TN Success story. What next?

[Guest guest]

Dear eFORUM members,

This is in response to Mr. Ramasundaram's posting on Tamil Nadu

Success story [ eFORUM, Message # 290]. Let me congratulate

him for highlighting such an important success story.

I agree with Mr. Ramasundaram's observations, that as a result of the

combined efforts of Tamil Nadu State AIDS Control Society (TNSACS) and

AIDS Prevention and Control Project (APAC), significant achievements

have been made in AIDS prevention and care in Tamil Nadu. As Mr

Ramasundaram observed, success stories in the area of AIDS prevention

are hard to come by. There is no doubt that Tamil Nadu experiment

presents a ray of hope. All those who have contributed to this

achievements deserve to be congratulated and their contributions has

be acknowledged, locally, nationally and internationally.

However, the success stories should not lead us to complacency. The

objective of this posting is to make few comments on certain issues

to be taken into consideration in developing a road map for sustaining

the achievements and to move forward with the AIDS work in Tamil Nadu.

It appears that when we look forward, one of the key issue we have to

address is what are the parameters we are using to measure the success

of AIDS prevention interventions.

Some of the key indicators we are using to measure the success are

mostly behavioral change indicators such as, increase in condom use

and changes in risk reduction. Recently, there has been a greater

appreciation to the fact that parameters of success in AIDS prevention

work also should taken into consideration of success in reducing AIDS

related stigma and violations of the rights of people living with

HIV/AIDS, and reducing the vulnerability of people infected and at the

risks of infection. I would particularly argue that efforts to enhance

access to treatment, particularly access to Anti Retro- Viral (ARV)

Treatment also should be a key indicator to measure success in AIDS

prevention and care efforts.

Let me emphasis the fact that prevention is not a substitute for

affordable treatment for people who are already living with HIV/AIDS.

How much ever be the cost of prevention low, it will never alleviate

the pain and suffering of the people living with HIV/AIDS.

There is ample data to prove that ARVs slows mortality and morbidity

rates and enhances quality of life of people living with HIV/ AIDS.

Till recently, one of the main argument against offering ARV treatment

in developing countries like India was the cost of ARVs.

During the past few months our understanding about the political

economy of access to ARVs has dramatically changed. Today we know that

Indian companies could manufacture most of the ARVs within an

affordable level of prices. Also, government of India (particularly,

the ministry of commerce and industry) could accelerate the process

of producing the ARV in India by offering " Compulsory License " to

local pharmaceutical industries to produce generic ARVs locally. ( I

am quite sure that Mr. Ramasundaram's colleagues from the ministry of

commerce could advice the process and mechanisms of how to produce low

cost generic ARVs in India)

We have no excuse for not taking necessary steps to enhance affordable

ARV treatment for people living with HIV/AIDS in Tamil Nadu and in

India. I agree that, without adequately trained health care providers

one may not be able to administer ARVs. But we should not wait for all

the health care providers to get trained in administering ARVs.

Already, within India a significant group of physicians do have

experience in offering ARV regimes for people living with HIV/AIDS.

I would urge TNSACS, APAC and Mr. Ramasundaram to take necessary

preparations to carry out pilot projects on this area. As a first step

towards enhancing access to ARVs for people living with HIV/AIDS in

Tamil Nadu, I would suggest all of you, to call for a national

consultation of " Enhancing access to ARV for people living with

HIV/AIDS in India: Issues and Challenges "

This consultation may address issues related to legal and political

issues related to producing ARVs in India, need to declare HIV/AIDS

as a national public health emergency, need for preparing an

essential HIV/AIDS medication list, strategies for rapid skill

development of health care providers to administer ARVs, issues of

diagnostic facilities, developing indigenous markers to monitor the

progress of infection etc., to list a few issues which deserves

immediate attention in such a consultation.

With the combined effort of committed people like Mr. Ramasundaram,

key functionaries of TNSACS and APAC, significant achievements could

be made in the area of offering affordable ARV treatment for people

living with HIV/AIDS in Tamil Nadu. Today, we have an opportunity,

to measure the success in the area of AIDS prevention and care by

measuring the success in offering affordable ARV treatment to People

living with HIV/AIDS.

Please don't let this opportunity for leadership, slip away from all

of you. All the best for your good work and keep the ray of hope.

With warm regards

Joe

E-mail: Joe_thomas123@...