With statistics being released last month of IndiaÂ’s HIV rate of 5.7 million total infections the following news makes me want to yelp with joy. Yelp!

India plans to provide free anti-retroviral drugs to combat HIV — the virus that causes AIDS — to around 100,000 people by early next year, a top health official said, as this nation struggles with the largest number of AIDS infections in the world. [Link]

Armed with a budget of about $200 million U.S., availiability of free ARV drugs is going to expand from 52 clinics supplying 35, 000 people to a whole 100 clinics:

“By August, we will be able to reach anti-retroviral therapy drugs to around 85,000 people infected with the virus,” Rao told journalists. “But by early 2007, we will have drugs made available to 100,000 people with HIV.”

According to Sujatha Rao (Director General, National AIDS Control Organization), treatment is going to supplement a newly strengthened AIDS awareness campaign:

Among the new initiatives is a program to reach out to pregnant mothers so that mother-to-child transmission of AIDS can be controlled. So far, only 4,500 pregnant mothers had been given doses of nevrapine — a drug that prevents the transmission of the virus from an HIV-infected mother to a newborn infant.

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Everyone knows the ‘brain drain,’ I presume — the flight of educated professionals from the Indian subcontinent in the 1960s, 70s, and 80s to the west. A number of the immigrants were doctors, who were in desperately short supply at a time when the U.S. population was spiking. My own family was part of that event, which admittedly must have hurt the progress of health care in India itself (though I don’t know if this has ever been formally studied).

And while there now are, perhaps, too many doctors in the U.S., there aren’t enough nurses. According to one statistic in today’s New York Times, there were 118,000 nursing vacancies in U.S. hospitals last month, and the deficit could reach as high as 800,000 in the next decade. Now the U.S. Senate’s immigration bill contains a clause that will remove the immigration cap entirely for qualified nurses from India, the Philippines, and China.

The lack of qualified U.S. nurses is due mainly to the lack of places to train them; nursing schools turn away scores of applicants since there simply aren’t enough Professors of Nursing around. But despite the severe shortage, the American Nurses Association is opposed to the current measure, which it calls “outsourcing.”

The repercussions on the health care systems of the affected countries could be severe, even if there is some overall benefit to the local economy:

The flight of nurses from the Philippines, a former American colony, has provided a huge boost to a weak economy, through remittances. Some government agencies there have encouraged the export of nurses, who send home billions of dollars each year to their families.

A nurse in the Philippines would earn a starting salary of less than $2,000 a year compared with at least $36,000 a year in the United States, said Dr. Jaime Galvez Tan, a medical professor at the University of the Philippines who led the country’s National Institutes of Health.

He said the flight of nurses had had a corrosive effect on health care. Most Filipinos died without medical attention in 2003, just as they had three decades earlier. (link)

For the Philippines, there’s already a care drain. The same may be in store for India if this bill passes and goes through the House, as seems likely.

Incidentally, there is already a recruiting company, called RNIndia, that specializes in bringing Indian nurses to U.S. hospitals. And Abhi talked about another side of this issue here. Continue reading →

I recently picked up Atul Gawande’s Complications: A Surgeon’s Notes on an Imperfect Science in a bookstore in Philly. I thought I already had a favorite Indian doctor-writer in Abraham Verghese, but Gawande gives Verghese a run for his money in this excellent, thought-provoking book.

Complications is essentially a warts-and-all portrait of the field of medicine in the U.S. for lay readers. It’s built on extensive research and interviews as well as Gawande’s own experience as a surgeon at Harvard. Gawande’s overarching interest is in what can be done to reform the practice of medicine from within. It’s fitting that Malcolm Gladwell has a blurb on the back of the book, since Gladwell’s detail-oriented, problem-solving method clearly resesmbles Gawande’s in many ways.

Complications has been a success — it was a National Book Award Finalist. In 2003, Gawande was invited to do the commencement address at the Yale School of Medicine, which is a pretty remarkable honor for a young doctor. He’s also written a number of times for the New Yorker (try here and here), as well as the New England Journal of Medicine, where he published an influential article about casualty rates in the ongoing Iraq war. Continue reading →

After two years of market research, Hindustan Latex Limited (HLL) is ready for a commercial launch of the female condom in India. It will be distributed under the brand name ‘Confidom’. The condom is manufactured in the U.K. by the Chicago-based Female Health Company (FHC). In addition, the FHC announced this week that it has received an order from the National AIDS Control Organization of the Government of India for over 500, 000 condoms. [Link, in PDF]

Research conducted by HLL last year indicated an interest in the product from commercial sex workers as well as from college girls [Link]. While HLL is eying the moolah in upper middle class spheres the Indian government is giving them a helping hand by working with NGOs to reach sex workers:

Positioned as a high-end lifestyle product targeted at the segment of women aged between 18 to 35 years, the product has been priced at Rs. 250 for a pack of two. It expects to sell five lakh units in the first year. Meanwhile, the government has already ordered about five lakh pieces to be distributed free through NGOs or at a subsidized price of Rs. 5 to sex workers. [Link]

Female condoms are unique because they give women simultaneous control over STD prevention and contraceptive technology. Their influence on HIV prevention programs dealing with sex workers, such as Kolkata’s Sonagachi Project, could be huge. While promoting HIV awareness in the Sonagachi brothels, public health scientist Smarajit Rana found some very basic obstacles preventing the use of male condoms:

It transpired that if a prostitute insisted on condom use, her customer just went to someone else. Unlike AIDS, starvation posed an immediate threat, and the program seemed doomed. “Counseling, educating–it just doesn’t work,” Jana states. “Higher up in the social hierarchy, people are able to act on the information given to them. Not so in the lower levels.” [Link]

Confidoms could drastically reduce such difficulties faced by sex workers but at Rs. 5 a pop I wonder how accessible this method really is to them. HLL is looking at negotiating a deal with the FHC that would allow them to manufacture the condoms domestically, which would lower the price, but no word of a definite agreement as yet. Continue reading →

Google Trends reveals the most sexually repressed (and Internet-literate) nations in the world by showing who spends the most time searching for the word ‘sex’ (via Andrew Sullivan).

The #1 city: Delhi. The #1 country: Pakistan.

Three of the top six cities are in India: Delhi, Chennai and Bombay.

The top U.S. city: Salt Lake City. Then Chicago.

The top language: Arabic. Was it really a surprise?

Also check out who searches for the word ‘pornography’ and the word ‘desi.’

One of the ultimate ironies of the traditional Indian gender roles is that, although they strive to keep chastity on every cherubic mind, they accomplish quite the opposite… every interaction is viewed through the filter of gender… it’s a perversion that the platonic part of our lives is defined by the sexual. If chastity were the objective, repression is clearly not the answer. [Link]

Related posts: Everyone’s having sex except you, No sex please, we’re Indian, Bad Indian Boy, There is no place to hide it in India

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