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. Ennis,

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

    It is you who reacted (#35) to my comment (#19), which was not aimed at you or any other Sepia writers. Anyhow, If you or anyone else deems my comment offensive or over the top, I apologise.

    And No, I never worked in internet marketing…. Or any marketing, for that matter.

  2. kush, we are just now (this week itself!) having our website fixed/revamped. we had a generous donor give us a small amount of money to pay a web designer to come in and get the whole thing up and running in a MUCH more cohesive and understandeable format. you will be the first to know when that new site is unveiled :)

    for all: the best way to donate to naz india is to go directly to giveworld.org and look for our name under the “health and sanitation” category they provide — from there you can donate and we will know of your donation right away.

    “Not only do they (potentially) decrease GDP, they also take people out of the economy during their most productive years. ” i know that this is a very fashionable topic, but they say this about TB and Malaria, and the combo of the three can put someone out of work for the rest of their working years. hence the global fund for “aids, TB and malaria” the three most devestating infections.

  3. Camille: A friend of mine works for a Candian NGO that helps raise AIDS awareness in Punjab. She has some horror stories to relate about the deep state of denial in that place. She mainly blames it on the “macho punjabi culture”. Punabis Sikhs make up large numbers of Truck drivers and Army Jawans, who stay away from home for long periods of time. Upon their return, some of them infect their wives.
    Most times these HIV infected women are shunned by their relatives and villagers. Forcing them to fend for themselves, alone, and evetually die a painful and solitary death. Do you have any idea/thoughts on how this issue breaks down state to state or culture to culture in India?

  4. Punabis Sikhs make up large numbers of Truck drivers and Army Jawans, who stay away from home for long periods of time. Upon their return, some of them infect their wives.

    I think it would be interesting to know what percent of HIV infections can be blamed on this. Lets not forget that these truck drivers are getting the disease from someone. We need to address this with the highest risk populations(“sex workers”) who happen to be the vector. Any program that does not include them will fail.

  5. hence the global fund for “aids, TB and malaria” the three most devestating infections.

    There’s also a bit of argument in development aid circles over “what’s worst” since the three leading causes of death, particularly in the developing world, are respiratory illnesses (incl. TB), malaria, and water-borne diarrheal diseases, in that order (source: World Health Organization, 2005). In terms of DALYs (disability adjusted life-years), all three are really awful diseases and mess with people’s capability to attend school, to work, to support family members, to care-take, etc., etc.

    Do you have any idea/thoughts on how this issue breaks down state to state or culture to culture in India?

    I can’t even pretend to know anything about the state by state breakdown, but I would bet that the problems your friend sees in Punjab are widespread throughout India.

  6. We need to address this with the highest risk populations(“sex workers”) who happen to be the vector. Any program that does not include them will fail.

    That is an equally tragic angle. Often, 14-15 year old “fairer skinned” girls from Nepal are kidnapped and made sex workers.

    Also, Born into Brothels touched the whole thing very poignantly. BTW, Zara Briski has a new book coming out with special edition worth $ 1000.00, and another limited one $. 100.00. The book is going to be released in December.

  7. legalizing and regulating prostitution is a must.. There is plenty of precedent in the se asian countries. prostitutes perform a valuable function in society.. make them legal.. insist that they use protection, have regular health checkups, in short, regulate the business. I find it hard to believe people dont know what AIDs is..They just assume that it wont happen to them, personally.. take bad bets.

  8. i’m not so sure about legalizing prostitution. But if there is someway to regulate it without legalizing it would be good. By legalizing prostitution, you give it blessing. And i don’t see what valuable function that prostitutes perform either(wrecking marriages?).

  9. i’m not so sure about legalizing prostitution. But if there is someway to regulate it without legalizing it would be good. By legalizing prostitution, you give it blessing. And i don’t see what valuable function that prostitutes perform either(wrecking marriages?).

    Sorry, this is a bit of a tangent, but it’s disingenuous to say something like this because it comes down to a judgement on women in sex work. I wouldn’t assign an inherent moral quality to it. Sex work goes wrong when people (usually women and children) are exploited and have no agency, not because sex work itself is a bad thing. As for wrecking marriages, sex workers don’t wreck marriages; people who allow their marriages to be wrecked wreck their marriages (this is NOT an automatic blame on the woman in said marriages – usually turns out to be the man anyway).

    AIDS, homewrecking… people always end up placing the burden of responsibility on women – women in sex work, at that, because they generally have the least amount of control over what’s going on around them (which is not to say that they can’t have agency and dignity in their profession, or that we should’t recognize and respect those things whenever they are existent).

  10. 60 – Your comments come from a well. Marriages don’t get wrecked because of prostitutes (unless the married woman is the prostitute). I would go as far as to say that some have actually been saved because of them. Most young men in the cities atleast get their sex education and their first sexual encounter from prostitutes. You have peope walking 15-19 years without having sex before they get married…something’s gotta give.

