The Hindu : The numbers don't add up

Online edition of India's National Newspaper
Sunday, Nov 17, 2002

Opinion

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The numbers don't add up

Projections of the future do not take into account the effort being made for prevention and control of AIDS/HIV, writes Gargi Parsai.

WHEN THE Microsoft chief, Bill Gates, committed $100 million as initial funding for the prevention of HIV/AIDS in India for the 15-24 age group, many did not know whether to rejoice or regret. The huge grant only pointed to the enormity of the problem in the making.

Yet, India has disputed the projections made by the United Nations and the recently released United States' National Intelligence Committee Report. India is bristling not so much over the estimates of current prevalence — which is about 3.97 million HIV cases at the end of 2001— but the projection that it would explode into 20 to 25 million affected persons by as close as 2010. And with good reason. The projections of the future do not take into account the effort being made for prevention and control in the country. Once again India's numbers are being held against it. Nafis Sadik, newly appointed Special Envoy on HIV/AIDS in Asia to the United Nations Secretary-General, says it is wrong to look into the future as what is important is taking action now. What India did not like was the implication that it was doing nothing about AIDS and that the epidemic would follow the course as it did in Africa, she said. "It also got irritated with the U.N. Security Council urging nations to address HIV/AIDS in the context of human security risk calling for testing of all national uniformed forces as well as its estimates of creation of orphans in countries most threatened by AIDS."

"The numbers game is not unimportant. However, let us not miss the wood for the trees," says Meenakshi Datta Ghosh, Additional Secretary, Ministry of Health and Family Welfare, who has recently taken over as Project Director of the National AIDS Control Organisation (NACO). According to her, the World Bank projections in a Project Appraisal Document of May 1999 (on the basis of a mathematical modelling exercise) appear to conform in terms of prevalence as shown in successive Sentinel Surveillances. The Bank said India would have roughly 10.9 million cases of HIV in 2024, if adequate interventions were put in place.

Having said that, it is must be pointed out that with the national prevalence rate of HIV and AIDS at 0.8 per cent, (except in Tamil Nadu, Andhra Pradesh, Karnataka, Maharashtra, Manipur and Nagaland), the epidemic in India is globally categorised as low. Yet, India faces a challenge which must be responded to with a sense of urgency and sustainability. To get to more realistic figures of prevalence, NACO is now commissioning the National Council of Applied Economic Research (NCAER) and the Indian Council for Medical Research (ICMR) to revisit the estimates with a burden of disease approach and with more refined methodologies for estimation. Officials admit that the existing surveillance sites which include medical colleges, district hospitals and ante-natal clinics may not fully capture the epidemic in all rural areas.

The first HIV case was detected in Tamil Nadu in 1986 and the HIV takes 10 to 15 years to show up as full-blown AIDS. Prevention is the best cure for this virus which is chronic and hits a person's immune system. Since the two major routes for infection are through unprotected sex and re-use of infected syringes, it is difficult to trace the channels of transfusion and the disease remains invisible and the victims stigmatised.

The predominant mode of transmission of infection is through heterosexual contact (80.86 per cent) followed by blood transfusion and blood product infusion (5.52 per cent), Intravenous Drug Use (5.30 per cent), prenatal transmission (0.72 per cent) and others (7.60 per cent). Males account for 77 per cent of AIDS cases and females 23 per cent (a ratio of 3:1). The estimated aggregate costs of HIV/AIDS by 2000 were $11 billion (five per cent of India's GDP). The factors increasing vulnerability to HIV/AIDS are poverty, migration of affected population and child mortality.

World donors have recently cut back funding to population stabilisation programmes and diverted finances to prevention and control of HIV/AIDS. For one, the Africa experience where the disease has taken epidemic proportions and is devouring the economic and social structure of the continent, appears to have scared the world. Secondly, the United States has withdrawn support for reproductive health and population stabilisation programmes made at the International Conference on Population and Development (ICPD) owing to differences on the issues of abortion and information of services to adolescents.

This has led to the global withdrawal of funds to population stabilisation programmes including in India. In India, health workers in the voluntary sector fear the huge funding in the HIV/AIDS sector will impinge on the public health care system that is grappling with controlling maternal and child mortality, diseases such as diarrhoea, malaria, tuberculosis, hepatitis and malnutrition. Mira Shiva, activist, fears that the huge funding for HIV/AIDS is driven by multi-national pharmaceutical companies who are into anti-retroviral drugs. "This is as if to say, you can die from other diseases but not from AIDS. The RCH (Reproductive and Child Care) programme will be reduced to just immunisation of children."

However, by all accounts, India needs the funds and the same time, proper utilisation, through education, information and meeting unmet needs for condom availability. The health system will have to be upgraded to manage HIV/AIDS patients and funds will have to be re-allocated to assure that no sector suffers.

The NACO has a five-year package of Rs. 1,455 crores which is capped by the Planning Commission. In 2002-03, the Government's premier AIDS control agency received a mere Rs. 225 crores. What really must be emphasised at the policy level is political will, integrated approach and commitment to impeccable medical practices — clean gloves, syringes, blood transfusion techniques. But above all what is required is looking the challenge in the eye.

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The numbers don't add up