Interview with NACO DG. Ms. Sujatha Rao: ‘Drug supply is our biggest problem’

[Guest guest]

`Drug supply is our biggest problem'

National AIDS Control Organisation Director General K. Sujatha Rao discusses the issues affecting the organisation's work in tackling the epidemic in the country

K. Sujatha RaoPhoto by Aditya Kapoor

There is stigma attached to testing. It must become less stigmatised in societyCan you comment on the different estimates of the number of HIV-positive people given by the government and the UN?

To me, it's a minor difference if the UN is saying 5.7 and we're saying 5.2 as well as 1 lakh children. What is important is that there are more than 50 lakh Indians living with HIV/AIDS. And we have to provide them with treatment.

What about the difficulties in counting HIV-positive children?

We're estimating up to 1 lakh children, but so far, only 20,000 have been tested and diagnosed HIV positive.

What about those who are treated in the private clinics?

We measure the HIV headcount through our sentinel sites survey, which include these private clinics also. So private HIV-positive patients are included in our assessments. Our sites include anti-natal clinics also but there have been problems in UP and Bihar, where child birth takes place in homes only, they don't go to nursing homes or hospitals, so sentinel sites cannot take these people into account. We are trying to think of the methods to solve this problem.

What are some of the obstacles naco currently faces?

Our biggest difficulties right now are art drug availability and drug adherence and the establishment of stable supplies. Drug adherence is becoming even more important; keeping in mind we're only able to provide this 1st line treatment. To now, we've been able to prove up to 50,000 art treatments, but it's very difficult for migrant workers especially to adhere to these strict regimens for instance.

Otherwise, we face a tremendous amount of social stigma against AIDS in Indian society. Middle class medical and education professionals are especially prone to these biases, but there's a generalised discrimination, and the kind of "it can't happen to us" mindset, which is dangerous in monitoring and treating all segments of Indian society for this disease.

Another major difficulty is that because people themselves don't realise that they are HIV-positive and treat themselves for other diseases. It's only when they get tested, that we know their true health status. Devising ways to reach out to this segment of society remains very important to us. But at all levels of Indian society, testing must become much less stigmatised.

What are your targets for 2nd line arts?

We'll be reaching our target of one lakh in March of this coming year for 1st line arts. Obviously, we're considering how to bring in 2nd stage treatments but they are 10 times more expensive at the moment. We're not providing 2nd line art treatment at this time due to logistics and pricing. But we're currently negotiating and we're all hoping the patent law isn't upheld. Right now, we've not been able to cover sufficient art stage 1 dosages to be able to guarantee stage 2. But by March 2007, we'll have at least 90 art delivery facilities throughout the country, which will definitely make a difference.

We've just called for tenders for ngo partners for our art roll-out programme. Now that we've received the applications for private medical-not for profit-partnerships, we'll examine their suitability and finalise this part of the campaign as swiftly as possible.

We're also very committed to harm reduction strategies, such as needle exchange programs, modelled on Australia's very successful programmes and funded with $10 million by ausaid. naco provides clean needles through ngos who advise us of their requirements.

Is it true that when an HIV/AIDS patient's cd4 200+(viral load) count recovers sufficiently, they'll no longer get subsidised arts?

Absolutely not. Patients must continue on arts, even when their viral loads recover. The intention is to keep their cd4 cell counts above the 200 levels.

India is the world's largest producer of generic arts, but they're sold at much cheaper rates abroad than here. Why?

No, that's not true, we negotiate and we get the best possible prices. It would be a problem if the patent regime comes into force. We're all hoping against this.

Are you in favour of the reform of Section 377 as a health initiative?

Yes, but remember, this is our only legal defence against child abuse. We do advocate against criminalising sexual relations between two men. Homosexuality is a reality, and calls for reform of this law go beyond health concerns. Our strongest hope is the passage of the HIV/AIDS bill. We've been working on this for some time but it's a complicated process. The Bill is completely rights-based, meaning that it will become illegal to dismiss an employee on the basis of their HIV status, or to deny them rights to treatment, property, information, education, right to everything. My main concern is that if a woman's HIV status becomes known at the moment, she can be thrown out of her home, denied basic rights and services.

How does naco plan to combat the stigma surrounding HIV?

We're working hard to de-stigmatise HIV/AIDS. Remember, the discrimination is often coming from the most literate, educated Indian professionals. The story of five children being thrown out of school in Kerala, the most literate state, is horrific, but discrimination is widespread in private sector medical services as well.

We're working hard to develop counselling to accompany HIV/AIDS treatments, this is new in Indian medicine, we usually don't have much choice in discussing our medical situation with our doctors and they also need to be sensitised to HIV/AIDS and to remove the stigma. Counselling is very necessary in HIV/AIDS treatment, for all sorts of reason, and this must be done.

Sanjay Dubey and Jane Rankin-Reid

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