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. 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 manÂ’s disease from which they are racially immune. Only 11 percent use condoms. The struggle continues.

    This just illustrates that combating ignorance is the far more difficult part of the struggle, as opposed to securing treatment.

  2. even the most abundant supply of inexpensive drugs canÂ’t overcome poor distribution networks and, even worse, bonehead ignorance, especially when it comes from the people in charge of administering AIDS programs.

    There are also a lot of challenges that HIV+ folks confront with their families and with respect to care-taking. I don’t know how many folks have had their friends die of HIV/AIDS in the U.S., but imagine that and then compound it by 1000. Most of the HIV+ individuals I’ve met in developing countries go into morbidity fairly quickly, and it is incredibly painful to see. I can’t imagine how anyone would be able to journey for medication in that condition, but also, I rarely see their families travel on their behalf.

    Out of curiosity, does this pill have to be taken on a strict schedule like most ARVs? How are folks going to ensure compliance?

    Also, how do you encourage people to get tested? When so many people believe the urban myths about HIV transmission, it is hard to get people to identify the behavior or to change it. In some developing countries, high prevalence rates show that testing does nothing to change people’s behavior. So then what do you do?

  3. high prevalence rates show that testing does nothing to change people’s behavior.

    Increasing prevalence rates also usually reflect better survival rates, though.

    I mean, you may have meant that prevalence rates are higher even accounting for that, but I wanted to point that out just in case.

  4. I cringe when I think of those innocent women infected by their trucker husbands, it would really stink if they eventually are ostracized by their villages and condemned. I agree with Sriram, education would prove to me more effective, however I would add in some bitch slapping cos I can imagine the holier than thou Indian trucker male taking so easily to wearing a glove.

    A couple of yearÂ’s back we had a rumor in SA that if you slept with an Indian girl you will be cured of aids. Laughable, but there was an increase in brown violence. On another note, I bow my head in shame: http://news.bbc.co.uk/2/hi/africa/5319680.stm

  5. Increasing prevalence rates also usually reflect better survival rates, though.

    Explain/expound, please, Neal.

    A couple of yearÂ’s back we had a rumor in SA that if you slept with an Indian girl you will be cured of aids

    There is another common rumor that if you sleep with a virgin you’ll be cured of AIDS. Yeah, let’s talk about sick.

  6. If you die, there are fewer seropositive individuals in the population. If you survive longer, it increases the prevalance rate since the ratio of HIV+/gen_pop increases.

  7. Prevalence is just a measure of how many cases there are in a specific place. So the more people who are alive with a disease, the higher the prevalence.

    Incidence is usually a better indication of activity for epidemic infectious diseases since it measures the number of new cases. But HIV/AIDS is complicated because it takes longer to go from infection to morbidity and mortality, and even after it converts to AIDS, you can manage and live with it for years before succumbing (as long as you get care). So prevalence is an important number to look at, but it’s hard to draw conclusions from that number alone.

  8. Some stats from India’s National AIDS Organisation (NACO) on free drug distribution:

    “50,000 people in the country get free HIV drugs from the government, a number New Delhi wants to push to 100,000 in a year. India does not provide free second-line drugs to those who develop resistance to first-line drugs, saying too many people are waiting to start initial treatment.”

    Troubling discourse continues in the conservative regions of the country:

    “Tell people to keep away from adultery and immorality, which are reasons for AIDS,” “Tell them AIDS is God’s wrath on those who indulge in such things”

    http://in.today.reuters.com/news/NewsArticle.aspx?type=topNews&storyID=2006-12-01T195745Z_01_NOOTR_RTRJONC_0_India-278587-2.xml

  9. If you die, there are fewer seropositive individuals in the population. If you survive longer, it increases the prevalance rate since the ratio of HIV+/gen_pop increases.

    Exactly. It’s a similar situation to the fact that US soldier deaths in Iraq are relatively low, but casualties are high. Because a wounded casualty is one who would have died were it not for the field hospitals and medevacs and the like. That’s why the rate of amputees and other disabled folks is going to be rising in the US population in coming years, not that anyone is ready for that.

  10. Also, increased testing will almost ALWAYS show increased incidence and prevalence, since the whole point of doing the testing is to find more cases.

    The question is how well those cases are being treated (or at LEAST isolated) if they’re being treated. If you find out someone has AIDS but you have no ARV drugs or condoms on hand, you’re not helping him or her that much.

