India in Focus on World AIDS Day

THE VIRUS. The fever. The disease. The cocktail. The alphabet soup. The death. By any other red ribbon or name, today is December 1, World AIDS Day, and much of the day’s significant news on the topic comes, for better or worse, from India. (Photo: “An Indian sex worker wears AIDS symbols as she takes part in a rally in Siliguri,” AFP via Yahoo! News.)

aidsday06.jpgFor better, former US president Bill Clinton announced yesterday in Delhi a deal to dramatically reduce the price of effective treatment for children with HIV/AIDS. Among other things this is a fascinating example of a new approach to achieving health outcomes that combines public action with market tools. With funding from five countries, three European and two South American, the foundation has negotiated volume discounts on behalf of 40 destination countries. Thanks to the bulk purchase, the Indian generic manufacturers Cipla and Ranbaxy can sell single-pill tri-therapy drugs at 460 for a whole year’s supply. So the $35 million put up by France, Britain, Norway, Brazil and Chile ends up going a long, long way. $35 million! That’s NOTHING. Imagine if, say, the United States tossed in a little spare change from its daily Iraq expenditure. Grrrrr…..

Anyway, here’s a news story with details:

Only about 80,000 of the 660,000 children with AIDS who need treatment now get it, the United Nations AIDS agency estimates, and half the children who do not get the drugs die by the time they turn 2 years old. The United Nations Children’s Fund, or Unicef, has described children as the invisible face of the AIDS pandemic because they are so much less likely than adults to get life-saving medicines. …

Cipla and Ranbaxy Laboratories, Indian generic drug manufacturers, will be providing pills that combine three antiretroviral drugs into a single tablet, a formulation that is easier to transport, store and use than multiple pills and syrups. The combination tablets also need no refrigeration, an important advantage in poor countries lacking electricity, and can be dissolved in water for babies and infants too young to swallow pills.

Sandeep Juneja, the H.I.V. project head for Ranbaxy, said in a telephone interview that the company was able to provide the lower prices because of the larger volume of sales and because the Clinton Foundation, buying on Unitaid’s behalf, would consolidate many small purchases. He explained that the market for pediatric AIDS drugs was relatively small, fragmented and spread thinly across many countries.

“It would be a nightmare handling those small orders,” he said.”Imagine 40 to 60 countries buying a few hundred bottles individually, with no way to predict how many bottles would be needed.”

The new prices for 19 pediatric AIDS drugs are on average 45 percent less than the lowest rates offered to poor countries in Doctors Without Borders’ listing of AIDS drug prices, and were more than 60 percent lower than the prices the World Health Organization reported were actually paid by developing countries, the foundation said.

On the other hand — and here’s the “for worse” part — even the most abundant supply of inexpensive drugs can’t overcome poor distribution networks and, even worse, bonehead ignorance, especially when it comes from the people in charge of administering AIDS programs. Here’s a horror story this week from rural Gujarat:

Eighteen impoverished Indians with AIDS died in one district in western India in the last two months because the nearest state supply of free drugs is hundreds of kilometers away, an HIV advocacy group said on Tuesday.

“The absence of a regular supply of anti-retroviral (ARV) drugs has claimed 18 lives in the past 60 days,” said Umashanker Pandey of the Kutch Network of Positive People in Gujarat state.

Pandey told Reuters the deaths highlighted the failure of India to reach much of its HIV-infected population, the majority of whom live in rural and small-town India.

The 18 patients had been either too poor or too sick to make the journey every month on an overnight train to Ahmedabad, the state’s main city, to receive treatment and pick up their government-supplied drugs, he said.

D. M. Saxena, the head of the State AIDS Control Society, confirmed that 18 people with AIDS had recently died in and around the large town of Bhuj, and said he was looking into the matter.

But Sujatha Rao, head of India’s National AIDS Control Organization, said she had seen no evidence that the deaths were caused by AIDS.

“I can’t understand why an overnight train journey would deter them,” she said.

NACO considers Gujarat to be a “moderate prevalence” state. It estimates there are 102,684 people with the virus, but only 7,599 cases have ever been reported in the state as of October this year.

The Gujarat Network of Positive People says a true estimate is closer to 200,000 infected people.

Meanwhile, a study of 252 Indian truckers finds that over 40 percent have passed an STD to their wives, and that many believe that AIDS is a white man’s disease from which they are racially immune. Only 11 percent use condoms.

The struggle continues.

108 thoughts on “India in Focus on World AIDS Day

  1. I was recently chatting with a friend and he was like, gawd, this HIV things is like sooooo difficult to cure, dude. And then, when Kyle and Jessica told me that they had trouble trying to find a cure for HIV in Mt. Sinai as well, I was like, if we can’t do it at Hopkins, and they can’t do it at Sinai we should probably just give it up man. Also, I was talking to this guy who isn’t really a doctor, he is more like an amateur economist and sorta like this awesome eastern philosophy dude, and he thinks, get this, he thinks that we can put little daggers on little nano-robots and they can go and kill each of those viruses. One. By. One. I mean, how AWESOME is that? It’s like effin nano-Quake man. With…haha…TinyFcukingGuns!