    In Tamil Nadu, in the 70s or 80s, The then DMK govt. (Karunanidhi) wanted to legalize prostitution and they lost the elecetion. I remember the discussion in my household (i was too young to form an opinion) was about how K wanted to “nationalize women” and that was despicable. The next thing you know someone will enter the house and try and pay for sex with your wife. Utterly baseless argument and for a few years I parroted similar views because that’s what I had heard my family say. Fortunately the teen years set, and I was compelled to challenege everyting my parfents ever said and think I was the better for it.

    Think about it a little. Do you really find prostitutes that heinous, especially considering that most of them in India are forced into it or land in prostitution due to circumstances?

  11. Before abrahamics, commies, lesbian-led sexual health NGOÂ’s in India, cockroach infested leftist blogs and Amitava Kumar started conspiring against assertive nation, before pseudosecular defeatist homosexual mentality took a grip on the saffron balls of Indian men, squeezing them till they reduced to size of peanuts, Vedic sperm could actually cure AIDS.

    It is very noticeable that so called leftists on this site could not give many answers to this thread, proving they are actually the AIDS virus in human form, come to destroy immunity of assertive nations youth to Islamo-Abrahamic-Commie-Negro-Christo FascismÂ’s influence and destroy our assertive confident testes by squeezing them subtly and seductively.

    Thus our new slogan to awaken masses:

    Sepia Mutiny: The AIDS of Hindu Nation!

    LeftistCabal! DonÂ’t touch our balls!

    Macho culture of Punjabi truck drivers can be handled easily it is also main culprit unlike remainder who are innocent.

    Death to Faggots and HIV patients! Victory to Free Markets!

    Hail Mogambo!

  12. Sorry, this is a bit of a tangent, but it’s disingenuous to say something like this because it comes down to a judgement on women in sex work.

    yes, and the people who force them into it.
    would go as far as to say that some have actually been saved because of them. Most young men in the cities atleast get their sex education and their first sexual encounter from prostitutes

    Yes, their first sex education as well as their first STD’s. The point is that you don’t want to condone an atmosphere where females are looked at as sexual objects. The second you sell your body for money, your body becomes a commodity to be rented or bought.

  13. Think about it a little. Do you really find prostitutes that heinous, especially considering that most of them in India are forced into it or land in prostitution due to circumstances?

    I don’t find prositutes heinous, but certainly the people who force them into it. Why legalize prostitution and let these guys profit more from it. I saw a documentary about girls from former soviet republic getting forced into it(kindo like the gals from nepal?). The girls work in the legalized Dutch world and earn nothing while the pimps are millionairs.

  14. 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?

  15. What about male prostitution?

    prostitution in all its forms is unjust. But i really don’t think male prostitution is much of a factor. In the history of human kind females have been exploited a lot more in this way than the males.

  16. This is going to be a long post. The inanity that pervades people’s notions about AIDS/HIV deserves elaboration.

    DDiA/Camille/theresa

    HIV/AIDS as a major risk factor that could impede India’s GDP growth in the coming years

    This is a politician’s soundbyte. He is telling you exactly what you want to hear. He knows that his target audience(of NGOs who survive on government’s dole) will never stand up and ask: “Really? How can you objectively measure in Rupees and Paise the effect of X truck drivers, Y prostitutes and Z jawans having AIDS? Will you add up their salary and then divide by the net salary of everyone in India? Because that will come out to be such a ridiculously low figure that you will be ashamed that you brought it up. Or will you add up the purchasing power of.…” But wait, the politician has left the stage.

    It is the same reason taxpayer money should be spent to forecast tsunamis.

    Tsunamis, earthquakes, volcanoes have warning systems, not a cure. Nobody is saying that the government should spend money to stop all earthquakes – just to forecast them. I have no problem if government money is spent on identifying high risk areas for AIDS: truckers, jawans, affairs etc. They have already done that. Newpapers, TV shows, movies are blaring loudly. Don’t spend taxpayer money trying to find a cure or to prevent the disease. Have laws that regulate blood banks and implement them. Have stricter quality control standards for condoms. Mandate that hospitals use disposable needles that are actually disposed – not recycled. The government doesn’t even do its job properly in these areas – and you want to give them more money for other things?

    AIDS problem is more like dowry problem or caste problem or obesity problem. It is an individualist problem – a collectivist solution will not work for it, just as it has not worked for dowry or caste.

    .markets are often short-sighted to deal with large pandemics. global fund for HIV, Tuberculosis and Malaria

    Tuberculosis and Malaria are highly contagious diseases. They are airborne and water borne. They can even be spread across different rooms with a common ventilation. They need to be tackled on a war footing because innocent people die every year from it – far far more than AIDS. That’s where the money needs to be put in – not into a disease that’s not contagious. You cannot get AIDS by talking to a coworker. You cannot get AIDS by shaking hands with a customer. You have to have an intimate relationship, or you have to get it through contaminated blood (even this is rare).

