The Hindu : Opinion / Editorials : CONFRONTING AIDS

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Saturday, Jul 10, 2004

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CONFRONTING AIDS

THE ACQUIRED IMMUNE Deficiency Syndrome, or AIDS as it is better known, is already being called "the Black Death of our time." During 2003, almost five million people became newly infected with the Human Immunodeficiency Virus (HIV) that causes AIDS, "the greatest number in any one year since the beginning of the epidemic," points out the Joint United Nations Programme on HIV/AIDS (UNAIDS) in its latest report on the global epidemic. Nearly three million died of AIDS during 2003; over 20 million have died since the first cases of AIDS were identified in 1981. HIV/AIDS is the leading cause of death worldwide among people in their most productive years (15 to 59 years), notes The Lancet Infectious Diseases. The scourge has devastated countries in sub-Saharan Africa, the worst affected region in the world, leaving many on the brink of economic collapse. In India, HIV infection was first confirmed among sex workers in Tamil Nadu in 1986 and by 1994 there were 1.75 million infected people. The number rose to 5.1 million by the end of 2003; only South Africa has more infected people. Although the prevalence of HIV/AIDS is still low in India, no part of the country is free from the disease. In 1994, only Maharashtra reported that more than one per cent of the women coming to ante-natal clinics during their pregnancy were HIV-positive, a danger sign that the disease had spread from high-risk groups to the general population. Now, five more States — Andhra Pradesh, Karnataka, Manipur, Nagaland, and Tamil Nadu — are in that category.

Towards the end of 2003, the Union Government announced that it would start supplying antiretroviral drugs free of cost to 100,000 people in the six high-prevalence States. It is estimated that one-fifth of all those infected could require such therapy, which means drugs might need to be provided to over a million sufferers in India. Indian companies are producing generic combination drugs whose efficacy has now been demonstrated, and the cost of these medicines has dropped. As a result, first-line drug combinations now cost about Rs.1,000 a month while second-line combinations cost six to seven times as much. In providing free drug therapy to all who need it, finding the money is only part of the problem. According to experts, patients who fail to take the medicines regularly can, in a matter of months, develop forms of HIV that are resistant to the first-line drug combinations. Therefore, a large-scale antiretroviral programme must minimise the risks of drug resistance through proper training of physicians so that they strictly follow treatment guidelines; and by finding ways to foster patient compliance.

Antiretroviral drugs do not cure the disease; they only reduce the viral load in the body so that the person can lead a normal life. The spread of HIV/AIDS can be stopped only through prevention strategies that help people avoid contracting the infection. As sexual contact is the primary route for infection in India, prevention programmes must encourage people to adopt safer sex practices (such as by using condoms). Increasingly it is women within marriage who are being infected with HIV, showing that effective prevention strategies that help married couples are badly needed. Senior officials of the World Bank have pointed out that South Asian countries should avoid "the trap of inaction and denial" and must scale up their anti-HIV/AIDS activities exponentially. India needs a comprehensive national effort to stop the spread of HIV and to offer hope to the afflicted.

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