Inter Press Service - October 24, 2003
Ranjit Devraj

"The Indian government cannot afford to provide anti-retroviral treatment to those already suffering or even subsidise it," said Prasada Rao, secretary in Union Health Ministry.

Rao, who was earlier the director of the National AIDS Control Organisation (NACO), said the emphasis would continue to be on "prevention rather than cure".

"The overall goal is to decrease the prevalence of HIV in high-risk groups and stabilise it in the general population by 2008," said Rao.

But those involved in the care of HIV victims say that extra funds for treatment could greatly extend the lifespans of those already suffering and alleviate their misery.

Less than 10 percent of the 300-odd patients who have been attended to at the Naz Care Home, one of the city's four voluntary institutions that provide care to HIV victims, have had any treatment with anti-retrovirals.

"Most of the people who come to us just cannot afford treatment," said Irfan Khan, coordinator at the Naz Care Home.

"It is time that the Indian government moves out of its preventive approach and helps hundreds of thousands of HIV-positive people rather than leave them to die," said Shruti Pandey, an activist of the Human Rights Law Network.

Curiously though, India is a major producer and exporter of generic anti-retrovirals. Large Indian companies like Cipla and Ranbaxy are poised to provide medication to several countries in the Africa and Caribbean region under a deal backed by former U.S. president Bill Clinton.

An official for Ranbaxy confirmed that his company would be providing generic 'triple-drug cocktail' regimens at less than 40 cents a day per person under an agreement with the William J Clinton Presidential Foundation, which has been working on ways to cut treatment costs for millions of people with HIV around the world.

When compared with the costs of generic drugs, treatment with the original patented medicines would cost at least three times that and the beneficiaries would include HIV patients in countries like Mozambique, Tanzania and Rwanda.

But even 40 cents a day is unaffordable to most patients who seek help from care homes in the city, said Irfan Khan, who believes that it is time the government stepped in to provide treatment free to prevent spread of the virus.

Anti-retrovirals from Cipla, Ranbaxay and a third company called Matrix have been assessed by the World Health Organisation (WHO) and declared to be of international quality.

Across the world, some six million of the 40 million people with HIV are estimated to require treatment but that figure is expected to rise in a few years.

In the developing world, only about 300,000 people are on anti-retrovirals. More than a third of that number are accounted for by Brazil, mainly because that country has already legislated to provide free and universal treatment through the public health delivery system.

While pressure has been growing in India from voluntary groups to follow Brazil's example, few see that happening in the immediate future. The Indian government spends less than a dollar per person on HIV/AIDS treatment and less than 12 dollars overall per capita on health care.

Estimates made by the Lawyers Collective's HIV/AIDS unit have placed the annual cost of treatment with anti-retrovirals at 1,000 dollars per head, but say that major changes have to be made to the ailing public health delivery system before it can take on care and treatment.

With a population of over one billion people, India has the second largest number of HIV-positive persons in the world, or around four million cases.

According to Helene Gayle, director of the HIV/AIDS, TB and reproductive health programme at the Bill and Melinda Gates Foundation, India has a "very small window of opportunity within which to control the HIV/ADS epidemic".

Gayle, who was in India last week to announce the enhancement of her foundation's outlay for India from 100 million dollars to 200 million dollars and disbursal of the money before the middle of 2004, said she believed that the level of infection could be rising by as much as 20 percent per year.

The foundation's 'District Focus State Impact Initiative' will support HIV prevention programmes in the six highest-incidence states of southern Andhra Pradesh, Tamil Nadu and Karnataka, western Maharashtra and north-eastern Manipur and Nagaland for male and female sex workers, their clients, injecting drug users and other populations with high-risk behaviour.

Additionally, a National Highways initiative will be implemented along 700 km of the major highways in India, covering inter-state truckers and highway-based commercial sex workers and their partners, Gayle said. (END/IPS/AP/HE/SD/DV/RDR/JS/03) .

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