InterPress News Service (IPS); Friday, 26 September 1997.
Mitu Varma

The official figures, however, do not appear unduly alarming.

Till August 31 this year, there were 66,460 persons who tested HIV positive, while the People With AIDS (PWA) numbered 4,846, according to the National AIDS Control Organisation (NACO). But these are only the reported cases.

According to the WHO, only one out of 10 cases is reported to it on a worldwide basis. A nearer estimate of the HIV positive population in the country could be closer to the four million mark. According to the United Nations Development Programme (UNDP), there are likely to be one million PWAs and seven million infections in India by the turn of the century -- the largest numbers in the world.

The costs could be killing. Detection itself is expensive and costs the government nearly Rs 600 per case. It does not charge for the tests. Then there are the costs of treating the opportunistic infections that arise from the destruction of the immune system caused by AIDS. These include tuberculosis, pneumonia, meningitis and diahorrea.

The health care system is already showing signs of strain under the onslaught. According to economist Gita Mehta, there has been an increase of more than six percent in the number of TB cases in the past few years. Already TB is the most important single cause of infectious disease mortality in the world.

The direct costs of AIDS -- hospitalisation, surgery (where required), counselling, drugs etc. are expected to be phenomenal.

"But the medical costs are minor compared to the loss of income from morbidity and mortality of those afflicted," says Dr. David Bloom of Colombia University, a specialist on the economic impact of AIDS on developing Asian nations.

This is more so because, "the country has neither geared itself in terms of strengthening the health infrastructure nor in terms of initiating economic measures to stem the potentially negative impact of AIDS on savings and productivity," says Ritu Priya, involved in research on social medicine and community health.

The economic liberalisation programme has increased the large scale immigration from villages to the urban areas. Bereft of the close village community and thrust into the anonymity of big cities, the migrant workers are susceptible to high risk behaviour. Poor housing and health facilities compound the problem.

While some big business houses and industrial associations such as the Confederation of Indian Industry, the Federation of Indian Chambers of Commerce and Industry and similar state level bodies have tried to initiate awareness programmes, the workers themselves are reluctant. They do not like to be seen as indulging in high-risk behavior and they feel the next step could be compulsory testing.

Their experiences in this regard have not been very salutary. There have been summary dismissals of workers found to be HIV positive. Very few have the resources to fight such dismissals in court. Till earlier this year, even those who did appeal for justice found themselves ostracised once their identities were made public. It was only in March this year that a landmark judgement made it possible for petitioners to appeal anonymously through their lawyers.

Even higher up the in professional scale, there are no schemes to provide by safety nets for HIV positive persons. The government controlled insurance sector flatly refuses policies to anyone who tests HIV positive.

For the vast unorganised sector things are even worse. There is rarely any money put by to fall back upon when the infections strike. And when the earning member of the family succumbs, there are no means of sustaining the dependents.

The same story holds good for the agricultural sector as well. Nearly two thirds of Indians depend on agriculture for sustenance, which is still highly labour intensive. And the problem with AIDS is that it strikes adults in their most productive years -- between the ages of 30 and 40. The lack of able bodied adults to work in the fields is likely to reduce productivity.

Besides, the depletion of family coffers from repeated AIDS- related infection is likely to affect the amount of disposable income that is normally used for purchasing inputs such as seeds and fertiliser.

The most devastating effect of the disease is likely to be on families. Usually, the head of the household is the first to succumb putting the very existence of the family as a viable economic unit in jeopardy. The women have to take on the burden of providing for the family in addition to their back breaking domestic chores.

For many women in villages, the loss of the husband entails loss of economic status. It leads to migration to cities in search of sustenance, resulting in their joining the vast urban underclass. Some are also likely to be pushed into prostitution, thus increasing their risk of infection if they are not already infected by their spouses.

Children are likely to be withdrawn from schools to help add to the family income, or, in the case of girls, to take charge of younger siblings. Usually, the husband infects the wife and it is a matter of time before the children loose both parents. The numerous AIDS orphans throughout Africa are a testimony to this pattern.

In India there is as yet no institutional structure to take care of AIDS orphans, specially those infected with HIV prenatally. If the children are not absorbed by the family structure, they are usually left to roam the streets on the fringes of society, resorting to petty crime and prostitution to earn their living. This again makes them susceptible to AIDS.

As of now, the numbers are still too small to show visible effects on the economy. Says Dr. Richard Feachem of the World Bank, "The best time to spend a dollar on HIV control is when you have no HIV in your country, the cost effectiveness of control declines markedly as prevalence rises ... But all India spends on AIDS prevention is a mere two cents per person."

This could turn out to be a classic case of being penny wise and pound foolish. For when the effects of the disease on the economy become visible, it might be too late.

Already the UNDP estimates that the income losses due to the death of skilled adults will cost the country Rs 352,000 per case and, in macro-economic terms, medical care and income losses could work out to 352 billion dollars by 2000. This works out to a full 5 percent of the country's Gross Domestic Product. Can India really afford this? (End/IPS/ap-he-02/mv/an/97)

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