The AIDS epidemic in India could reach a scale that would dwarf India’s natural disasters. The main route through which is AIDS and HIV is spread is the sex trade. They will go to great lengths to make sure that people are unaware that they are infected. This problem is compounded by the fact that medical establishment in India is doing very little to actively treat the epidemic.
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GWEN IFILL: UN Secretary-General Kofi Annan began today’s special session on AIDS with a call to action against a disease that has already killed 22 million people worldwide. While much of the focus has been on the devastation in Africa, Annan also talked of the frightening speed with which the disease is spreading elsewhere. One especially worrisome country is India.
Fred de Sam Lazaro of Minnesota’s Twin Cities Public Television was there recently. Here is his report.
On the level of natural disasters
FRED DE SAM LAZARO: In a country that has had to mobilize against massive earthquakes and killer floods, AIDS has seemed to get much less attention. Yet the toll from AIDS will soon dwarf decades of natural disasters. Already the official count of HIV-infected people is four million, a small number amid a billion population. But many experts say in little more than a decade, India could have more AIDS cases than the entire continent of Africa. Already, those who work with patients, like Dr. Ishwar Gilada, say in reality, India’s HIV tally has skyrocketed well past the official figure.
DR. ISHWAR GILADA: Currently, it is doubling at the rate of 18 months, or the rate of every 24 months. And I’m estimating something like ten to 12 million HIV infections today. So we find ourselves in a tight spot.
FRED DE SAM LAZARO: Since the early ’90s, Dr. Ishwar Gilada has been one of India’s most prominent voices on AIDS, a fixture in the red-light areas of Bombay, India’s commercial capital and the likely birthplace of India’s AIDS epidemic.
DR. ISHWAR GILDA (translated): We’re not here from any condom company. We are doctors here to tell you about AIDS, and why it is important to pay attention to AIDS.
FRED DE SAM LAZARO: We first met Gilada seven years ago, as he pounded the streets as a safe sex apostle to clients of the commercial sex industry. At the time, he estimated that half the city’s 50,000 sex workers were positive for the AIDS virus. Bombay now has an estimated 350,000 HIV-positive cases, and Gilada says the problem has spread nationwide. The vast majority of those infected don’t know they are HIV-positive. Those who do know usually find out when they become ill and seek health care, like Lata, a 30-something mother of two. She is one of thousands of desperately poor people who live on the streets of Chennai, the southern city better known as Madras.
LATA (translated): I had no support from anyone in his family. I was just lost.
FRED DE SAM LAZARO: Lata was infected by a man she began seeing after her husband, a habitual offender who was incarcerated for burglary.
LATA (translated): He would spend one month on the outside and six months in jail. When he was in jail, it was just so difficult to get by. I was so vulnerable, and that’s why I got caught with this man, who gave me this disease.
The commercial sex trade
FRED DE SAM LAZARO: Most male HIV cases can be traced to the commercial sex trade– cases like 28-year-old Srinivasan, who used to drive a scooter rickshaw before coming down with full- blown AIDS symptoms. Today his elderly mother has taken a job as a domestic worker to support her only son. She’s also the only person aware of his condition.
SRINIVASAN (translated): Nobody knows. If anybody asks, I tell them it’s typhoid or jaundice. My mother is the only person who knows that I have AIDS.
FRED DE SAM LAZARO: Srinivasan says he knew nothing about HIV or AIDS when he became infected about eight years ago. Experts say that awareness has improved. Still, India, with traditionally conservative sexual mores, remains one of the harshest social and health care environments for HIV patients.
DR. ISHWAR GILADA: The difference between the response to HIV And response to other calamities is, they are all visible calamities. HIV is invisible calamity.
