International Cost Limits Treatment of HIV in India

By Julia Angwin 938 words 28 July 2003 The Wall Street Journal A9 English (Copyright (c) 2003, Dow Jones & Company, Inc.)

CHENNAI, India -- Munuswamy Suresh used to be a middle-class Indian. He owned a 2,000-square foot house with three bedrooms, two bathrooms and a garage. But since last year, he has been on the verge of poverty. Mr. Suresh, his wife and his parents have been sharing a rented three bedroom, one bathroom house with two other families. He has sold his television, camera and all of the family's land and jewelry. The reason for his family's financial fall: the high cost of buying antiretroviral AIDS treatment medication to keep the one wage-earner in the family, Mr. Suresh, alive. The plight of HIV-infected Indians such as Mr. Suresh is of particular concern today, as it becomes increasingly clear that this country of about one billion people has a growing AIDS problem. Last week the Indian government disclosed that the country's number of HIV/AIDS cases had jumped 15% in 2002, raising the total number infected to 4.58 million, or about 0.5% of the population. The absolute number is!

 the second highest in the world after South Africa, where an estimated 4.8 million, or 11% of the population, is infected, according to the Nelson Mandela/HSRC study released in December. Most experts say the Indian government's estimate is likely to be too conservative. In June, two researchers from the University of California, Berkeley, published a paper in the British Medical Journal saying the AIDS epidemic in India is following the same pattern as that of sub-Saharan Africa in the 1980s, with the potential to be just as devastating. The researchers, Malcolm Potts and Julia Walsh, predict that by 2010, as many as 25 million Indians could be infected with HIV. According to the World Bank, studies in Africa have shown that when more than 8% of a country's population is infected with HIV, the country loses about 0.8% GDP growth every year. Researchers are divided about the best way to address India's AIDS epidemic.

Some philanthropists, such as the Bill and Melinda Gates Foundation, are focused entirely on preventing the epidemic from spreading. The foundation has pledged to spend $100 million in India during the next 10 years, starting with efforts to convince truck drivers to practice safe sex. The epidemic is nearing a tipping point where "there is a window of time to work on prevention before the numbers will swamp us," says Ashok Alexander, the project's director. Others say it is foolish to focus on prevention alone. "You cannot separate care and prevention," says Dr. Suniti Solomon, director of Y.R.G. Care, the private AIDS clinic that is treating Mr. Suresh. The Global Fund to fight AIDS, Tuberculosis and Malaria has pledged to spend $100 million for AIDS care in India, which the government says it will use to provide antiretroviral drugs for pregnant women and newborns.

Both sides agree, however, that much more needs to be done to prevent the epidemic from spiraling out of control. The Indian Health Ministry's AIDS policy division says ! its annual budget for prevention and treatment was just $50 million in the fiscal year 2002-2003. And even though Indian manufacturers make cheap AIDS treatment drugs that they sell to the rest of the world, the Indian government says it can't afford to buy those drugs for its people. The generic antiretrovirals cost less than $1 per patient per day. So, for now, India's private AIDS clinics struggle to provide treatment on an extremely limited basis. The Swiss nonprofit Francois-Xavier Bagnoud has convinced the Indian state of Rajasthan to buy antiretroviral drugs for 10 of its 315 patients. The Naz Foundation in New Delhi provides drugs for six orphaned children and to pregnant women during their last two months.

The Freedom Foundation in Bangalore provides drugs for 120 of its 3,000 patients. "It's very difficult to choose" who will get the drugs, says Dr. Nirmula Skill, who runs the Freedom Foundation clinic. "I look at who really needs it the most: Are there people depending on them? Have they been abandoned by their family?" R. Ravi Kumar, 34, a soft-spoken man with an easy smile is one of the chosen ones. When his family discovered he was sick with HIV four years ago, they threw him out. He arrived at the Freedom Foundation clinic semi-comatose, suffering from tuberculosis. Now, the clinic pays for his medicine and he works as an attendant in the clinic. "Now I can work, I have no tiredness," he says. "If it wasn't for the drugs, I wouldn't be here today."

Even Dr. Solomon's clinic, Y.R.G. Care, in Chennai, which is among the best known and best-funded in the country with a $773,000 annual budget, only doles out the drugs to about 10% of its more than 5,000 patients. Only pregnant mothers receive the drugs free; relatively affluent patients like Mr. Suresh can buy the drugs at a discount rate negotiated by the clinic. But Mr. Suresh will soon run out of money to pay for the drugs. When he is feeling well, he can earn 3,000 rupees a month ($65) as an air-conditioner repairman. The medicine costs 1,600 to 2,000 rupees per month, not including the expensive viral load tests that are required every few months. So he doesn't always buy his medicine. "When I have money, I will purchase some little bits of medicine," he says.

Document j000000020030728dz7s0001w © 2003 Dow Jones Reuters Business Interactive LLC (trading as Factiva). All rights reserved. Julia Angwin Reporter The Wall Street Journal work: 212-416-3462 cell: 917-532-5279 fax: 212-416-2653