India's AIDS Crisis: A shame !?

[Guest guest]

India's AIDS Crisis:March 27, 2001. NY Times editorial.

Outside of Africa, India likely has the world's most worrisome AIDS

crisis. India suffers the same virulent strain of AIDS that is killing

Africans, its general health conditions are poor, and heterosexual

transmission is common, putting the whole population at risk. In the

last few years, the Indian government has begun to carry out a

well-designed campaign to cut the spread of AIDS, but it has been

spottily administered and will not show real gains for several

years. India's experience is a warning to other nations that

prevention plans are complex to carry out and take time to show

effects ¯ all the more reason for governments to begin now.

J. V. R. Prasada Rao, the director of India's National AIDS Control

Organization, says that India had a total of 3.7 million people

infected with the AIDS virus in 1999. Some outside experts believe

the real number is double that or more. Many parts of India have a low

infection rate of under 1 percent. But there are pockets where AIDS is

far more prevalent, especially in Bombay, Calcutta and Madras. Some

prenatal clinics in the state of Tamil Nadu report that nearly 5

percent of their patients are infected.

The AIDS program, which is financed by the Indian government, the

World Bank and Unaids, provides money to local governments, which in

turn give much of it to hundreds of nongovernmental groups. Initially

the plan tried to build awareness of AIDS through the media, but the

message did not stick.

Now health workers talk to people individually. Prostitutes and the

truck drivers who spread the disease as they travel get particular

attention. The biggest achievement so far has been to clean up the

blood supply. In 1992, 8.5 percent of India's AIDS infections were

transmitted through tainted blood. But India has now outlawed payments

to blood donors, which attracted drug users. Today only 4 percent of

those infected contracted the virus through the blood supply.

Commercial sex workers are also beginning to use condoms more

regularly. Condom use among prostitutes in Calcutta is now more than

70 percent, up from single digits a few years ago. In Bombay, condom

use is beginning to rise. But it will take time before it reaches 80

to 85 percent ¯ the level that actually cuts the AIDS transmission

rate.

India is an example of the perils of starting late. Although the first

AIDS cases were seen in 1986, in 1993 the country spent less than a

million dollars on AIDS prevention. The government still lacks a sense

of urgency and has been slow to acknowledge the spread of AIDS through

homosexual contact, leading to a lack of awareness of the dangers of

unprotected gay sex. The general public has yet to pay much attention

to AIDS. The more backward states, with little health infrastructure

and hapless governments, have done practically nothing.

India is also failing to prevent women from passing the disease to

their newborns. The appropriate drug, nevirapine, is simple to

administer and costs about $1 per child. Yet India is only now

beginning pilot projects to cut mother-to-child transmission. Generic

manufacturers in India are negotiating to sell a cocktail of AIDS

medicines to African governments for $600 a year.

But, shamefully, India's government does not buy these drugs. It

claims that even $600 a year is too much and would drain health

budgets.

However reasonable that fear, the solution is not to let people die of

AIDS. India needs to spend more money on health ¯ far more than the

current 2 percent of its gross domestic product ¯ and the world needs

to create a pool of money to help poor countries like India buy AIDS

drugs.

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