Forget the figures, save lives

Pharma companies—Indian or MNCs—are not waiting at the doorstep of the India’s HIV-affected community to provide them with drugs. They, especially Indian pharma companies, are more interested in making their money in the US or the Europe. As for the other argument, there is no need to be shy about demanding money where it is needed. More money comes in today for HIV/AIDS than before, but it is a mere drop in the ocean.

Then what is the controversy about?

UNAIDS estimates that nearly four lakh HIV-related deaths occurred in India last year. By any measure, the figure is shocking. And it is no wonder the government and National AIDS Control Organization (NACO) find the figure unacceptable. The government—while it has commissioned their own studies about the figure— wants to know the methodology that UNAIDS has used to arrive at the figure. The government’s doubts are justified. After all, UNAIDS had severely overestimated the HIV sero-prevellance projections in southern Africa based on modeling studies.

But ultimately it is of little comfort.

Even if the government were to come up with a lower figure—say 50 per cent or 25 per cent of the UNAIDS figure, which amounts to 2 lakh or 1 lakh deaths—the figure is still shocking. The government simply cannot take cover of the alleged overestimate by UNAIDS to abdicate its responsibility towards the HIV-affected in India.

HIV even today means a certain death sentence. But since 1996, the anti-retroviral therapy (ART) has helped millions to live with the disease. And Indian generic pharma companies make these drugs available to the third world countries. So why should four lakh or even one lakh HIV affected have to die in India —where drugs are available at the cheapest price in the world? Therein lies the key question, and some would say the culpability, of the government.

Way back in 1997, Brazil showed the way to help its citizens. Based on the idea that no Brazilian need to die of HIV/AIDS as long as treatment is available, the Brazilian government is currently providing treatment to all those who need it. That is approximately 1,40,00 of a total of 620,000 HIV-affectd people. Not surprisingly, the death rate has fallen drastically.

It must be noted that both UNAIDS and NACO accept the figure of 5.7 million (point estimate) as the number of HIV-affected in India in 2005. They also do not disagree that as of today the number of HIV-affected who need treatment in India is anywhere between 5 and 7 lakhs.

But India made a late start in providing treatment to these people—from April 1, 2004. As of now, the government is providing free ART to only about 20,000 people. Another 15,000 are provided free ART by the ESIC, railways and the armed forces. By any standard this is abysmal, as it does not amount to even 2.5 per cent (or 3.5 per cent, including the other 15,000) of those who need treatment.

The corresponding international figure for 2005 is 40 per cent—about 1.3 million against the targeted 3 million. This has been criticised internationally and rightly so. But our figures are humiliating.

By 2010, the government hopes to cover 1,80,000 people—far short of 25 per cent of today’s requirement. In another five years, with the number of HIV-affected going further up, it can only only fall shorter. The rest are supposed to be left to goodwill of private sector, where goodwill is sadly lacking—and will probably face death without any treatment.

This is again totally unacceptable. Under the circumstances, the government cannot afford to complain about the UNAIDS methodology and data and figures and hope to be taken seriously itself. The provision for treatment has to be taken with a missionary zeal—with the Brazillian motto that “no Indian shall die only because he/she cannot afford or access ART”.

Anand Grover is a practising lawyer and the Director of the Lawyers Collective HIV/AIDS Unit, which drafted the HIV/AIDS Bill