BANGALORE: S. Thimmaiah, a retired clerk, sold his two-bedroom house two months ago to pay for his medical treatment.

The 62-year-old, HIV positive person, spends Rs. 25,000 every month on medication. "I had no other choice but to sell my house to continue paying my medical bills. It was my only way out," he added. Mr. Thimmaiah has been living with HIV/AIDS for the past 15 years.

With the Government rollout of Antiretroviral drugs reaching only one out of every 10 persons who need it, many persons living with HIV/AIDS such as Mr. Thimmaiah are forced to go to private clinics. A number of them are facing debts due to the high cost of treatment.

A study by National Aids Control Organisation and National Council for Applied Economic Research has revealed that the "burden of hospitalised illness is five times more for HIV households." The study showed that the financial implications of the epidemic, which includes the cost of drugs and the pressure on the public health system, are particularly severe for the poor and low-income households.

Another study by United Nations Development Programme showed that death caused by HIV and AIDS could pull down total incomes of HIV households by 9.24 per cent. The insurance schemes offered by two non-governmental organisations, Karuna Trust and Freedom Foundation, also fall short of providing coverage for complete treatment.

Karuna Trust in association with National Insurance Company (NIC) offers a health insurance that will cover "all illnesses" including pre-existing conditions. The insurance will be available at 25 primary health centres, each catering to 20,000 people. It will be offered at a premium of Rs. 22 a year and will cover "some investigations as well as treatment of opportunistic infections". To compensate for wage lose incurred by the policy holder while undergoing treatment, the insurance scheme offers Rs. 50 per day for a maximum of 25 days and an additional amount of Rs. 50 a day to buy medicines that are not available at the hospital.

H. Sudarshan, secretary of Karuna Trust, said the policy could be used only for treatment in government hospitals. "We want to promote public health centres and improve its accountability by having more people visit it," he said.

However, a problem with the Karuna Trust insurance is that it does not cover the cost of hospitalisation or of Antiretroviral treatment (ART), which is expensive. It is the cost of ART, which pushes up the medical bill for most HIV positive persons. A HIV positive person based on his medicine regimen can spend anywhere from Rs. 10,000 to Rs. 50,000 on ART. As availability of subsidised ART in government hospitals is limited, most people are not able to avail themselves of it. The Union Government has promised ART for 1.3 lakh affected persons over the next five years. National AIDS Control Society estimates that 52 lakh Indians are HIV positive. Experts said that at least 20 per cent of them require ART.

Freedom Foundation is planning to provide insurance on a pilot basis to 1,000 HIV positive persons. The premiums will be at variable rates starting from Rs. 1,000. Hospitalisation for treatment will be at one of the Freedom Foundation centres, said Ashok Rau, its Director.

However, whether these small initiatives can be replicated on a larger scale is a moot question. The National Insurance Company is not planning to cover HIV/AIDS, according to Ashwathnarayan, regional head of NIC, Bangalore.

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