FRED DE SAM LAZARO: Well over a decade into the epidemic, India’s public response to AIDS has been a small one, the domain of a few non-governmental organizations offering education programs, such as this mobile van in Bombay. The government has offered very little money, and even less sympathy. For example, it’s not illegal to fire someone from their job for being HIV-positive. It is, in fact, against the law for carriers of the AIDS virus to marry. This commercial, featuring film star Shobana Azmi, is one of the few efforts on AIDS to come out of India’s hugely popular movie industry. The ad preaches that HIV Cannot be caught through touching or breathing. Dr. Gilada complains that the stars could do much more to prevent the marginalization of AIDS sufferers.
DR. ISHWAR GILADA: India has not yet seen the replica of Rock Hudson, Magic Johnson, Freddie Mercury, though we have a lot of big people having HIV and dying of that, dying of the infection. Unless some of those people come out openly and say that, yes, I have this problem, it is… it will be seen as a disease of sex workers, drug addicts, economically unfortunate. It will not be seen as a disease of everybody.
FRED DE SAM LAZARO: In fact, India’s HIV-positive population comes from across the social spectrum. Dr. Janak Maniar has a thriving private practice in Bombay. He has several thousand paying patients, most– like this 38- year-old man– from the middle or upper middle class.
DR. JANAK MANIAR: How are your parents? You’re living with your parents and your brother along with you?
DR. JANAK MANIAR: How are they taking this problem of HIV? Supportive? Or are they just…
PATIENT: Well, they’re not aware about it.
DR. JANAK MANIAR: Who knows in your house?
The health care system
FRED DE SAM LAZARO: Experts say the health care system is ill- equipped to deal with HIV And AIDS, and even helps feed the general denial by not recording both cases and deaths. Dr. Shilpa Merchant is an AIDS advocate.
DR. SHILPA MERCHANT: They’ve been reported as deaths, which is also true– deaths due to tuberculosis or one of the opportunistic infections– but nobody writes “AIDS,” with the result that people say, “where are the people dying of AIDS?” Because of the stigma, people are covering up, and then that’s becoming a vicious cycle.
FRED DE SAM LAZARO: Ironically, just down the street from the epidemic’s ground zero is the headquarters of Cipla, one of several Indian pharmaceutical companies that produce anti- retroviral drugs that can greatly extend the life of people with AIDS.
FRED DE SAM LAZARO: Give us a sense of how much you can produce this for, versus what they would cost on the market in the West.
FRED DE SAM LAZARO: Even approximately?
FRED DE SAM LAZARO: Indian companies like Cipla have called for easing patent restrictions so they can export the AIDS drugs to African countries at a fraction of their price in the west. Yet patients in their own backyards, like Lata, are unlikely to ever benefit. Even discounted prices are out of reach in a country where the public health expenditures on AIDS are about three cents per person per year, and where the per-capita income is less than $400 a year, about what Lata earns from selling jasmine flower arrangements. Also, anti-retroviral therapy calls for a solid diet and a disciplined regimen of up to 20 pills each day for life. Patients like Lata clearly lack the wherewithal. Perhaps even more depressing, Dr. Maniar says even those patients who do manage to find the money lack the commitment to the therapy.
DR. JANAK MANIAR: The compliance rate at the end of one year is not even 50 percent. It’s not because they have not been explained. They’re enthusiastic to start with. When they feel well – in three months time or six months time – they say, “Dr. Maniar, I don’t think I need the drug anymore. My appetite is good, my working capacity good, I’ve gained a lovely weight and I look nice.” And then, in another six months time, one year time, they come back to me sick and they stopped the treatment. And they are really sick.
FRED DE SAM LAZARO: So they’ve completely squandered the opportunity at this point?
DR. JANAK MANIAR: Yes, and the whole family is ruined because they’ve spent out the money in this; there’s no money left.
FRED DE SAM LAZARO: AIDS isn’t the only health care crisis India now faces. It also has one of the world’s largest outbreaks of tuberculosis. HIV fuels TB and vice versa. The UN estimates that India could have up to 35 million HIV-infected people by 2010. Many at the epidemic’s front lines say that grim landmark could arrive much sooner.
GWEN IFILL: We’ll be looking at various aspects of the AIDS problem this week.