Inter Press Service - September 12, 2001
Ranjit Devraj

"We have to know what is the exact figure of HIV/AIDS cases so that planning can be done accordingly," India's health minister, Dr C.P. Thakur said Tuesday.

He said doctors would be resposible for reporting cases to his ministry.

Thakur earlier this year charged UNAIDS, the joint-U.N. anti- AIDS programme, with releasing exaggerated and inaccurate figures on the number of Indians suffering from HIV/AIDS and those who may have actually died of it.

A UNAIDS fact sheet released in June listed the number of children orphaned by AIDS in India as 560,000, a figure which Thakur described as "highly exaggerated" and one which, he said, implied that at least a million people have died of the disease.

On the other hand, Thakur has also complained that India, with over 10 percent of the world's HIV infected people, received just one percent of global funds to fight the virus.

He said India was now keen to start a mother-to-child transmission prevention programme and needed to have an idea of how much it will cost in the way of necessary drugs.

The programme envisages increased testing facilities across the country and changes in the law that will allow informing HIV positive pre- natal mothers of their status and counselling.

Commenting on the move, Dr Mira Shiva, a leading public health expert, said the programme would not work because of the stigma attached to sexually transmitted diseases in this country.

Shiva, however, said there was a need to establish actual figures of people suffering from HIV/AIDS because the governments sentinel surveillance system had failed and was possibly underestimating actual infections.

"What is needed is to first build community-based structures which can carry out reliable surveys but they just don't exist," Shiva, who works for the Voluntary Health Association of India (VHAI), said.

According to Dr Bitra George, a consultant with Sharan (refuge), an NGO which works to prevent HIV spread, the compulsory testing being planned by the government would violate the confidentiality principle emphasised by UNAIDS and other international bodies.

George said once a system of compulsory notification is enforced, people would stop coming to centres such as those run by Sharan and where voluntary testing is available.

"The problem is confidentiality and patients' right to give information to the government when they want. The issue here is are we driving people with HIV underground?"

"HIV/AIDS is not just a medical problem, it has social dimesnions and stigma and discrimination are the biggest problems that prevent people with HIV from accessing health care services," George said.

Rights activists have long been unhappy with the government's strategy of tackling HIV which they say has only succeeded in creating an AIDS scare in the country and stigmatising individuals and even sections of the population labeled as high-risk.

Many have criticised the vast amounts of money being spent on containing HIV/AIDS when far more people were dying of vector and water-borne diseases for lack of basic sanitation.

The World Bank has approved 275 million dollars in interest- free credits to support the second phase of the government's National AIDS Control Programme which began last year. The first phase received 84 million dollars.

The central government's National AIDS Control Organisation estimates that 3.7 million people are living with HIV/AIDS in the country.

"What guarantees can the government give to people who test HIV positive when it cannot even ensure that people do not die of hunger and starvation?" Anju Singh, rights activist demanded to know.

Her reference was to reports of hundreds of poor people having died of starvation in recent months while some 60 million tonnes of surplus foodgrains lay rotting in government godowns for want of a mechanism to distribute it.

Singh, convenor of the Health India Forum (HIF) charged the Ministry of Health with succumbing to the pressures from pharmaceutical companies that were seeking to "medicalise" the HIV/AIDS issue while disregarding "huge and inevitable social consequences".

For his part, Thakur was determined to go ahead with plans for extensive testing. "We have decided that in each district we should open testing centres and even in sub-divisional (small) towns."

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