The AIDS initiative

Print edition : January 16, 2004

While welcoming the government's initiative to provide ARV treatment at reduced cost, the HIV/AIDS community hopes that it will also strengthen diagnostic facilities and extend coverage of the plan.

in New Delhi

Union Minister for Health and Family Welfare Sushma Swaraj.-RAVEENDRAN/AFP

SEVENTEEN years after the first cases of Human Immunodeficiency Virus (HIV) infection were detected in India, Union Health Minister Sushma Swaraj announced on November 30 the government's plan to provide anti-AIDS (Acquired Immune Deficiency Syndrome) drugs to one lakh HIV/AIDS patients at reduced prices in Tamil Nadu, Andhra Pradesh, Karnataka, Madhya Pradesh, Manipur and Nagaland, which account for more than 80 per cent of all reported cases of AIDS in the country. The government aims to implement this by April 1, 2004.

Four pharmaceutical companies - Cipla, Ranbaxy, Matrix and Hetero - have agreed to supply anti-retrovirals (ARVs) to the government. Though the exact price has not been agreed upon as yet, industry representatives expect that it will be at a rate slightly lower than Rs.6,419 per patient per annum, the price offered to the Clinton Foundation recently. (The Clinton Foundation, set up by former American President Bill Clinton, provides ARVs to African and Caribbean countries.)

Says Ashok Alexander of the Melinda and Bill Gates Foundation: "Pharmaceutical companies are able to provide lower prices by promising bigger volumes in the future. This helps lower the costs." However, with the government waiving excise on several pharmaceutical ingredients used in the making of ARVs, in effect the government will be spending as much as earlier. The National AIDS Control Organisation's (NACO) announcement that the companies were willing to bring prices to a level lower than that offered to the Clinton Foundation is more of a publicity exercise. Sushma Swaraj has announced that she will take up the issue with Finance Minister Jaswant Singh and the Planning Commission to ensure that these exemptions are given in the Union Budget.

What the government has committed itself to is Rs.200 crores for the infrastructure needed to implement this programme by April. Of this, Rs.113 crores is meant for medicines and Rs.87 crores for providing infrastructure to screen people for HIV/AIDS infection. The supply of drugs will initially be to three categories of patients - children of persons living with AIDS or HIV infection, women having AIDS or HIV infection, and men who suffer from full-blown AIDS. Says Sandeep Juneja, HIV Project head of Ranbaxy: "The scale of the project is put in perspective when one looks at Brazil, which has an advanced government-run programme that provides ARVs free to the public. The total number of people who have access to this programme is only one lakh." The Brazilian government has ensured a system of providing universal access to all AIDS-related treatment, including ARVs, through the public health system since 1996.

Though this is an important step that the government has taken, the question is where the government will find the funds. India is estimated to have an HIV seropositivity rate in adults of 0.7-0.8 per cent. It has 3.14-4.58 million HIV-positive people, a figure much lower than those for sub-Saharan Africa and South Africa. NACO had an expenditure allocation of Rs.18 crores for the year 2001-02. The Global Fund to fight HIV/AIDS has already released $100 million to India to fight HIV/AIDS and another $30 million to fight tuberculosis. The government's existing proposal, for which funds have not yet been made available, provides for ARV prophylactic care to 3,50,000 HIV-positive pregnant women and their families, and ARV treatment to 15,000 persons living with HIV infection/AIDS. It is therefore possible to envisage a government-run programme that provides universal access.

Anti-AIDS drugs produced by Cipla, one of the four pharmaceutical companies that have agreed to supply anti-retrovirals to the Union government at reduced prices.-AFP

Even as the government increases fund allocation for ARV treatment, people living with HIV/AIDS (PLWHAs) are still discriminated against. Hospitals continue to deny treatment to HIV/AIDS patients. Moreover, a large number of PLWHAs cannot tolerate ARVs because of the toxicity of the medications or because they are resistant to the treatment. The drug that is provided has to be of high quality. The person taking the drug has to be constantly monitored and the drugs may have to be changed if resistance or toxicity is observed. The patient has to adhere to a strict regimen and the government has to ensure that information about the exact regimen is communicated to the patient, that there is a regular supply of drugs, and that side-effects are handled. Says K.K. Abraham of the Indian Network of Positive People: "This is a good initiative. All these years, the epidemic was neglected. This announcement will give hope to the 4.58 million people living with HIV/AIDS in India."

According to Ritu Priya, Assistant Professor, Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi (Economic and Political Weekly, December 13), given all these complexities, if free treatment with regular drug supply is not through a structured system, the suffering of HIV patients will only get compounded. This is the imperative of the ARV technology.

It is to allay such fears that the Health Ministry has said that the Confederation of Indian Industry (CII) has offered to procure about 150 CD4/CD8 count machines to monitor the viral load in people with the illness. But the government has to ensure that these machines are distributed in a rational manner. Says Abraham: " These machines have to be practically placed after consultations at the State level. The government has to make plans to strengthen the diagnostic facilities for at least 10 lakh people in order to figure out who needs ARV treatment."

A number of petitions have been filed before the Supreme Court asking that the government provide ARVs. The most recent one, filed by the Voluntary Health Association of India (Frontline, September 26, 2003), requests the court to direct the government to provide PLWHAs the right to treatment under the country's public health system.

The petition asks the state to provide free and equitable access to ARV treatment for HIV-positive persons by creating the required infrastructure in public health institutions. Earlier petitions specifically dealt with the right of PLWHAs to receive non-discriminatory treatment from health care workers and the right to a safe working environment for health care workers and medical practitioners.

The challenge before the government is to address these concerns too while implementing its plan. Says Abraham: " The HIV/AIDS community is happy that the government has taken this initiative. But it has to strengthen diagnostic facilities and expand its programme to include cities like Kolkata and Delhi."

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