    Let’s just go and give up. Besides this dude who totally owns this awesome idea is like right ALL the time. Never wrong. The dude’s so fucking awesomely contrarian and yet so abso-fcken-lutely right, he makes me wish I had his renaissance-man-like qualities and his spirit of scientific inquiry.

  2. I am still hazy about what it is exactly about the cutting of the foreskin that leads to a decreased transmittance, whether it is an upsurge in awareness, a biological mechanism, etc.

    In addition to what was already cited, there’s some discussion about whether (physiologically) there is less semen hanging around on circumcised men than on uncircumcised men. Who knows, though?

    e.g., the luo in kenya are uncut, and have the highest HIV infection rates of kenyan groups.

    No offense, but having lived with the Kenyan Luo I really don’t believe that circumcision is a key factor in why they have a higher HIV incidence than their neighbors, say the Luhya or Teso.

    The burden of proof is upon you to make others understand why a non-air borne disease like AIDS is more debilitating to the economy than airborne/waterborne diseases like SARS, Plague, malaria, Dengue fever, Elephentiasis, lung Cancer(via second-hand smoke)

    This is a total non-sequitor. The question at hand is not whether HIV/AIDS is worse or more debilitating to the economy, it is that it has a profound effect, as do malaria or dengue or TB or epilepsy or what have you. Again, if you are interested in looking at how disease – particularly acute diseases – effect the macroeconomy, then start looking at papers focused on DALYs, etc. Or you could continue to ignore everything that has been cited and written previously in this thread on that same issue.

    Couldn’t it be because of different sexual mores in those countries compared to India?

    This seems much more probable to me than the circumcised/uncircumcised idea, particularly because you see this [lower incidence rates] especially in Africa between countries with high Muslim populations and those without. This is really interesting once you introduce the idea of polygamy, though, which is often targeted by health NGOs as a major contributing factor to the spread of the disease and is much more sanctioned in Muslim countries than non-Muslim countries.

    Also, sometimes I wonder if UNAIDS’s problematic methdology also under/overestimates incidence rates depending on the country. It could be that the crappy numbers make it even harder to adequately gauge the key routes of transmission in a particular economy.

    And lastly, on the socioeconomics of HIV/AIDS, in many developing countries it is higher income individuals – especially men – who have higher incidence rates. Some argue that this is because there is an urban bias in HIV/AIDS and that poorer communities also tend to live in more rural areas where they are “sheltered” from rapid transmission, which is often facilitated by population density.

  3. Lovely conversation, but to interject so I can answer Manju’s question on my little tangent, here’s my one liner that turned into a massive rant:

    hey shruti: you seem to be the person to ask this question to. i’ve noticed the emergence of this term “sex worker,” presumably b/c it is less offensive than “prostitute.” where did this term start. it strikes me as more offensive than prostitute. no prostitute i know use the term ;-) . seriously, i’m just curious, where did the term come from?

    Yeah, the term is used mostly in the academic and activist circles, but I don’t think it’s one of those hipster buzz words that gets thrown around so much it means nothing. The term “sex worker” is like the term “queer” in that it’s a reappropriation/reclamation of identities with negative connotations (in this case, prostitute, slut, whore, gold-digger, etc) that’s intended to be inclusive of variation and nuances. I don’t think it’s offensive for a sex worker to call herself a prostitute, but prostitution isn’t the only kind of sex related work that people do that is subject to the same set of prejudices and consequences. It accommodates for “entertainment” work (i.e. escorts, strippers, Asian women forced into massage parlors, etc) that is of a sexual nature. And remember that the word “prostitution” has accumulated its own connotations – almost all bad. I use “sex worker” as a neutral term so that I don’t end up appropriating a moral value to what they’re doing because I don’t know enough about the situation (the only one who can really tell you is the sex worker her/him/hirself).

    Before I go on, please understand that I’m not dismissing or trivializing the violence women suffer because of sex work (I’m more aware of it than my poor little heart can handle). I’m just dryly explaining the context of the term “sex work”.