  11. Thanks Ennis and Neal. Given the long disease trajectory of HIV/AIDS, though, do you think that’s [survival] is a useful interpretation of the prevalence rate? Particularly given declining life expectancies? (which, I know, are confounded by a number of factors)

    “50,000 people in the country get free HIV drugs from the government, a number New Delhi wants to push to 100,000 in a year. India does not provide free second-line drugs to those who develop resistance to first-line drugs, saying too many people are waiting to start initial treatment.”

    Shireen, is there any evidence/following on take-up? I’m really curious about this, because if folks don’t comply you have the dual problem of having “wasted” a bunch of money, but also in fostering multi-resistant strains if individuals are not strict with their compliance.

  12. A very, very, very dangerous secret, which the Indian Govt. is trying to keep under wraps.

    A friend of mine (Major D), left the Indian army last year, following six years of active duty in Kargil and Poonch (both across the border from Pakistan).
    He revealed – “anywhere between five and ten percent of Army personell (mostly Jawans/Privates) are HIV positive. These (most in their early twenties) guys are away from their families/wives for years, leading extremely high pressure lives. On home visits, just like the truck drivers,they carry the HIV contracted from prostitutes and pass it to their unlucky spouse.

    Given the Indo-Pak relations, you can all surmise, the very nasty situation this could lead to..

  13. Siddartha..very timely post.

    A Billion++ people,increasing liberal lifestyle, ‘spare money’ for entertainment of all sorts(thanks to economic growth),growing mobility of people within the country,failing or already delapidated public health services and finally, no information/mis-information/little-information : make it a daunting task to successfully tackle the curse of AIDS in India.

    But all is not lost. Gossiping..the age old ‘mode of communication’ has come in handy in rural places. Dad who worked (now retired & volunteers) in Publich Health Services, is amazed at how illiterate women in these rural areas grasp the seriousness of this illness, its mode of transmission and how to prevent or reduce the probability of getting it. All accomplised through good old ‘gossiping’. Its helps the volunteering public health officials, as these women have often pointed, specific and action oriented questions. Obviously, even if this is helping, its clearly not enough. Additionally, people use ‘Street plays’ ( Nandita Das does it as well), to educate the masses in villages on this deadly illness.

    Much remains to be done.

  14. The methods of the last decade from the usual suspects are not working – but let’s do more of the same just to see what happens!

    >>United Nations AIDS agency estimates

    the nearest state supply of free drugs is hundreds of kilometers away 50,000 people in the country get free HIV drugs from the government

    Because…

    too many people are waiting to start initial treatment.

    As anyone who has lived in India knows, if you put a board up that says “FREE “, there will be a long line for it within an hour. It does not matter if the in question is used shit-bucket.

    Volume discounts are certainly a welcome step.

    Tell people to keep away from adultery and immorality.

    Why is this such a troubling discourse? Apart from those innocent folks who gets AIDS due to bad blood transfusion and HIV+ mothers, all cases have their roots in adultery. Truck drivers, army jawans, Rich yuppies all get it through adultery. So why mince words about calling a spade a spade?

    Of course, the spouses of those adulterers are victims too, but with marriage comes shared responsibility for all good and bad things that happen to a couple. One cannot happily accept the husbands’s stock market gains to be a result of mutual understanding in risk taking (and spend it on a necklace) but not take acceptance for the husband’s philandering to a lack of mutual understanding. You take the good and the bad.

    M. Nam

  15. A couple of yearÂ’s back we had a rumor in SA that if you slept with an Indian girl you will be cured of aids.

    In Botswana, it is the virgin (therefore, increase in rape cases), and getting pregnant.

  16. This is what happens when no one wants to talk about sex but everyone wants to do it and people in India do it more often then other country on the planet. You cant kiss on TV, but feel free to bring 10 children into the world using 10 different positions from the Kama Sutra. That’s right India, forget the poor in the country and just concentrate on those fancy call center’s and lets see how far you go.

  17. Once again, Siddarth (thanks, btw) draws our attention to one of the most important issue facing south asia and the globe. And, once again, the apathy, evidenced by the number of comments, is sad. Here I assumed that the lefties were more in tune with such things?

  18. Here I assumed that the lefties were more in tune with such things?

    Maybe your assumption that they are lefties is wrong.