    Prostitutes and STD’s have been around since the begining of time.

    Vatsayana has written about it in the Kamasutra. Indian society has always managed it very well. Ancient India was one of the few countries where prostitution was not considered immoral, but made into a caste/varna. The best singers and dancers belonged to this caste. Words like “exploited” and “prostitute” were not used in the same sentence. They were welcome in temples and social functions.

    As to STD’s, up to just fifity years ago, if you got an STD, you would most likely die. Only in the 1950′s did medicine find a cure for it (and made a nice profit). Which is when the sexy sixties and swinging seventies took off with a bang. But Mother Nature was not sitting quietly. She had something much bigger planned starting in the eighties to put man in his place.

    U.S. pharmaceutical industry is not going to suddenly grow charitable and start investing in “the greatest good” versus “the greatest profit

    I am not going to respond to socialist nonsense.

    conversations about sex are still very much a taboo subject…talk about sex

    Again – how will this be implemented? How can you justify taxpayer money on something so vague and hazy? Who will implement this?

    patriarchal nature of Indian families…are assuming that married women have a say …impossible for a woman to deny sex to her spouse, demand condom use…lacks compassion and also common sense…this is NOT an automatic blame on the woman in said marriages – usually turns out to be the man anyway

    I think I know why we talk past each other. You assume husband and wife to be individuals who have their own unique rights and responsibilities, and can go their own ways as and when they feel like it. I, on the other hand, consider them as a unit which has to make it or break it together.

    moornam — who are you and where are you coming from

    It’s not about me. I would love to talk about myself on some other thread! You write:

    we are able to provide such a high level of care among ALL who are infected with HIV and living healthy lives with ..we are leaps and bounds ahead of where we thought we would be But the Naz website says. Various estimates suggest that the number of positive children requiring care has increased tremendously.

    Which of you is correct? Please make up your mind.

    NAZ has existed since 1994. So have many other NGO’s campagining against AIDS. But the problem has kept getting worse, year after year, in city after city and town after town.

    What if I allege that you actually contribute to the problem? What if I allege that you have no intention of solving this problem, that you have no sympathy for these children, and that you are doing all of this because you want to keep getting money from taxpayers that can be siphoned off to make swanky websites that accept credit cards? What if I allege that one of the reasons you keep hammering against pharma companies is that if they suddenly come up with a cure with an AIDS pill that costs as much as Aspirin, you folks will actually have to find some other job to do? What if I allege that you have an interest in the explosion of this disease, because only then your contributions will increase. What if I allege that many of these NGO’s are actually in the pay of foriegn interests who want to weaken India by diverting its health resources into AIDS rather than to Malaria, TB, Dengue fever, Elephentiasis, Cancer and a host of other diseases which are collectively at least fifty to hundred times more painful to India’s GDP and productivity of its people? What if I allege at some of these NGO’s had their funding from Pakistan ( this was found to be true – they have quietly shut down now)?

    What if I allege that should you busybodies be gone from the scene, pharma will find a cure for it very soon. Sure, it will cost $200/- a pill in the begining, but over the years the prices will come down when the generics hit the market.

    What if you are the problem – not the solution.

    M. Nam

  17. 1) anyone consider mass circumcision as a possible solution?

    2) economic development is the main way to fix this issue i think. western nations hit it more than african nations, but don’t catch the bug as much. i suspect that westerners are more individualistic than africans, but that’s just my hunch

  18. 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?

    Hmmm…if you’re going to insist on calling a spade a spade, I’d like to point out that technically, adultery is sex outside the confines of marriage for someone who is married. Sex before marriage is fornication. So adultery per se is not necessarily to blame for AIDS.

    In the larger scheme of things, this argument is reflective of the pea-brained policies of the Bush administration who advocate only supporting STD education programs that preach abstinence. While I’m not morally opposed to other people sleeping around, I agree that from a preventetive health perspective, monogamy makes sense. However, teaching abstinence to the exclusion of safe sex practices is just stupid, and as long as people blame “adultery” for AIDS, we’ll continue with this counterproductive reasoning. Abstinence training, often taught in American schools, isn’t enough.

    I agree that people have jumped on the AIDS bandwagon while there continues to be no malaria bandwagon. However, I’m just glad that someone is paying attention to some disease that is a problem in the developing world. And if international attention to AIDS results in a stronger healthcare infrastructure in India, it will only help with tackling other public health issues.

  19. #60

    i’m not so sure about legalizing prostitution. But if there is someway to regulate it without legalizing it would be good. By legalizing prostitution, you give it blessing. And i don’t see what valuable function that prostitutes perform either(wrecking marriages?).

