India forgets its afflicted

Indian figures are therefore appalling. Indeed, even the targets are set too low. The 2001 UN Declaration of Commitment, to which India is a signatory, aimed at providing drugs to 50 of those in need by 2005, yet India only aims to provide 10 coverage by 2007. What explains this abysmal coverage? Due to 8216;lack of funds8217; the number of ARV centres in India is terribly inadequate 8212; there are a mere 52 centres in 25 states 8212; and not all of them are operational. Most functioning centres are in state capitals. Given that ARVs require monthly hospital visits, transport costs are naturally prohibitive. Those who can afford such frequent journeys will tend to access the drugs privately. The government has essentially transferred the cost of accessing ARVs to the patients, and in most cases this cost is a serious barrier to access. Why can8217;t we give ARVs to the globally accepted target of 50 of those in need?

Two arguments are often made against this, both of which are unsound. The first is that our scarce resources should be utilised for prevention instead of treatment. However, treatment has enormous implications for prevention because, by offering life to those who are positive, it encourages people to test. Without treatment, the incentive to test is reduced as the only consequences of testing positive are stigma and discrimination. ARVs also bolster prevention efforts by reducing the viral load of HIV in the blood, thereby lowering the probability of transmission. Hence not only do ARVs allow patients to live longer but they also lower their chances of infecting others.

The second argument is that the demand for ARVs is low since most people do not know their HIV status. This argument misses the point. We must provide people with incentives to test, not simply accept that low levels of testing are an unchangeable constant in the Indian context. In India, so far, the only solution to increasing testing levels has centred on mandatory testing 8212; a process that is both undemocratic and unsound on human rights grounds 8212; provision of ARVs is a powerful alternative to this. Nor is funding a problem. Indeed, there has never been more money in AIDS than there is today. Global pledges, already at US 9 billion per year, are increasing steadily. India is far from laying claims to its share of funds for treatment. South Asia has a quarter of the number of people infected with HIV as sub-Saharan Africa but only receives one tenth of the funds available for treatment. With political commitment, these resources can be harnessed. Furthermore, India is the largest manufacturer of cheap ARVs in the world; we even export these drugs to other countries. This makes it particularly economical to treat people in India.

What is the way forward? Firstly, ARVs should not only be provided in every state capital but also in district hospitals. Providing ARVs does not require extensive facilities 8212; only a laboratory for simple blood tests 8212; so provision at district hospital level is not unreasonable. Secondly, ARVs should be marketed aggressively to encourage testing and facilitate prevention. If we are to address the growing epidemic in India we need to recognise the role that treatment plays both in prolonging life and in bolstering prevention efforts. A full-blown AIDS crisis in India would impose staggering human and economic costs. Yet, through ARVs, India has an opportunity to escape an African-style disaster. The drugs exist. The funding exists. Now is the time for action.

The writer is visiting research fellow, Health Economics 038; HIV/AIDS Research Division, University of Kwa-Zulu Natal, South Africa