, will be on HAART. The rest will

have to make do with treatment of their ``opportunistic'' infections.

This would only precede a gradual and wasting death from AIDS for

hundreds of thousands of Indians. As HAART also contributes to a

reduction in the virus transmission rate, its inaccessibility for

most of the infected will only mean that the Indian population

afflicted by HIV/AIDS - already the second largest in the world -

will keep growing.

The only cure for AIDS is its prevention and India does need to do a

lot more in this respect. Indeed, if India had done better in

prevention it would not now have had millions of its citizens struck

by the deadly virus. But the 4 million Indians now infected with HIV

cannot be abandoned to a wasting death when an affordable therapy is

available. If the numbers about HIV infections are correct, the

country is facing its biggest ever epidemic that in its devastation

will spare no region or socio- economic class. In the absence of

universal therapy the tragedy will become a catastrophe that is

likely to surpass what is now unfolding in Africa. The issue has long

since ceased to be one of ``violating'' patents on drugs. It is one

of respecting life. There is no alternative then to a state-run

universal and free programme that provides HIV therapy to any Indian

who needs it.

[Guest guest]

Forwarded from sci.med.aids newsgroup:

" This time the genocide is not being committed by an evil lunatic, but by the

very world we ourselves have created through our indifference, greed, and

neglect. I increasingly feel ashamed to be living in such a world. "

Another astonishingly moving missive from documentary filmmaker

Bilheimer. He writes eloquently about the impact of AIDS on India.

http://www.thebody.com/closerwalkfilm/journal7/journal7.html

Bilheimer is the director of the soon-to-be-released film, " A Closer

Walk, " the first feature-length film to document the global AIDS pandemic.

A Closer Walk was conceived in 1996 by nominee Bilheimer,

President of Worldwide Documentaries, and the late Mann, the visionary

public health leader and human rights activist who was the architect of the

World Health Organization's program on global AIDS. Dr. Mann died, with his

wife, Lou Clements-Mann, in the crash of Swissair 111 on September 2,

1998.

A Closer Walk was in many ways inspired by Dr. Mann, and will reflect his

lifelong commitment to health, dignity, and human rights.

http://www.thebody.com/closerwalkfilm/background.html

M.

Email:<gmc0@...>