    I am familiar with one country that has legalized prostitution and maintains very strict checks. In this place, all the pimps are regular businessmen (registered) and there is no place for criminals (unless the govt itself is considered such)and prostitutes are have relative degree of freedom. Basically their plan of action is to work for x number of years (x is in the single digits) and save for their future.. many of them are paid very well.. thats the reason why they consider this profession. The AIDs rate is almost zero in this country and most of it is drug/gay related… still there is the occasional hiv contracted abroad.. many young men in this country regularly visit prostitutes.. sex is simply a recreational activity.. there is no need to get uptight about it.

  20. 72

    I am familiar with one country that has legalized prostitution and maintains very strict checks.

    Could you share the name of this country?

  21. Netherlands

    What percent of prostitutes in Neatherlands are from former Soviet Republic? Would be interested in knowing.

  22. x number of years (x is in the single digits) and save for their future.. many of them are paid very well.. thats the reason why they consider this profession. Whats your definition of paid very well? As in they are able to make enough money to live comfortably for the rest of their life? considering they only have x number of years to earn, a relatively good yearly income will just not do. For example, we all agree that Doctors are paid very well in U.S.A. But if they only had 9 years in the profession, most doctors will not have earned enough to sustain themselves. Ofcourse its all mute point, India is not Neatherland and will never be that open in our life time. But manditory sex education focusing on safe sex may be a good first step.

  23. (apologies for the length!)

    There is an excellent PBS Frontline series called The Age of AIDS. You can watch the entire program online. It discusses the scientific and political history of the spread of HIV in the western world, Africa and other developing nations. It is made from a primarily western perspective, but there is info on India found in the last chapter, part 2. Very well researched, very relevant and very informative. Please WATCH it! It is a great account of the government/community involvement and the practices/measures of different countries that have worked and are working, which can serve as good models where needed today. The bad models and mistakes… well, they are still happening, even in the western world… approaches and interventions that need to be changed are clearly highlighted. We need to pay attention to them and change!

    As for the discussion on India specifically…. It has been well documented and is also mentioned in the PBS program (and in the latest AIDS epidemic update on Asia, pages 27-30), that key routes of HIV spread in the most affected states are via unprotected sex, via sex workers (moreover the sex worker to client to spouse transmission chain), via male homosexual transmission and via injection drug use. The same factors exist elsewhere but the social context of India is different.

    I find that the lack of education about HIV/AIDS is critical in driving infection. There is evidence showing a reduction in HIV spread after education programs are implemented (study on a group of truck drivers funded by the Clinton Foundation). Education works, but in addition to awareness. Awareness alone, about what AIDS is and how it spreads, through commercials, films, billboards etc is not sufficient… people need knowledge to realize the reality of risk and how to protect themselves and their familiesÂ… this requires more specific and explicit dialogue that is difficult to have with the masses due to cultural barriers. It needs to be done in smaller centers and needs to reach men, women and teenagersÂ… as you can imagine this isnÂ’t going to be easy in India, for various reasons.

    There is still great denial about the threat of HIV in India, and we are already passing the stage where the spread of infection needs to be nipped in the bud. Once it becomes a reality to the public, it will be too lateÂ…. In 2003, projected numbers of HIV+ individuals in India by 2010 is 20 million without effective prevention strategies!!! As of the end of 2006, 5.5-6 million people are HIV+ in India (remember these are reported cases and does not account for unknown status).

    There are some very good community based interventions in place by NGOs, especially those linked with and funded by NACOÂ… however, they are also restricted by various factors (lack of funding, lack of employees/volunteers, lack of tools). Other than social stigmatization and women inequality as social obstacles, I find that the problems India faces in efficiently and rapidly controlling the spread of HIV are rooted in lack of political leadership. The history of HIV shows clearly that the success of a country’s ability to control the pandemic depends largely on how seriously and aggressively it promotes prevention and treatment programs, and most importantly how they implement and sustain them (watch PBS program for specifics). India is currently lacking in the implementation and has not really done much thinking about sustenance. There needs to be treatment, care and resources for those infected, but the bigger challenge for India is in controlling the rapid spread of the virus, to prevent the 20million projected mark.

    Speaking of political leadership, the lack of education, knowledge and reality check also exists among the state MPs and cabinet ministers in India. At the international AIDS meeting this year, there was an evening session held about the HIV/AIDS situation in India. It was moderated by Sujatha Rao (NACO) and there were some known faces (like Sharmila Tagore representing UNICEF) and state MPs on the panel. I was present at the session and was very enthusiastic at the start, very positive about IndiaÂ’s efforts. After Sujata Rao’s talk however, the MPs took stage and the session turned its focus from HIV to money and funding concerns. It was clear that the MPs did not know about HIV/AIDS in great detail and did not understand the urgent need for realistic strategies required in their respective states. The idea of government vs NGOs, neither trusting the other esp with regards to money, kept cropping up. To be fair there were only 4 MPs (Bihar, West Bengal, Assam and another one), but these states ARE affected by HIV (esp West Bengal) and the non-urgency of the government re AIDS is present. How are programs to be implemented by leaders that are uneducated about HIV themselves, and seem to care more about the money coming in than the issues? And anyone who has tried to get any official work done in India knows about the ‘wastaÂ’ and corruption issues. This isnÂ’t vocalized but it is a serious practical problem holding back progress.

