Footing the bill for the AIDS-affected


The Health Ministry’s announcement that AIDS treatment should not be free is dictated by economic compulsions

Patralekha Chatterjee

Illustration:Anand Naorem

THE PUBLIC statements that have made Union Health Minister Ghulam Nabi Azad so newsworthy have also successfully antagonised those living with HIV and AIDS. Barely had the minister retracted his gaffe about gays and unnatural sex, when he made another statement. Azad made it clear that the government was in no hurry to table the HIV/AIDS Bill in Parliament.

Treatment activists, lawyers and networks of people living with HIV and AIDS clamouring for the passage of the Bill were hugely disappointed with the minister’s statement, when he also said that the government was against free treatment for all HIV patients, which the draft law currently mandates. Drafted after consultations with many groups, it has been hanging fire for over five years now. One of its most important provisions relates to ‘Access to Treatment’.

Although the government provides free first-line treatment to HIV positive people, availability of free second line or antiretroviral treatment (ARV), is limited. Further, diagnostic tests and treatment for opportunistic infections (OIs) are also not freely available. According to the Bill, it is the government’s responsibility to provide treatment free of cost, including first, second and third line treatment, diagnostics and OI treatment.

New HIV infections have fallen by more than 50 percent in India in the past decade. More than 4 lakh people living with HIV currently access ARV treatment. But challenges persist: an estimated 2.5 million Indians live with the AIDS virus, often confronting acute stigma and discrimination. The current Bill could dramatically impact the battle against AIDS.

However, the government appears to be backtracking on its own agenda. Raman Chawla, Advocacy Officer with the Lawyers Collective’s HIV/AIDS unit, who was part of the delegation that met Azad, fears “a slowdown in the passage of the Bill”.

The slowdown could affect those needing third-line treatment and more. All this is happening when the next phase of the National AIDS Control Programme (NACP IV) is being finalised. Expected to be launched in April 2012, NACP IV will define India’s response to HIV and AIDS over the next five years. The minister’s recent statements are at odds with NACP IV’s stated goals of inclusiveness and focus on the marginalised and hard-to-reach populations.

Azad has argued that free treatment cannot be statutory only for those living with HIV and AIDS, as it would discriminate against other patients. The real reason, however, seems to be something else — the global economic slowdown has cast a shadow over India’s AIDS control programme that depended heavily on external donors. If donors do not commit funds, India may have to spend a lot more for NACP IV.

The delay in passing the Bill could affect those needing third-line treatment and more

But surely, an emerging economic power that extends a $5 billion line of credit to African countries can find money to treat its own people who are living with HIV and AIDs. Currently, India spends less than 2 percent of its GDP on healthcare.

Recent developments show that timely treatment for all those infected with HIV is not only a ‘rights’ issue, it is in the interest of public health. In May, the United States National Institutes of Health (NIH) announced results of clinical trials that confirmed that if an HIV-positive person adhered to an effective ARV therapy regimen, the risk of transmitting the virus to an uninfected sexual partner could be reduced by as much as 96 percent. UNAIDS has a new, simpler and cost-effective approach to HIV treatment called Treatment 2.0. It’s a good time for India to tap into that.

The idea of ‘Treatment for Prevention’ is gaining ground, raising confidence in the vision of zero new HIV infections and zero AIDS-related deaths. India, the home of low-cost ARV drugs, can play a key role in shaping the future of HIV treatment. It only has to have the political will to do so.

Patralekha Chatterjee is senior journalist, development issues.


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