Can't count the dead

[Guest guest]

Can't count the dead

Usha Rai

The recent UNAIDS report which estimates 4,00,000 AIDS deaths in the

country in 2005 is not only shocking, but questionable.

All international estimates of infections and deaths are based, or

should be based, on nationally available figures of HIV infections

gathered from surveillance centres, state AIDS control societies and

those under anti-retroviral therapy (ART).

Ironically, UNAIDS death estimates for India come just two months

after a report published in Lancet that there has been a 33 per cent

drop in HIV infection in southern India, which has three of the six

high prevalence states in the country.

Canadian and Indian researchers studied for four years after 2000

the HIV infection rate among women in the 15-24 age group. It had

dropped from 1.7 per cent to 1.1 per cent.

National AIDS Control Organisation (NACO) never puts estimates of

AIDS deaths because no one really dies of AIDS. People die of a

culmination of various infections with the immune system. Arriving

at an estimate of death from AIDS is extremely difficult.

Last year, NACO estimated 5.21 million HIV infected people in India.

UNAIDS maintains the figure is 5.7 million because India had not

included a large segment of its population when it worked out its

estimates based on those in the 15-49 age group.

Last year, the then DG of NACO, S Y Quraishi, said there were only

28,000 new infections. This year, NACO has admitted to 72,000 new

infections.

UNAIDS and NACO should put out more accurate estimates because

figures are important to show infection trends. Recent efforts by

the National Family Health Survey-III are expected to shed some

clarity on the AIDS situation.

What is worrisome is the manner in which the contours of the

infection are changing. It has spread from high prevalent states

(Andhra Pradesh, Karnataka, Maharashtra, Tamil Nadu, Manipur and

Nagaland) and certain sections of society like commercial sex

workers, truck drivers and drug users to the general population.

In several states, there has been a phenomenal increase in the

number of MSMs (men having sex with men) but we continue to treat

them as outcastes.

Unless there is legal recognition of their sexual preference, the

government will find it difficult to cope with this large segment of

HIV-infected population who continue to stay underground.

Surveillance data of NACO puts 110 districts at high risk. In states

like UP, Bihar, Orissa, Chhattisgarh and Jharkhand, the state AIDS

control societies are non-existent.

There are not enough voluntary counselling and testing centres

(VCTCs). Those who know about the infection find it difficult to

access VCTCs and get ART.

Women and children from poor families in rural India find it

tiresome to climb on to a bus and make repeated trips to the big

cities for testing and medicine, which is free.

Further, because of the stigma and discrimination associated with

the infection, people are reluctant to admit they are infected.

ART has enabled people who have access to the medicine to live

fruitful lives 15-17 years after contracting the infection. India

has been grappling with HIV and AIDS since the early 90s, though ART

started only in April 2004.

Though Indian pharmaceutical companies are making drugs available to

Third World countries at highly discounted rates, in India barely

3.5 per cent of those who need the treatment are able to access it.

There were just about 36,500 on ART (government funded and other

centres) on February 28 this year. By 2010, the government hopes to

provide ART to 1,80,000 far short of the requirement.

Though there is a significant increase in the number of infected

children, paediatric drugs are just not available for them.

Meanwhile, the Indian government should have a proper policy on

promotion of condoms for safe sex. Condoms have traditionally been

promoted in India for family planning.

There is a strong political and religious lobby against condom

promotion because it is seen as encouraging promiscuity. If the use

of condom is not encouraged, the infection will spread.

The writer is a development journalist.

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