    If the politicans actually lead, oversee the development and implementation of prevention programs, change laws, improve infrastructure, the situation is bound to turn around. There was a request for NACO to arrange for a session with the state MPs this year to educate them about the AIDS situation nationally and state-wise, so that they know what to do with the funds allocated to HIV/AIDS. I havenÂ’t heard about this happening so far but I really hope it does sometime.

    Anyway, there was far more chaos at the meeting and I doubt people left with anything constructive. I thought I was in one of the notoriously roudy Lok Sabha meetings in India and left thinking ‘how the f*ck is the country going to fix these problems in time?’

    The work being done by the NGO and community-based sectors keeps the hope going. I just hope that they can compensate for the lack of political leadership that is so obvious in some states.

  24. Dear MoorNam, (comment #69) I’m usually very dispassionate when I post here but, with due respect, some of your views seem pretty f@#ked-up. The 1st of your 2 most f@#ked-up* observations is:

    U.S. pharmaceutical industry is not going to suddenly grow charitable and start investing in “the greatest good” versus “the greatest profit” I am not going to respond to socialist nonsense.

    The italicised comment may be socialistic, but (unlike certain types of knee-jerk socialistic rhetoric) it is hardly nonsensical. The instances where the for-profit pharma industry has been primarily responsible for the control and eradication of a pandemic comparable to HIV-AIDS, where said eradication came about through the following mechanism: Step 1) The in-house development of one or a series of pathbreaking drugs driven solely by the profit motive, the profit stemming from a very high initial price pegged by its “rational market demand”; and Step 2) The trickle down of the above fruits of profit-driven R&D once these products pass into the generic domain;

    are almost unknown!! The containment, during the middle of the last century, of a number of tropical diseases of pandemic proportions came about not because profit-seeking pharma corporations, driven by the incentives of a vast potential market, came up with the therapies that worked the best. Rather, the therapies that worked the best were, with one or two exceptions, developed at state-funded laboratories and teaching hospitals by teams that were spurred by the sheer intellectual challenge. The reason that these therapies could be passed on to the target populations so speedily is because the relevant agencies didn’t have to spend a decade negotiating with profit-driven drug companies on what a mutually acceptable sale-price would be. Until I see three or more reports of pharma corporations being chiefly responsible, via the above Step(1)-Step(2) mechanism, in mitigating large-scale human misery – where the said reports are not “studies” commissioned by the principals (!) – I shall be forced to assume that you are merely being ideological.

    And, dude, ToomarNam, this is not just f@#ked-up, but waaay f@#cked-up*

    patriarchal nature of Indian families…are assuming that married women have a say …impossible for a woman to deny sex to her spouse, demand condom use…lacks compassion and also common sense…this is NOT an automatic blame on the woman in said marriages – usually turns out to be the man anyway I think I know why we talk past each other. You assume husband and wife to be individuals who have their own unique rights and responsibilities, and can go their own ways as and when they feel like it. I, on the other hand, consider them as a unit which has to make it or break it together.

    It doesn’t matter a iota what you “consider”; whether you consider a couple “a unit which has to…” etc., etc. What you want to do is spend time in villages and semi-urban areas in countries like India to see what the family dynamic is, as opposed to your idealised, prescriptive perception of it. I refer you to #44/Sentence:3 by Camille, to which you seem to have no response!

    • Please don’t assume that I’m calling you f@#ked-up. I usually give your comments more seriousness than many of your interlocuters do. It’s some of your views that I’m calling f@#ked-up, in the hopes of shaking you up into introspecting more on the issues above.
  25. Vedic sperm could actually cure AIDS

    Genius.

    destroy our assertive confident testes by squeezing them subtly and seductively.

    Pure genius.

  26. What if I allege that you actually contribute to the problem? What if I allege that you have no intention of solving this problem, that you have no sympathy for these children, and that you are doing all of this because you want to keep getting money from taxpayers that can be siphoned off to make swanky websites that accept credit cards?

    Please, by all means, allege away. What if I ignore public health research and the experience of development practitioners in favor of my conspiracy theories? What if I brush away the comments of everyone on this thread who takes issue with my completely skewed, un-reality-based depiction of the HIV/AIDS epidemic in India by calling them names, devaluing their perspectives, and assuming they are generally ignorant? What if I blame them for being the cause of the problem? Then, why don’t I accuse them of being heartless for not dedicating their lives to working on other acute/deadly diseases in the third world without any knowledge of their backgrounds, work experiences, or views? And finally, why don’t I label their arguments “socialistic” and “nonsense” so that I can avoid having to engage intelligently with anything that challenges my narrow worldview and definition of how the world should work.

