The Hindu : Spreading scourge

Online edition of India's National Newspaper
Monday, Dec 02, 2002

Opinion

Opinion - Editorials

Spreading scourge

A QUARTER CENTURY after the HIV/AIDS epidemic erupted in the Americas, west Europe and sub-Saharan Africa there is no sign of what has now become a pandemic abating in the world. This is the bleak message from the latest update on the global spread of AIDS from UNAIDS. Considerable research has been done and continues to be carried out on different strands of the virus. There has been substantial progress as well in development of treatment regimes. The cost of medicines used for anti-retroviral therapy has fallen dramatically in recent years, largely because of aggressive interventions by Indian pharmaceutical companies. But what has prevented greater success in the global struggle to control the spread of AIDS is the absence of two simple but yet critical factors. Awareness of what transmits the virus from one person to another and of the associated prevention practices is growing by the year, even in the remotest parts of the least developed countries. This knowledge, however, is nowhere near universal, which creates enough of an opening for fanning the pandemic. The second missing factor is the translation of awareness into strict adoption of prevention practices. This by far has been the bigger failure. With an effective anti-HIV/AIDS vaccine many years away, prevention is the only instrument available. So, it remains the task of society, Governments and international organisations to check the spread of AIDS by improving the levels of adoption of prevention practices.

There are now 42 million people suffering from HIV/AIDS in the world. UNAIDS estimates that before the year is out, 3.1 million people would have died from AIDS and five million would have contracted the virus in 2002. Globally, only 1.2 per cent of the adult population is infected with this virus, but the numbers in absolute terms are huge. Worse, UNAIDS predicts that unless there is a dramatic improvement in the adoption of prevention practices, another 45 million people will be infected with HIV between now and 2010. While sub-Saharan Africa is still home to the largest HIV/AIDS population and the highest prevalence rates, the virus is beginning to flare up in the populous regions of south, south-east and east Asia. The UNAIDS report does not update the 2001 estimate for India which placed the HIV/AIDS population in the country at a little under four million and a prevalence rate of less than one per cent of the adult population. There has been some valid criticism of the "sentinel" surveys which have yielded estimates of a large HIV/AIDS population for India. Based as they are on prevalence rates among particular socio-economic groups and in specific geographic areas, there is scope for errors in projections of the future incidence of the virus. However, once the virus takes root in a populous country, there is no escaping its spread across a large population. This is what is happening in India and has begun to happen in China as well. So, while one can quibble about the accuracy of estimates such as those made recently by the U.S. Central Intelligence Agency, which estimated that by the end of this decade India would have the largest HIV/AIDS population in the world, it is not possible to deny the enormity of the problem that the country will soon face.

Recent national surveys, the results of which the new UNAIDS report has referred to, indicate that awareness of safe sex practices is high in India in both towns and villages. Among highly vulnerable groups such as sex workers this is also being translated, in some cities, into safe practices that would prevent the spread of HIV/AIDS. However, there are differences in levels of awareness and use of safe practices between literates and illiterates and also according to the place of residence of the larger population. This suggests that it is not enough, as commonly believed, to focus on the marginal and vulnerable groups. Controlling the scourge in the country requires a broader strategy that addresses awareness of AIDS and adoption of prevention methods in the larger adult population.

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