  19. What about this? Does anyone ascribe significance to it?

    India seemed to have all the ingredients for an Africa-like AIDS explosion: relatively low condom use, an uneven public health system and a large population of truckers and migrant workers — a natural client base for prostitution. But experts’ worst fears have not panned out. What they overlooked was the apparently crucial importance of one factor: Indian women often don’t have sex outside marriage. HIV did sweep through the ranks of sex workers. They passed the virus to their customers, who in turn infected their wives. But then the disease came to a halt. Only 2 percent of Indian women reported having sex with people other than their husbands in the past year, according to a government survey.
  20. Once again, Siddarth (thanks, btw) draws our attention to one of the most important issue facing south asia and the globe. And, once again, the apathy, evidenced by the number of comments, is sad.

    Doesn’t the volume of comments usually correlate more with disagreement?

    I mean what can you really say about this article (unless you’re on the front lines fighting the epidemic yourself). AIDS is bad. No shit. It is important, and I’m very glad it was posted, but there’s not much one can really add to this.

  21. Does anyone know the prevalence of AIDS transmission through rape? In war torn countries like Sudan, rape is a common effect of war and I’m wondering if the numbers for rape are higher in countries that are at war, particularly civil wars?

  22. That article’s reference to caste was ****ing annoying! From now on, everytime I have to address inequality anywhere, I’ll say “Like the race system in America ….”

  23. the apathy, evidenced by the number of comments, is sad

    There is apathy because there’s no incentive to solve the problem.

    When it took ten years to get a telephone connection in the 80′s, there was similiar apathy because there was no incentive for anyone to do anything about it. Only in the 90′s when the government opened up the markets did the private players came in to solve the problem within five years. They made a nice profit, but nobody complained. Everyone is happy.

    The only people who have an incentive to try and solve the AIDS problem are the Clintons and Gates of the world who are seeking the Nobel Prize or some other fancy recognition that cannot be bought with money. No medical company has incentive to solve this problem because making money off of AIDS drugs is a no-no.

    Give the incentive, and watch what happens within a decade.

    M. Nam

  24. Correction RE: 25 I meant numbers for AIDS might be higher in countries that are at war.

  25. M.Nam – Unless you are you suggesting, we handover the AIDS awareness campaign to a for profit company, I don’t know what else can be handled by the private sector?

    Except drug research, ofcourse.

    p.s. i am an ardent free marketeer.

  26. Neal,

    Doesn’t the volume of comments usually correlate more with disagreement?”

    Not always.

  27. Having spent part of my childhood in South Africa, AIDS was always talked about but that didn’t seem to have stopped the explosion. I went back recently (3 years ago) after finishing school and did my rounds of Jo’burg, Cape Town and most of the Kwazulu Natal province. Jo’burg is suppposed to have 17% HIV positive among it’s population. There I was at the bar, drinking my 6th Kilkenny’s (does anyone know where to find a pint of Kilkenny’s in NYC?) and looking at the no-prenup pretty ladies, and i thought, shiyit, better not mess around. With 1 in 5 positive, it’s not worth the risk. Ofcurse, that 17% is heavily skewed toward the blacks, but you never know which white or desi chick had a little black fever.

    There is a point to my flashback and that is I don’t know how effective awareness alone is. As several have mentioned in comments, if you keep saying sex is bad, sex is taboo, but if you are going to do it, then use protection. That’s mixed messages not very unlike what is happening here in the US between the conservatives and liberals. Indian society needs to be realistic. You ban child marriages, frown upon dating and mingling with the opposite sex, make professional success a pre-requisite for marriage which has pushed the average marrying age of men to 27 (in cities atleast).

    From 13 to 28, there are a lot of people walking arround saving their sperms and eggs for that one person. Scary thought. Thank God for prostitutes. There are hormones raging out there people and while prostitutes themselves can be encouraged to use condoms, it’s the pimps and brothel owners and bhais that have all the power. Educate them and better yet, legalize prostitution (gives them the incentive to keep their prostitutes in good shape and healthy, ROI and all) as many have suggested in the past but it seems to go against indian culture. Take a leaf out of Thailand’s book, but don’t follow it too closely. We don’t want India becoming a sexual tourist destination.

  28. MoorNam,

    Why is this such a troubling discourse? Apart from those innocent folks who gets AIDS due to bad blood transfusion and HIV+ mothers, all cases have their roots in adultery. Truck drivers, army jawans, Rich yuppies all get it through adultery. So why mince words about calling a spade a spade?

    Adultery and immorality according to whom? What you perceive as an immoral, adulterous liason could be an experience that sustains someone else’s mind, body and soul. But if you’re comfortable casting the first stone, that’s your prerogative.

    Your exclusion clause leaves out women forced into prostitution…..

