The Hindu : Opinion / Editorials : TREATING HIV

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Saturday, Feb 05, 2005

Opinion

Opinion - Editorials

TREATING HIV

THE NEW YEAR has begun on an encouraging note for the campaign against HIV/AIDS, with the World Health Organisation/UNAIDS reporting that its "3 by 5" initiative to help provide drugs to people living with the virus has achieved the global targets. The capacity-building project derives its name from the target of covering three million people in need of treatment by 2005. The progress report states that an estimated 700,000 people have been put on antiretroviral treatment (ART), representing more than 12 per cent of 5.8 million people who currently need ART in developing and transitional economies. As a coordinated endeavour, the 3 by 5 programme has made rapid progress, already meeting targets in some countries; elsewhere, the challenge ahead is to evolve national policies, and co-opt the citizen sector, and people living with HIV/AIDS in order to identify weaknesses and suggest remedial measures. Guided by state policy, such a framework must provide universal access to drugs at no cost to people living with HIV/AIDS and help them live a more productive life. There is persuasive evidence to show that a combination of antiretroviral drugs reduces morbidity and mortality.

Over the past few years, the campaign to manage HIV/AIDS in India has acknowledged the importance of making treatment accessible to all. As international experience shows, more people come forward to get tested when there is an assurance that the health system will provide medication to all who need it. Such a programme also offers a social dividend since it enables people living with HIV/AIDS to remain economically productive with the help of drugs. A well-founded campaign to address the HIV/AIDS pandemic, therefore, includes access to treatment and formulation of policies to prepare the health system at all levels to offer it. Guided by such concerns, the 3 by 5 initiative was launched to help countries create institutional structures that provide testing, counselling, and treatment. Yet not enough ground has apparently been covered in the country, as the WHO assessment at the end of 2004 indicated; India joins South Africa and Nigeria on the list of countries that have made insufficient progress in expanding ART.

The review of the 3 by 5 initiative serves to focus the debate on the question whether the public health system in the country is equipped to undertake a long-term commitment. Although treatment has become part of the discourse in the fight to control HIV/AIDS, many who seek testing and medical help are generally unable to avail themselves of such services at a nearby health centre. Such a situation is untenable in a country where an elaborate network of institutions starting with public health centres and care givers from the level of village health nurses is in place to cater to the remotest regions. Voluntary counselling and testing facilities must continue to be expanded in a mission mode and the system cleansed of the stigma attached to HIV/AIDS. The message must go out that HIV is a chronic condition that responds to treatment. HIV-positive individuals are disappointed that those among them who have managed to remain marginally healthy by relying on their own meagre resources, and therefore have a lesser viral load, find themselves unfairly excluded from the state-managed treatment. There is also the issue of the high cost of ART drugs and service delivery. The Central Government must work to create strong partnerships internationally and within the country to extend antiretroviral medicines to all those who need it. In the process, it may have to overcome obstacles presented by the patents regime for drugs, which is certainly no friend of the battle against HIV/AIDS in the developing world.

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