    Grow up.


    Back on topic…

    Regarding all the talk of regulating vs. legalizing vs. neither the sex industry, I honestly don’t think that this will change, help, or be a realistic solution. I definitely felt different until I worked in an area with a burgeoning sex industry (on the border, frequented by truckers, in the “developing world”). I don’t know how the Netherlands works it out, but my gut would say it’s much better to help women own their own incomes, to work on campaigns towards bolstering attitudes towards women and women’s legal protections, and to fund health education campaigns/programs/projects. I don’t have any “proof” or whatnot to back that up, mostly because hardly anyone evaluates the efficacy of their development projects, but just destigmatizing HIV/AIDS alone could potentially make a huge difference.

  27. chitowndesi

    Whats your definition of paid very well? As in they are able to make enough money to live comfortably for the rest of their life? considering they only have x number of years to earn, a relatively good yearly income will just not do.

    the country is singapore (and malaysia to some extent as well at least in the border towns like johor baru). most of the workers are from neighboring countries (malaysians etc.), have profession cards, have monthly checks etc. its not an aspect of singapore that is advertised (like the netherlands or thailand).. there is zero violence in this trade, condom use mandatory. without this legalizaton, the hetero hiv rates would go up tremendously as the men from singapore would go to other more “dangerous” countries in larger numbers. as for earnings.. 5000 USD per month is not exceptional and the high end would be more than twice or thrice that. But even assuming 2000 USD per month as the average, that is enough to have a substantial savings (for Malaysia). Its not that these workers are going to retire.. A common pattern is to use some of these savings to start another business that is legit in malaysia/thailand/etc.

    obviously its unrealistic to enforce this on a country wide basis in India. Perhaps what might work is the equivalent of a special trade zone.. i.e where legitimate sex is traded and more importantly regulated very strictly, targetting the high risk groups.

  28. GB:

    Your statement…

    The containment, during the middle of the last century, of a number of tropical diseases of pandemic proportions came about… developed at state-funded laboratories and teaching hospitals by teams

    … has been sub-consciously responded to by Sumiti who writes:

    If the politicans actually lead, oversee the development and implementation of prevention programs, change laws, improve infrastructure, the situation is bound to turn around.

    Let me try once more…

    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!! The smallpox virus could be used as a biological weapon by the Nazis, so the British had to find a cure for it quickly to protect its country. The influence virus could be used by the Japanese so the Americans had to discover a cheap vaccine to protect its soldiers and civilians.

    The politicians of India or the US (or anywhere else) have no incentive to find a cure for AIDS because it does not affect them. They call up their expensive doctor and tell him: “I’m sending my son/daughter over to you. Can you give a pep talk about the birds, bees and AIDS? Thanks. Yes – I’ll see you at golf this weekend.” It’s the same case with rich and upper middle class everywhere. They don’t care, and frankly, they shouldn’t have to care. They make sure that their family is fine and well informed. End of story.

    Because AIDS is neither airborne nor waterborne. Pakistan’s agents cannot mix the AIDS virus in New Delhi’s water supply to cause a genocide. If they could, the establishment will find a way to cure AIDS faster than you can find a parking spot on Black Friday. Bangladesh’s agents cannot mix the AIDS virus into the air-ducts of a software company. If they could, the establishment would find a cure for AIDS faster than some people on this board take personal offense where none was intented.

    See – my problem is that the approach to AIDS cure by these so-called “concerned” people is flawed. Cures for diseases throught human history have had a close co-relation with Man’s survival instinct: Self-defence/Self-preservation or Profit. No cure has been found because people were “dedicating their lives…for poor and underpriviledged people”. ***

    Currently, AIDS is not a self-defence issue. Politicans do not worry that their children will get AIDS by sitting in the same room as AIDS patients. Generals do not worry that their soldiers can be killed by an AIDS-bomb. In this scenario, if the Government is assigned money or responsibility for this issue, it does not matter if you spend trillions of dollars -money will just disappear into the coffers of vested interests without any results.

    Which leaves us with the profit motive – and that’s what I am advocating. Don’t stand in pharmaceutical companies’ way with regards to how much they can charge. They will find a cure to please their board of directors.

    M. Nam

    *** 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.

  29. The politicians of India or the US (or anywhere else) have no incentive to find a cure for AIDS because it does not affect them.

    M.Nam – there are many challenges concerning HIV/AIDS but people confound them a lot of the times. you mention above that there is no incentive to find a CURE… that is a loaded statement because what a cure may be for AIDS can be debated to no end alone. what i was talking about was the incentive to implement prevention and treatment programs. that is not a cure for the infection, it is public health intervention to control the spread of infection.

    as for the political incentive, your overall message is right, the politicans won’t care till it affects them… that is often the level of closeness needed for anyone to take the threat of HIV seriously.