    There’s still a pretty heated debate among the activist-academics on the nature of sex work. The focus on nuances is, obviously, a postmodern-y thing. I’m trivializing a bit, but it’s basically a privileged liberal vs. Third Worldy leftist debate. (In case you’re wondering, I hate Western liberal feminism.) Liberal feminists can only see gender as an operative in sex work, considering it synonymous to “(sex) slavery”. As Sheila Jeffreys explains:

    Since the late 1960s, radical feminist theorists have analysed prostitution uncompromisingly as the ultimate in the reduction of women to sexual objects which can be bought and sold, to a sexual slavery that lies at the root of marriage and prostitution and forms the foundation of women’s oppression (Millett, 1975, Barry, 1979, 1995, Dworkin, 1983). But in the last two decades the ideas of many feminists about prostitution have changed. [Link]

    (Oy! Pet peeve: I have a big fuckin’ problem with all of second wave feminism being called “radical”.) Anyway, one such Western liberal vs. Third Worldy leftist clash was when Dorchen Leidhold, co-executive of CATW to the UN in 1995, called Radhika Coomarswamy (Sri Lankan) of the UN Special Rapporteur on Violence Against Women a “madame” for emphasizing, as she does here in a later address, the various other social constructs that shape and dictate the global sex trade industry, including race, caste, economics and non-Western cultural values. Given the notion that sex and gendered work (gendered, for example, in that domestic work is done by women imported from the Third World) is driven by various motives, it’s only logical to conclude that the results of sex and gendered work will also vary. Sometimes, as dabba mentioned in #62, sex work is what ultimately liberates sex workers (at least economically, which is still a huge accomplishment).

    So going back to the issue of legalizing prostitution: Legalizing sex work doesn’t have to mean legalizing violence towards women or making them responsible for getting and spreading AIDS and STDs, even though it will end up like that if governments continue to make women’s health and safety a “low politics” issue. What legalization should mean is that women who choose sex work are protected. And criminalizing sex work really only criminalizes the sex workers themselves; it disenfranchises them and makes them illegal bodies, while the traffickers get away scot free because they have the agency to do so. OTOH, automatically victimizing sex workers also disenfranchises them because it uses a particular ideology (usually Western liberal feminism) to make incorrect assumptions and impose inappropriate identities and “solutions” for the “problem”, thereby denying any possibility of agency on the sex worker’s part. At the very least, especially given how enormous the global sex trade is, we should use the term “sex work” to recognize that, for better or for worse, these women and children (and sometimes men and intersexed people) are real human beings who must perform a real task/work.

    For more, you can check out Ratna Kapur’s The Tragedy of Victimization Rhetoric or Kamala Kempadoo, among others.

  4. The cure, prevention, vaccinations etc of the early/middle part of last century were tackled on a war footing by leaders of all advanced countries because of … war!! …There have been rare examples of cure for disease being found when certain people took it as a personal challenge. But these were never funded by the Government.

    really? what about polio vaccine? the discovery of OPV was funded largely by the National Foundation for Infantile Paralysis (now known as the March of Dimes), which was started as a Presidential initiative. When Salk was asked who owned the patent for OPV, he famously said that “the people” owned the patent, since the research was funded by public money. Polio vaccine is one of the biggest success stories of modern medicine, and it didn’t come from private industry.

    In regards to a ‘cure’ or vaccine for AIDS, I would encourage you to examine any of the many Public-Private Product Development Partnerships (PDPs) that are working to eradicate AIDS and disease of the developing world. They are hybrid organizations that work to tap industry expertise and incentivize private investment through innovative financing mechanisms, but also work to ensure low prices and global accessibility. All new health technology innovation doesn’t have to rely solely on industry.

  5. Thanks Shruti, from now on you’re my go-to person on all things (post) feminist/modernist linguisitical.

  6. This thread practically wore me out, and it’s not even noon yet. And yes, I know I’m a little late in getting in on the game.

    Regarding the circumcision question: For a long time I was very skeptical of the pro-circumcision argument, assuming that it was a spurious correlation due to bias on the part of the entrenched oh-so-pro-circumcision American medical establishment. I assumed the obvious counter argument (in the African context) was differential sexual behavior patterns in Muslim (circumcised) vs. non-Muslim (predominantly uncircumcised) populations. However, I couldn’t believe that medical researchers would overlook such an obvious behavioral explanation.

    I’ve since done a little reading, and it seems like part of the rationale is that the interior of the foreskin is actually a moist mucous membrane, and that there are indications that the cells of that part of the foreskin actually have higher concentrations (?) of the HIV virus. When you equate the foreskin to a mucous membrane, it’s much easier to see how it might contribute to infection. Of course, that still doesn’t mean I think widespread circumcision is a great idea (I’m opposed to it in general), and I’d want to see more scientific studies of the issue, but it’s definitely an interesting correlation.

  7. I’m very often scurrying throughout the on-line world nearly all of the time and so I choose to learn substantially, which sadly shouldn’t be typically a helpful matter as a number of of the web assets I discover are composed of ineffective garbage copied from many other internet sites a thousand instances, however I gotta say this blog is in actual truth half respectable and even includes some authentic content material, therefore thanks for splitting the pattern of just copying other peoples’ websites, keep up the good work! Bye.