The Hindu : Controlling an epidemic

Online edition of India's National Newspaper
Friday, Jul 11, 2003

Opinion

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Controlling an epidemic

By N. Gopal Raj

India needs to quickly boost its AIDS prevention effots.

WORDS OF warning are already being voiced. The incidence of infection with the Human Immunodeficiency Virus (HIV) and the Acquired Immune Deficiency Syndrome (AIDS) it causes could be set to explode in India and China, the world's two most populous countries. "China and India stand on the brink of widespread epidemics, as HIV spreads from groups at high risk to the broader population," observed a recent report. The current low prevalence rates are deceptive. The Joint United Nations Programme on HIV/AIDS (UNAIDS) puts the prevalence of HIV among adults in India at less than one per cent, compared to nine per cent in sub-Saharan Africa, currently the worst affected region in the world. On the other hand, India stands second only to South Africa in the number of HIV-infected people. Worse still, there are reports that HIV infections are spreading twice as fast in South Asia as in sub-Saharan Africa.

There are fears that India (and South Asia) could go the sub-Saharan way. "India shares some of the same risk factors as Africa, including a similar pattern of health expenditure, an uneven health infrastructure and prevalent high risk sexual behaviour," say Malcolm Potts and Julia Walsh of the School of Public Health at the University of California at Berkeley in a recent article in the British Medical Journal. They argue that India needs to apply the lessons learnt in Africa. An oft-quoted estimate is that there could be 20 million to 25 million new HIV cases in India by the end of this decade, a many-fold increase over the present four million HIV-infected people. But if Ventaramana Chitta Balasatya, who was head of the Andhra Pradesh State AIDS Control Society and is currently doing doctoral research in the United States, is correct, the picture could be even grimmer. In a published journal paper, he and a colleague estimated that the commercial sex networks could create over 50 million HIV infections in India by 2005 in a worst-case scenario. Even his more conservative estimate of 12 million HIV cases by 2005 would be a marked escalation of the HIV/AIDS epidemic in India.

The African experience shows what high levels of HIV in a society mean in everyday terms. According to UNAIDS, average life expectancy in sub-Saharan Africa is now 47 years, when it would have been 62 years without AIDS. Loss of income and mounting medical expenses push HIV/AIDS affected families deeper into poverty, stripping assets from the already impoverished. As parents die, the care and upbringing of children, who might themselves be infected with HIV, become major social problems. By affecting those in the prime of their lives, HIV/AIDS has a severe impact on national economies. The rate of economic growth in sub-Saharan Africa is believed to have reduced by two to four per cent as a result of AIDS.

There is as yet no effective cure which can remove the virus entirely from the body of an infected person or a vaccine which can prevent infection. But as the Global HIV Prevention Working Group said in a recent report, a massive expansion of the HIV/AIDS epidemic was not inevitable and could be reversed if proven prevention techniques were used in combination and on a sufficient scale.

In India, sexual contact is the primary route through which HIV spreads. Prevention requires awareness among the public of risky sexual behaviour combined with ways to avoid such risks. As in many other tradition-bound societies, open discussion of sexual issues is often problematic in India.

The myths and realities around sex and sexuality issues in India are similar to those that exist across the world, says Renate Ehmer, who chairs the U.N. inter-agency group on AIDS in India. Young people should be encouraged and provided information to make informed choices to protect themselves from infection, she says.

Inadequate funding for AIDS prevention work is a global problem. A new report from UNAIDS points out that, despite the increased funding promised by the U.S. and Europe, this year low and middle income countries would not be spending even half the amount needed annually by 2005.

The Global HIV Prevention Working Group estimated that the funding gap in Asia and the Pacific was about $1.48 billion. While Dr. Potts and Dr. Walsh note that the Rs. 300 crores India currently invests on AIDS prevention is "much less than needed", no estimate on the extent of this deficit seems readily available. But if the gap is in the same proportion as for Asia and the Pacific, the shortfall could be as much as Rs. 1,000 crores.

India needs to quickly boost its AIDS prevention efforts. An analysis in The Lancet showed that implementation of a comprehensive prevention package by 2005 would more than halve the total number of HIV infections between 2002 and 2010. One-third of this global reduction would benefit two countries — India and China. But the experts also warned that delayed implementation of the prevention package would lead to large reductions in the infections prevented. India has a window of opportunity — but it may not remain open for long.

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