    China is an example of a government that did take the threat seriously … what it took for them to do so though, was SARS. When SARS affected china, the government realized for the first time how a public health issue CAN affect a nation’s economy, national security, trade etc. These aspects hit closer to a politicians and they accepted their denialism re AIDS and took steps to prevent a projected catastrophe. India has been given the same warning signals and the same level of attention and consultation by UNAIDS, the Gates and Clinton foundations, Bono/Jeffrey Sachs etc… but they haven’t taken the threat seriously yet.

    Governments of some countries in Africa (Uganda, Rwanda) are also good examples when it comes to addressing issues re AIDS seriously and systematically… the incentive there is clear, their productive populations are dying, who’s going to run the country.

    GW Bush’s baby PEPFAR was also created to address HIV/AIDS issues, albeit with a different kind of incentive… let’s just say, evangelical. Bono pitched the idea to GWB. Bush believes that ‘it is a ‘duty’ of the rich american (christian) nation to help God’s children in need.’ (Watch the PBS series Age of AIDS… this is all in there in far more detail!!) Anyway, here you see that incentive can be created to make governments invest money in HIV/AIDS related causes. PEPFAR is loaded with problems, not to mention 30% of the prevention budget alocated to ABC interventions… oh, but they casually leave out the C – condoms, which is what is effective about ABC, as per evidence collected over the past 10 years. Some argue (like Clinton) that in the end at least some money is going there… true, but it is a waste of money that can be used SO much more effectively. I’m off on a tangent, will stop.

    As for the ‘cure’ aspect – that involves medical interventions, and currenty microbicide and vaccine research are the key targets. Like Razib mentioned, circumcision has also been shown to be an effective preventitive measure and will hopefully become practice soon (once certain bodies come to a consensus about it). This research is funded by governments and grant agencies (national/ international/ Gates foundation is giving billions), a totally different sector from funding for treatment (ARVs etc) and prevention strategies.

  30. Politicans do not worry that their children will get AIDS by sitting in the same room as AIDS patients.

    Well, they should worry that they will get AIDS by having unprotected sex, which is a practice frequently engaged in by privileged youth all over the world. You seem to be buying into the belief that AIDS is only a disease of the poor and underprivileged. This is akin to the mistake made early in the epidemic–AIDS was thought to be disease of gay men. Perhaps if people had not dismissed it (or had actually cared about gay men), it would not have reached the epidemic proportions of today.

    AIDS has the potential to affect everybody. I sometimes treat college students who picked up STDs on a casual spring break encounter. These aren’t uneducated truck drivers sleeping with prostitutes who aren’t properly informed about the potential consequences. They are members of America’s elite and they are putting themselves at risk for contracting HIV. It is a disease everyone should be concerned about.

  31. As for the ‘cure’ aspect – that involves medical interventions, and currenty microbicide and vaccine research are the key targets. Like Razib mentioned, circumcision has also been shown to be an effective preventitive measure and will hopefully become practice soon (once certain bodies come to a consensus about it).

    I’m not sure if one can say that circumcision has been absolutely proven to decrease the spread of STI’s [following the link to the original article posted by Razib] so further research is required, but it is an intriguing theory. 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.

    Also- my only problem with touting this as a long term public health practice is that while male circumcision may be found to be associated with substantial benefits, it is only a matter of time until some quack decides to shift this circumcision ‘burden’ from males to females, and we see a spike in FGM. I think its an important cultural and ethical consideration that needs to be taken into account when debating these biologically related interventions, especially when implementation is suggested in areas where this issue is already a problem.

  32. Which leaves us with the profit motive – and that’s what I am advocating. Don’t stand in pharmaceutical companies’ way with regards to how much they can charge. They will find a cure to please their board of directors.

    And yet, they didn’t. Not even in the west. As a matter of fact, all the major breakthroughs came out of basic research funded by the federal government. The first cocktail came out of a nonprofit laboratory.

    You can assert all you like, but the track record doesn’t bear you out on this one.

  33. I’m not sure if one can say that circumcision has been absolutely proven to decrease the spread of STI’s [following the link to the original article posted by Razib] so further research is required, but it is an intriguing theory. 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.

    circumcision seems to be something that is effective in non-developed countries because healthy/sanitation/etc. make spread of heterosexual AIDS likely.* in contrast, it seems pretty unimportant for developed nations like japan or europe, who have lower HIV rates than the USA where most males are circumcised. it might not be possible for circumcision to be an option in south asia because of its association with islam, but i threw it out there because it is a possible solution.

