AIDS is still hot in India

A series of articles by guest writers for World AIDS Day Part of AVERT's World AIDS Day 2012 campaign, ‘Reflections on the Epidemic’ are a series of articles by guest writers. Our guest writers range from global leaders, writers, experts, activists, physicians and people personally affected by HIV and AIDS; and they represent various countries, experiences and backgrounds from all over the world. We are grateful to all our guest writers for their effort and the diverse and insightful viewpoints that they contributed to the world’s response to HIV and AIDS. We will be re-featuring these articles over the next few weeks on a weekly basis. Browse through this week’s featured articles, and see the full list below.

Around the globe, the HIV infected and affected are struggling a lot with stigma and discrimination in diverse means. Even HIV and AIDS service providers, such as counsellors, clinician’s laboratory personnel, paramedical staff, and NGOs working in the HIV and AIDS sector are no exception to this stigma. Here I recall two incidents that were narrated by Members of Parliament at a Youth Parliament session on AIDS, which was inaugurated by the Honourable Prime Minister of India in November 2004. The first was a health minister of a South Indian state expressing reluctance to even talk to social workers of an AIDS service organisation, perhaps due to fear of stigma or infection. The second was a Member of Legislative Assembly from another state in India feeling embarrassed to shake hands with those working in HIV/AIDS clinics.

As I was one of the speakers in that session, I was amazed on hearing these two episodes of elected representatives. These incidents, even after decades of detection of HIV/AIDS in India, reinforce the intensity of stigma attached to HIV and AIDS. The question arises – what is the way forward to eliminate the stigma?

Well, socially, the civil society and governments (Local, Provincial and National) should speak loudly in every forum that HIV/AIDS is just another disease. Moreover, “Positive Networks” should come forward more openly to sensitise the general public by setting aside their inhibitions. On the political front, Presidents & Prime Ministers of various nations, celebrities from celluloid and sports should jump into action to mingle with HIV patients through “COMMUNITY FEASTS” or  “PUBLIC AWARENESS SUMMITS” so as to send a strong message that it’s a proud and dignified moment to honour these positive people with due respect. Also, Heads of State can greatly contribute by publicly hugging HIV/AIDS patients to create belief that they are integral to the developmental process. Finally, ways to bring a “Social Revolution” through legislative action to eradicate stigma are to be seriously contemplated.

Although ART (antiretroviral Therapy) centres in India are providing free medication for HIV/AIDS patients, there is much to be desired in practice. Honestly speaking, advanced care for AIDS is out of the reach of commoners. Therefore I have been urging the Andhra Pradesh government to extend the Arogyasri scheme (a government sponsored free medical treatment) to HIV/AIDS cases also. Such a programme at Pan-India level would be a boon to the HIV/AIDS affected population. Is it not a great injustice to exclude HIV/AIDS patients from Arogyasri while covering patients of heart and kidney diseases that cost lakhs? It looks as though the life of an HIV/AIDS patient is less precious than kidney or heart patients. So, “Right to lead a dignified life”, an inferred fundamental right of every citizen including HIV/AIDS patients under Article 21 of Indian constitution should be followed in letter and spirit.

In HIV treatment, very often choice is not given to patients, whether they can afford it or not. A disease by itself has no discrimination between poor and rich patients. Therefore, the physician recommends what is essential to save a patient’s life, irrespective of the financial burden on them. Since AIDS is of recent origin, many ARV drugs and laboratory tests are dear. HIV genome, viral load, HIV monitoring capsule etc are also not within the reach of even middle class patients in India. Some patients further say, “When we are going to die, why waste money on treatment? Instead, the money may be helpful for our children’s education or marriage etc”. But due to recent advancements in AIDS treatment, the average life expectancy of people living with HIV on a quality treatment is around 71.5 years.¹ Thus, concerned physicians face great ethical dilemma on the plight of poor patients.

So, I suggest a multi-pronged approach to moderate this predicament, which includes more expenditure on R&D as a percentage of GNP, flexible use of “Compulsory Licenses” under the TRIPS Agreement and production of more generic drugs at much cheaper rates.

Dr. Kutikuppala Surya Rao MD., Ph.D has spent most of his medical career in clinical research associated with HIV and AIDS. He is a Chief Consultant in HIV Medicine. Among his achievements is the large epidemiological study on the sexual behavior of long distance lorry drivers that was published in BMJ. He was the Resource Person on HIV / AIDS for academic training of programme officers at several Universities (1990-2005). The Government of India awarded PADMASHRI to Dr. Kutikuppala in 2008, the India’s second highest civilian award for his outstanding research in Medicine. His current studies are towards discovery of an indigenous microbicide gel to empower women in HIV prevention.

For further information on HIV in India, see AVERT's page.