    Poverty and gender inequality are powerful catalysts in the spread of AIDS. Recognizing this and empowering those affected seems to be a better form of advocacy than religious/moral edicts that alienate.

    And tackling gender discrimination and poverty does not rule out the need for personal responsibility.

    Camille, Sorry I don’t have additional information on the situation in India. MSF’s data from South Africa, their longest running program, shows that 17.4% of people who have been on treatment for five years have had to switch to second-line therapy.

  29. kritic writes:

    .Unless you are you suggesting, we handover the AIDS awareness campaign to a for profit company, I don’t know what else can be handled by the private sector

    Awareness creation of AIDS has been going on very well by the private sector.

    Paper media, from the New York Times to the small Tamil newpapers carry articles about AIDS periodically. They sell their papers for a profit, and hence they make sure they include useful information for their paying customers.

    TV media, from the NBC/HBO to Bengali channels have included AIDS themed serials and other programmes for the benefit of their paying customers. Even Saas Bahu serials have started incorporating this.

    There have been a few AIDS themed movies as well as movies with stray (not straying!) character here and there who is HIV+.

    So private sector is playing a very important role in AIDS awareness, because it makes fiscal sense to do so. The activists who attack pharmaceutical companies who try to profit from AIDS drugs remain mute when media profits from AIDS themed shows and movies. No wonder the incentive to find a cure is non-existent.

    If the government takes the responsibility for creating AIDS awareness, fiscal ripoffs like this is what the taxpayer gets.

    shireen:

    adulterous liason could be an experience that sustains someone else’s mind, body and soul.

    Whatever. Just don’t ask the taxpayer to pay for your drugs.

    Your exclusion clause leaves out women forced into prostitution…..

    Those pimps must be tried for murder.

    M. Nam

  30. It’s one thing to deny to yourself that you have HIV after a positive test (and thus refuse treatment,) but what about the families of infected men who don’t receive treatment based on this shameless ignorance? I think it’s wonderful that Clinton has secured lower priced drugs to treat children, but how are they to be treated if their own father refuses to admit to his own disease, and therefore will not provide medications for his family?

  31. the apathy, evidenced by the number of comments, is sad.

    Previous posts have led to few comments as well. I think it’s less about apathy and more about the presumed inaccessibility of the topic. Everybody has an opinion on fashion, but people feel ill-informed or like they have little to say about AIDS.

    BTW – I’m not at all convinced that our readership leans left. I think the comments do, but the commentors are just a small fraction of the people who read the blog daily.

  32. Everybody has an opinion on fashion, but people feel ill-informed or like they have little to say about AIDS.”

    Lack of knowledge about a topic has not prevented people, including myself, from commenting in many previous instances.

    I’m not at all convinced that our readership leans left. I think the comments do, but the commentors are just a small fraction of the people who read the blog daily.”

    Unless you personally know all or most of the people who read this blog, I fail to see how you can make that determination.

  33. That’s why the rate of amputees and other disabled folks is going to be rising in the US population in coming years, not that anyone is ready for that.

    One of my old bosses’ wife is head of the neuro department at Walter Reed, an Army hospital in DC. She actually had to take time off because there were so many patients coming in from Iraq with major head trauma that she was getting burned out. To add to the story, my cousin lives across the street from a Walter Reed housing center that was built in VERY short order because it’s going to be housing assisted living patients who were Iraq veterans. So sad.

  34. Excellent and timely post, Siddhartha.

    The issue of who bears the burden for HIV/AIDS is a troubling one, and as far as I think, entirely irrelevant to this discourse. Similarly, looking for immediate incentives for treatment, care and even prevention is exceedingly myopic.

    Moornam, if you think that the state and the taxpayers do not have an incentive in curing and stopping the spread of HIV, and in treating AIDS, you are sorely mistaken. PC Chidambaram, the Indian finance minister recently outlined HIV/AIDS as a major risk factor that could impede India’s GDP growth in the coming years. A quick look at the HR crisis in Central Africa is enough to warrant such fears. The reason the taxpayer needs to defray some of these expenses is because, for the most part, markets are often short-sighted to deal with large pandemics. It is the same reason taxpayer money should be spent to forecast tsunamis.

    The only people who have an incentive to try and solve the AIDS problem are the Clintons and Gates of the world who are seeking the Nobel Prize or some other fancy recognition that cannot be bought with money.

    Secondly, let us not read too much into the motivations of other people who give to non-profits/charity lest our skepticism in these matters only reveal our selfishness and lack of empathy.

