Thank you for your comment Maya. In India, the public health system adheres to guidelines recommending that ARV treatment be available to those patients whose CD4 cell count, a measure of immune status, falls below 225. Such patients receive free ARV treatment from the public health system. I think this approach is justified because our national public health system has many urgent priorities other than AIDS.

I have already pointed out the mayhem created by private practitioners who are launching patients on ARV without following prescribed regimens, leading to a need for second line treatment. It is extracting a huge cost for patients and the public health system. Pharma companies and Western donors are pushing ARV without ensuring the placement of infrastructure and trained professionals to monitor its impact. Neither is there assessment of whether malnourished, poor patients have the means to sustain this lifelong therapy with its many adverse side effects.

Indian patients do not have blind faith in Western medicine. We have a highly advanced system of traditional medicine – ayurveda or sidha – which is being used by many AIDS patients with good results. Lack of funds and official support are preventing measurement of its impact through the tools of Western science. When AIDS patients began to fall prey to rapacious quacks, public pressure forced the government to support trials in alternative medicine at designated public health centres in Chennai or Mumbai.

The main cause of death amongst AIDS patients in India is TB and malnutrition. Hence, prompt treatment of opportunistic infections through comprehensive primary health care is vital. India now has a nation-wide programme to provide free TB drugs, through DOTS. Delivery of the regimen remains a problem because it depends on a neglected primary health system that is in shambles. A major felt need was nourishment for patients on the TB regimen and some Mumbai NGO’s have stepped in to provide it. Until the many missing linkages are in place, the massive investment in the TB programme cannot deliver the results we seek.

I have followed with interest writings on the history of health in Africa. Could Africa’s current health crisis be traced to the impact of the Structural Adjustment Programme (SAP), which destroyed local food self-sufficiency, created aid dependency and plunged it into political, economic and social chaos? Could it have affected at least three generations of Africans – particularly in sub-Saharan Africa – where populations became vulnerable to malnutrition, the onslaught of deadly epidemics that lasted for decades and resulted in depletion of the mother’s nutritional pool and loss of immunity in subsequent generations?

Today’s Africans are in a state of total panic because of the reality they see. It might however serve you well to look at the experience of other developing and colonised nations, and consider their experience. It may provide insights into what brought us to this present situation.

The information that AIDS is primarily affecting a “high risk group” and the lower socio-economic strata of society in India, is based on the findings of our nationally appointed experts. This corroborates what we have long seen at ground level. Until it launched into SAP in the 1990’s our country policies protected our local economy and food sovereignty. It is perhaps for this reason that our rural populations, barring a few pockets, experienced local food self-sufficiency and remained nutritionally stable. In the most backward district of my state, Maharashtra, the hospital data shows that the number of AIDS affected is so far not high.

However, given the way we are plunging into globalization that benefits the elite, which is forcing our farmers to commit suicide and resulting in migration into cities, we are also fast heading into social and economic chaos, that will result in more AIDS cases and the rise of all other killer diseases.

I think it is urgent for developing countries in Asia, Africa and Latin America to share their experiences and evolve their own solutions. The West and its battalion of scientists and researchers have so far dominated the discourse on health but they have little experience of developing country realities. Their prescriptions focus on ‘vertical programmes’ and technologies that promote their own industries and do little to improve our health infrastructure and services. Their own experience of improvement in health focused on better housing, clean water and sanitation, nutrition and livelihood, but that approach is dismissed as being too expensive for us! And we are foolish enough to follow this line of thinking even though the money is coming out of our own pockets!

With regards,
Rupa Chinai