    • e.g., the luo in kenya are uncut, and have the highest HIV infection rates of kenyan groups. the xhosa are cut, and the zulu are uncut, and the zulu have far higher rates. west africa is cut and south africa uncut, and the former has higher rates. thailand is uncut and the philippines is cut and the former has higher rates.
  34. sumiti writes: >>When SARS affected china, the government realized for the first time how a public health issue CAN affect a nation’s economy,

    SARS is airborne…and a politician’s daughter can get it. Just like Manmohan Singh’s grandkid got Dengue fever in the recent outbreak in Delhi.

    M. Nam

  35. circumcision seems to be something that is effective in non-developed countries because healthy/sanitation/etc. make spread of heterosexual AIDS likely.* in contrast, it seems pretty unimportant for developed nations like japan or europe, who have lower HIV rates than the USA where most males are circumcised. it might not be possible for circumcision to be an option in south asia because of its association with islam, but i threw it out there because it is a possible solution.

    So presumably… there is a lower prevalence in Pakistan/Bangladesh (predominantly Islamic, ‘cut’ countries) than in India (predominantly Hindu, ‘uncut’)?

  36. there is a lower prevalence in Pakistan/Bangladesh (predominantly Islamic, ‘cut’ countries) than in India (predominantly Hindu, ‘uncut’)?

    yes. but look at ethnic groups of different religions in india. like the cervical cancer study among tamil muslims vs. non-muslims (non-muslim women, christian & hindu, had higher rates. in contrast, this doesn’t seem to happen in a comparison between sweden & the USA last i checked).

  37. >>When SARS affected china, the government realized for the first time how a public health issue CAN affect a nation’s economy, SARS is airborne…and a politician’s daughter can get it. Just like Manmohan Singh’s grandkid got Dengue fever in the recent outbreak in Delhi

    .

    moornam… read what i wrote carefully and understand the context… if ur just here to make ignorant comments then don’t expect a response…

    Gulaab, Here are some primary articles on male circumcision that can be accessed without subscription, in PLoS medicine and BMJ… i don’t think it is a fool-proof answer personally, but data shows that it decreases risk, that is important. This is a WHO news brief.

    the whole attention on male circumcision started with observations that circumcized men have lower levels of sexually transmitted infections than uncircumsized men when other risk factors were similar. it is an association thusfar, the biological/physiological reason for this is still speculative. it is being looked upon as a possible preventative tool such as male and female condoms.

  38. Just to chime in on the whole pharmaceutical company tilt. Pharmacetical companies have a great track record of doing research on methods to keep patients on medications. Diabetes is one of the oldest diseases known to mankind, yet to this day no cure, but we do have ways to manage it. The same thing seems to have happened to AIDS, they have done a great job in keeping these ppl alive. What incentive do they have to finding “cure” as long as they can keep ppl buying norvir on a monthly basis?

  39. it is an association thusfar, the biological/physiological reason for this is still speculative.

    well, it seems slam dunk if you consider the number of blood vessels and surface area of the foreskin. add to that that cut men have much thicker epidermal layers on their glans because it is always exposed.

    i think analogizing to condoms is problematic though. circumcision as a solution to this problem is drastic. i think it is justified in places like south africa where seropositivity is north of 10% and cultural traditions are more malleable (the zulu used to circumcise until shaka zulu banned the practice in the early 19th century). i don’t think it is justified in most of asia because seropositivity is pretty low. japan and south korea have almost the same HIV infection rates despite the former being uncut and the latter cut. it isn’t like there aren’t downsides off being circumcized.

  40. No wonder little headway is being made with the villagers in India. I can imagine a villager’s face when he’s raising objections and being told: “listen to me carefully and understand the context. if ur just here to make ignorant comments then don’t expect a response…”

    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) etc etc etc. This if-you-don’t-understand-it’s-your-problem-so-go-away attitude helps no one.

    M. Nam

  41. you’re very skilled at taking words and placing them out of context moornam, heck you could be a politician. thanks for showing me the kind of people i have to learn to work with.

  42. chitowndesi,

    I recently met a couple of people who have been involved in AIDS research for more than a decade, and they told me that most scientists they know have almost give up hope. So, managing the disease (like diabetes, cholestrol etc) may not be a bad option after all.

    I personally think that rather than biotechnology/medicine, nano-technology will be very useful in eradicating AIDS. Just imagine, small robots in the blood stream which emit friendly signatures to white-blood corpuscules and deriving energy from body heat. They leave everything else alone except the AIDS virus, which they destroy on sight. And since these bots are non-organic, AIDS cannot effect them.

    Basically, scientists will have to create an AIDS-like disease to the AIDS virus !

    M. Nam

  43. So presumably… there is a lower prevalence in Pakistan/Bangladesh (predominantly Islamic, ‘cut’ countries) than in India (predominantly Hindu, ‘uncut’)?

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

  44. Basically, scientists will have to create an AIDS-like disease to the AIDS virus ! Scientists would love to do it, but who will pay for it? I briefly worked on a novel approach to diabetes and know the difficulty in finding the funds to support such research. nano technology will be great.. hope to see it in my lifetime.