    Thirdly, adultery is a personal problem and one that cannot be addressed along the lines of easy “you should have known better” commentary. Many of the jawans and the truck drivers that you cite lead extremely difficult and stressful lives away from their homes. Moreover, your lack of empathy for the women…

    One cannot happily accept the husbands’s stock market gains to be a result of mutual understanding in risk taking (and spend it on a necklace) but not take acceptance for the husband’s philandering to a lack of mutual understanding.

    …who contract HIV due to their partners philandering is astounding. One of the biggest problems HIV/AIDS NGOs have in India, is that conversations about sex are still very much a taboo subject. Many of the women in this case prefer not to talk to their partners about the risks of extra-marital sex, even if they might have some inkling of it. Add that to the patriarchal nature of Indian families, and you have a perfect ticking time-bomb.

  35. ahhhhhhh— need to take a deep breath.

    i work for naz foundation (india) trust — we tackle issues of hiv/aids in delhi (and do trainings and awareness across india) we care for 30 hiv-positive children who have lost their parents to the infection. we do whatever in gods name we can to try and prevent the infection and care for those already infected. http://www.nazindia.org

    moornam — who are you and where are you coming from? awareness is being done well in the private sector? are you joking? please read today’s hindustan times, we have made over a dozen phone calls today, and recieved FAR more than that to correct the errors perpetuated by the media, and the vernacular makes far more mistakes. amd i love your characterization of innocent people getting aids from blood transfusions and their mothers — because those who get it from sex are not innocent? they didn’t try to express their sexuality and were limited by personal freedom and information. give me an f’ing break. i invite you to come to my office for just one week and see if you walk out with the same narrow minded ideas.

    i respect sujatha rao (head of NACO) and belive that she is on the right track. she heads the national organization, she can’t fix everything, but she can bring awarness where it is necessary. yes, treatment systems must improve for rural populations, but let’s please look at the metros and breathe a sigh of relief that we are able to provide such a high level of care among ALL who are infected with HIV and living healthy lives with it. we are improving rural systems day by day, truly, and mother-to-child transmission is rapidly decreasing. we are leaps and bounds ahead of where we thought we would be — we are still in a bloody mess but, on this of all days, let’s look to the positive.

    i know that i personally enjoyed my world aids day. i spent the day with our care home kids, we talked about world aids day, its importance, and a great many people in delhi chose to spend the day with our children to show that stigma is lifting… and these children benefit from the advances, not only in treatment and care, but in people’s attitudes. world aids day felt like a triumph in my world, and clinton’s announcement about pediatric medicine only made it better :)

  36. “Thirdly, adultery is a personal problem and one that cannot be addressed along the lines of easy “you should have known better” commentary. Many of the jawans and the truck drivers that you cite lead extremely difficult and stressful lives away from their homes.”

    that may be, but there is no excuse for knowingly passing it on to your wife or blithely assuming you didn’t contract it during your extra liaisons and then sleeping with your wife/girlfriend/partner or passing it on indirectly to your unborn children. especially when you are aware of the unfortunate and severe social stigma connected with the disease. i do understand that many people are just ignorant of the facts of HIV and how it is transmitted, which makes education all the more important. i’m not sure, but don’t some countries have laws that make such behaviour akin to attempted manslaughter or murder? there was a case of someone stabbing people with an HIV-tainted syringe. i lived in a small country that, for a time, had a very high AIDS rate per capita primarily because of irresponsible and cavalier sexual behavior, in spite of the fact that there was a widespread HIV/AIDS awareness campaign. while we shouldn’t cast aspersions or judge people’s morality, there does need to be some sort of balance. my parents saw young girls, boys, men and women whose lives were ruined by their irresponsible partners or who had ruined other people’s lives. the look on one young man’s face when he found out he was positive broke my mother’s heart. there needs to be a balance of practical education, material (healthcare) and emotional resources, empathy and, it may sound old-fashioned, some sermonizing, especially to younger people.

  37. Agreed completely, WGiiA. Which is why you notice my insistence that we talk more about sex within the household. Ignoring it, and ducking our heads into the sand will not make it go away.

  38. Ignoring it, and ducking our heads into the sand will not make it go away.

    DDiA, agree wholeheartedly. sorry, i didn’t mean to come across as an argument against anything you said.

