HIV/AIDS: A Tale of Two Indias

[Guest guest]

A Tale of Two Indias

On the cusp: The country stands on the brink of an Africa-style

disaster. But things may be turning around in the south.

By Jaya Shreedar, Pepper and Geoffrey Cowley

Newsweek International

June 5, 2006 issue - Thirty-five-year-old Rama Devi is not exactly

an icon of good fortune. She and her five children live in a dusty,

thatched-hut village called Kashiou, in the northern Indian state of

Uttar Pradesh. She once had a husband, a man who spent most of the

year selling fruit on the streets of Mumbai, but he contracted HIV

during his travels and came home a few years ago to die. Devi is now

HIV-positive herself. She works as a casual laborer in the wheat

fields around her village, receiving her daily pay in grain. But

Devi's luck could be worse. She happens to live within 20 kilometers

of Allahabad, where the Uttar Pradesh Network of Positive People

runs a drop-in center—and she has a brother who can spare a few

precious rupees to get her there each month for a free checkup,

followed by a five-hour bus ride to the nearest government treatment

center. Nearly 800,000 of India's 5.1 million HIV-positive people

are now sick enough to need the kind of medication that keeps Devi

alive to feed her kids. She is among the 10 percent who are getting

it.

Experts call India a " next wave " country—ripe for the kind of

devastation that South Africa has experienced during the past

decade, but also capable of the bold action that has helped

countries like Thailand and Brazil contain their epidemics. As you

travel through this vast land, those possible futures really do

appear as a fork in the road. To the south, in hard-hit states like

Tamil Nadu, vigorous public-health efforts now appear to be slowing

the spread of the virus. But to the north, poorer states such as

Bihar and Uttar Pradesh look more and more like disasters in the

making. Though their HIV rates are still far lower than those in the

south, their large migrant workforces provide a ready conduit for

infection—and their crumbling health systems are woefully ill

prepared for the onslaught. The lesson of the south is that

intervention works. The question is whether the rest of India—

indeed, the rest of Asia—will learn it in time.

Until recently, India's AIDS outlook has seemed uniformly grim. But

that changed this spring, when Indian and Canadian researchers

published findings from a four-year study involving 294,000 pregnant

women from 18 states. The results showed that HIV prevalence had

fallen by some 35 percent among young women throughout the " high-

prevalence " states of the south and west (Tamil Nadu, Andhra

Pradesh, Karnataka and Maharashtra). Sometimes, a drop in new

infections means only that the most vulnerable people have died.

But behavioral surveys suggest the decline in this region has more

to do with public safety measures, including the increased use of

condoms among sex workers and their clients. " AIDS was a great

opportunity for Tamil Nadu to better its entire public health

system, " says Vijaya Kumar, former director of the state's official

AIDS control society. " We cleaned up our blood banks and trained our

health workers down to the village level to educate the community. "

That kind of success is harder to find in Uttar Pradesh. With a

population of 170 million, it is home to 25 percent of India's

migrant workers. In villages like Tardeo, near Allahabad, almost a

quarter of the men are working in the big cities, and many bring HIV

home with them. The local women have seen enough AIDS to have their

own name for it. They call it the Bombaywala-bimari (Bombay

illness), yet Uttar Pradesh is only now launching the first few

prevention programs for migrant workers, and the entire state has

only three AIDS treatment centers. The neighboring state of Bihar

has none at all. Patients who fall sick in Patna or Muzaffarpur

often show up 1,100 kilometers away at Delhi's hulking All India

Institute of Medical Sciences, desperately seeking the medicine they

can't get back home.

" Why don't they open ART [antiretroviral therapy] centers in

Bihar? " asks Dr. S.K. Sharma of AIIMS. " Why are people traveling a

thousand kilometers? If they can't return every 25 days, they will

default on treatment and develop drug resistance. "

India does have a national AIDS program, but it's designed to

support state-level initiatives—and the states that most need those

initiatives are often the least prepared to plan and implement them.

In Muzaffarpur, a district of more than 3 million people, the main

public hospital sits all but abandoned. Broken, rusted cots are

scattered like old toys. Local officials would be hard pressed to

revive it without outside support—but they're stretched too thin to

document their needs, let alone address them. " We need to train

people, " says Dr. Ajay K. Khera, New Delhi's top officer in charge

of rolling out AIDS drug therapy. " We need to provide the right

equipment, the CD4 testing, the HIV testing, the counseling. It is

not just dumping medicine. "

When the Indian government first began opening free antiretroviral

centers in 2004, it projected patient enrollment would top 100,000

by early 2006. The actual number is still less than 30,000, though

officials say they expect to have 180,000 patients on treatment by

the end of 2008. " The government is committed to provide free ART to

all eligible people, " says Sujata Rao, director of India's National

AIDS Control Organization.

Meanwhile, countless thousands of HIV-positive Indians are turning

to traditional healers who peddle herbal potions as cures for AIDS.

In fact India's best-known AIDS doctor is not a doctor at all but a

68-year-old mining engineer named T. A. Majeed, who sells a product

called ImmunoQR. He won't say what's in the 23-herb formulation (a

100-day supply goes for $232), but he claims to have cured some

100,000 patients since 1993. " Can I fool that many people? " he asks,

amid the silk carpets and teakwood fixtures of his white marble

palace in the southwestern state of Kerala. Barred in 2000 from

advertising ImmunoQR as a cure for AIDS, his Web site now refers

to " killer viral diseases, " saying eight jars of pills are " all that

is required for the patient to be completely cured. "

If only the truth were so simple. India may yet escape South

Africa's nightmare, but the threat is still real and the social

obstacles are still as daunting as the practical ones. As Majeed

counts his money, and dying patients trek from Bihar to Delhi for a

shot at salvation, Rama Devi is preparing to marry off her 18-year-

old daughter in Uttar Pradesh. The groom is a fruit vendor who will

spend most of his time across the subcontinent in Gujarat. Has Devi

spoken to her daughter about HIV? No, she says—that would be

uncomfortable. Has her brother spoken to the groom? No idea, she

says. It wouldn't be her place to ask.

© 2006 Newsweek, Inc.

http://msnbc.msn.com/id/13007825/

[Guest guest]

Dear FORUM,

1)Why Mr T A Majeed of Kerala is not legally banned by International

Groups/Health Organisations as Govt of India can not take any action against

him.

2)Can not International Funding Agencies for Hiv-Aids understand

that funding is necessary for case detectation to management (i.e.primary

screening,elisa tests/W.B.tests,CD4 count/Plasma Viral

Load,starting ARV drugs,managing systemic complications of Disease,treating

O.I.infections & follow up Therapy)

If funding/facilities are not available for such programm billion$ aid will

neither eradicate aids from any part of world except arranging conferences of

statistics & opions in 5-7 star hotels.

3) Of Course much of the work done by scientific & clinical

Researcher are great obligations to society BUT EFFORTS MUST BE

DONE TO PREVENT QUACKERY UNDER THE NAME OF HOLISTIC MEDICINE unless

there is evidance of CURE AND ALL FUNDS from any source must have to

be utilised for the purpose mentioned above by giving funds in the

hands of right/truthful organisations or by setting only Hiv-Aids

Hospitals Yours Friendly,

Physician(Hiv-Aids).

" drsddrvs "

E-MAIL: <drsddrvs@...>