American Alarm On the Axis of AIDS
George Bush has spoken colourfully
about the “axis of evil” comprising Iraq, Iran and North Korea. Now,
there is an “axis of AIDS” as it were, covering China, India and Russia.
The US National Intelligence Council has recently released its analysis
on the expected growth of the pandemic in these three countries. A prestigious
journal published out of New York has just carried a study sketching
alternative trajectories-mostly gloomy-for the spread of AIDS in Eurasia.
And Bill Gates’s $ 100 million grant for AIDS control in India hit world
headlines last week.
Official estimates are that there are around 4 million HIV-positive
individuals in India. However, this figure is disputed especially by
some activists. Judged nationally, this level of incidence is not cause
for alarm. But at present there are six states—Andhra Pradesh, Karnataka,
Manipur, Maharashtra, Nagaland and Tamil Nadu-where the incidence is
high enough to be judged as an “epidemic”. AIDS in the northeastern
states is almost entirely because of drug use while in the other states
it is on account of heterosexual behaviour. Blood transfusion has been
a major contributory factor but the country has had some success in
limiting its impact.
India now spends about $ 40 million annually on its AIDS control programme.
85% of this money comes from bilateral and multilateral agencies. The
official expectation is that India would be able to stabilise the peak
prevalence of HIV-positive cases at around 8-9 million by the middle
of this decade and then have the level start declining. This is doubted
by almost all international AIDS experts. The US intelligence community
predicts 20-25 million HIV carriers by 2010-about a third of the sub-Saharan
infection rate. Nick Eberstadt of the American Enterprise Institute
writing in Foreign Affairs talks of greater ecological and behavioural
risks and projects cumulative new HIV cases in India during 2000-2025
at between 30 million (“mild” epidemic) to 140 million (“severe” epidemic).
Today, India registers about 100,000 new cases of AIDS every year. Even
under Eberstadt’s mild scenario, this annual addition zooms to well
over a million in 2015.
Drug therapy can help. At about a dollar a day per person, if this therapy
were to be made part of the AIDS control programme, India will have
to spend over a billion dollars a year for the current population of
HIV-positives. This is one of the reasons why India is one of the very
few countries that has not introduced such drug therapy although Indian
pharmaceutical companies are major suppliers of anti-AIDS drugs to world
markets.
What about the AIDS vaccine? India recently became part of the International
AIDS Vaccine Initiative that has placed its bets on the Therion vaccine.
There are two other promising candidates, one developed at Merck and
another at Atlanta’s Emory University. None of these three vaccines,
however, will actually be introduced in the market for another six-seven
years at least after clinical trials that are bound to rake up controversy.
Incidentally, the Vaccine Research Centre at Emory is headed by one
the world’s top immunologists Dr. Rafi Ahmed who hails from Hyderabad.
But the prospects of a vaccine should, in no way, lead to complacency.
It is true that previous doomsday scenarios on India-for example, about
its ability to feed itself– have been proved wrong. But the onus is
on us to prove these apocalyptic soothsayers wrong. We have a number
of pressing public health challenges beginning with improvements in
basic hygiene. Reduction of infant mortality all over the country to
Kerala levels is of the greatest priority. TB continues to be a scourge
and in actual fact the significant incidence of TB makes India that
much more vulnerable to AIDS. Nevertheless, nothing appears more devastating
and more internationally ominous than the “gathering storm” of AIDS.
Political mobilisation is of prime importance.