  39. Of course, the spouses of those adulterers are victims too, but with marriage comes shared responsibility for all good and bad things that happen to a couple. One cannot happily accept the husbands’s stock market gains to be a result of mutual understanding in risk taking (and spend it on a necklace) but not take acceptance for the husband’s philandering to a lack of mutual understanding. You take the good and the bad.

    Firstly, this completely lacks compassion and also common sense. You are assuming that married women have a say and are complicit in their sexual behavior. In many developing countries, India included, it is difficult if not impossible for a woman to deny sex to her spouse, demand condom use, or elsewise. I mean, that is difficult to command in the U.S. Further, you are completely ignoring sexual politics and the power dynamics in the bedroom.

    And with respect to your comment on sex workers, it’s not just pimps who should be prosecuted. Many women are trafficked (transnationally) into the sex industry against their will, but there are also many women who are relegated to the sex industry by poverty or through other means. Unless you address root issues of poverty and gender, you won’t even begin to make a dent in the health practices of sex workers.

    For the person who commented on the military having a high HIV/AIDS incidence, this is pretty common everywhere. Generally the three groups of men known to be “common carriers” are truckers, the military, and men who commute to work between the city and more rural areas.

    Unless you are you suggesting, we handover the AIDS awareness campaign to a for profit company, I don’t know what else can be handled by the private sector?

    Please refer to Kremer and Glennerster’s book, Strong Medicine. This is the underlying text that spun off the idea of creating a global fund for HIV, Tuberculosis and Malaria. Basically it would award a “prize” that would cover R&D and some element of lost profits for drug companies in exchange for an AIDS, malaria, and TB vaccine. There’s been a lot of talk about creating a fund, especially with respect to Gates and Clinton, for these illnesses, but not a lot of talk around how to incentive this given that the U.S. pharmaceutical industry is not going to suddenly grow charitable and start investing in “the greatest good” versus “the greatest profit”

  40. “I’m not at all convinced that our readership leans left. I think the comments do, but the commentors are just a small fraction of the people who read the blog daily.”
    Unless you personally know all or most of the people who read this blog, I fail to see how you can make that determination.

    Is that the only way to make that judgment? I really hope you don’t work in internet marketing.

    Furthermore, look at what I said: “I’m not at all convinced that our readership leans left”. Why do I need to talk to everybody who reads the blog to be skeptical of the idea that they all lean left? That’s a very odd conjecture.

    It’s amazing how you jump to conclusions based on what I write. It’s really quite impressive.

  41. Oh, I also wanted to pull out the heartless economist in myself for a moment and also mention that high HIV/AIDS rates are potentially disastrous for developing economies. Not only do they (potentially) decrease GDP, they also take people out of the economy during their most productive years. Also, shortened time horizons (i.e. a shorter life span) also lead to changes in behavior that can include a lack of investment/savings and poor long-term decision-making. The most vocal opponent of these theories behind HIV/AIDS incidence and the macroeconomy is a guy at UChicago I can’t remember off the top of my head, but I’ll follow up.

  42. Theresa,

    I have complimented your efforts in past too.

    One question: Why don’t you accept credit cards for donations @ Naz India. Give online button is not active. Is it due to red tapism in India? Or just web malfunction?

    I think a lot more people will be willing donate online.

  43. Kritic,

    “Doesn’t the volume of comments usually correlate more with disagreement?”
    Not Always.

    Think it does in this case.

    Lack of knowledge about a topic has not prevented people, including myself, from commenting in many previous instances.

    Talk for yourself, why speak for other people? I was watching this thread and made no comment as dint have anything to say till you happened to speak for me!

    MoorNam,

    The only people who have an incentive to try and solve the AIDS problem are the Clintons and Gates of the world who are seeking the Nobel Prize or some other fancy recognition that cannot be bought with money.

    Those who cant, question the incentive of others! despicable

  44. The most vocal opponent of these theories behind HIV/AIDS incidence and the macroeconomy is a guy at UChicago I can’t remember off the top of my head, but I’ll follow up.

    Camille,

    I’m sure you were literally referring to a guy and not a gal but there is a Becker Fellow at U of C, Emily Oster, who has written about HIV/AIDS from economics perspective. She gets pretty beat up in the comments section.

  45. I actually wasn’t referring to Emily Oster (I really was referring to a UChicago guy, I’ll have to look through my old class notes to pull up his name), but I had heard a bit about this also :)

  46. Theresa,

    You guys need to fix a few web navigation at Naz India.

    I did find the foreign donation links but some of the urls/ buttons are mucked up. It should be easy, it will help you guys in the long run.