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 Photo: martin Flynn |
According to the latest estimate, India has the second highest number of people living with HIV after South Africa. The number now stands at 4.58 million, or about 0.5 per cent of the population.
This is an increase of 15 per cent in 2002 or 560,000 people over the previous year.
Providing free antiretroviral medication for the huge population has not been possible for the state. Prohibitive costs, the indefinite period of treatment and the need for supportive investigation to monitor the progress of the disease are cited as reasons for the government’s inability to offer free treatment to the needy with the disease.
Yet ironically it is Indian companies who manufacture the cheapest antiretroviral drugs. Since the Durban Aids Conference in 2000 the prices of generic medication have fallen to less than $1 per patient per day.
India spends only 17.3 per cent of its total health budget on free public healthcare, says civil liberties group Social Watch in a recent report. (As reported last month in PN, this translates to India’s government spending less than $12 a year on each person under healthcare.) Neighbouring Sri Lanka in comparison spends 45.4 per cent of its health purse on public care.
According to the Health Ministry’s Aids policy division, the annual budget for prevention and treatment was $50 million in the fiscal year 2002-2003 (around seven per cent of what the UK spends). At the moment, the only people getting drugs are pregnant women and babies, and government civil servants.
In such a situation, most patients have to fend for themselves. A family with an Aids patient has a huge burden, and they may have to sell off property or write off savings for retirement to meet the cost of treatments.
Meanwhile, the private sector hospitals and charitable organisations try to fill in some of the gap. Even here, the demand is far more than the ability to serve.
One well-known clinic is Dr Suniti Solomon’s YRG Care in Chennai. Though one of the best-funded in the country, it can only provide free drugs to one in 10 of its 5,000 plus patients, primarily pregnant mothers and children.
The clinic negotiates with pharmacies to enable the other patients, relatively better placed financially, to buy the drugs at a discounted price. Even then, many have to buy medicines in spurts depending on the availability of funds.
Approximately 600 non-governmental organisations are implementing various HIV and Aids prevention and care activities, particularly for high-risk groups, through activities funded by the government and other donor partners.
The World Bank has approved US $275 million in interest-free credits to support India’s National Aids Control Program, and the Global Fund to fight Aids, Tuberculosis and Malaria has pledged to spend $100 million, which the government says it will use to provide care in this sector.
Prevention is a focus area for many charities. The Bill and Melinda Gates Foundation, for example, has pledged $100 million during the next 10 years entirely on prevention, beginning with projects focusing on inter-state truck drivers to practise safe sex.
Doctors like Dr Solomon believe that prevention alone cannot stem the tide and that money for providing care is vital. Others, however, feel that the drug cocktails are over-emphasised at the expense of many other possibilities in Aids care.
Of late, combining traditional ayurvedic medicines with prescribed drugs for treating HIV/Aids is getting a lot of attention, and a lot of research is going on in this area. One advantage of this is that the herbs for the medicines are available locally and can be much cheaper.
Many Indian doctors routinely use Indian ayurvedic or herbal compounds alongside standard Western medications. Ranjita Biswas
