Denial won't help

The United Nations report on the status of the global HIV/AIDS epidemic seems to have both positive and negative portents. On the positive side, it shows that the rapid growth in AIDS cases that characterised the first quarter century of the epidemic is given way to a slower spread of the disease. This is a clear indication that the menace is not insurmountable, as was once presumed, and that it can be contained through well-conceived strategies. The ominous aspect of the report is the section concerning India, conferring on it the unsavoury distinction of having the world's largest number of people (a whopping 5.7 million) affected by the HIV virus. In that respect, India has relegated South Africa to second position, with 5.5 million cases. Considering the relative size of the population in the two countries, India can still assert that it has a far lower proportion of affected people than many other countries, but that provides cold comfort. Indeed, the government goes further and claims that international estimates are much too high. This testifies to a state of denial that has persisted for far too long.

What needs to be realised is that the UN reckoning could in fact be an under-estimate, as India has no national information system in place to collect HIV/AIDS testing information from the private sector, which account for nearly 80 per cent of health care in the country. In any case, even 5.7 million carriers of the deadly virus are enough to pose a formidable threat to the whole society, if allowed to remain uncurbed and indeed spread. What is equally worrisome is that HIV/AIDS infection is no longer confined to a few 'at-risk' populations, such as sex workers, drug addicts and mobile segments of the population, including migratory labour and truck drivers. Some studies suggest that it is now spreading beyond these groups into the general population. This makes it imperative for the country to devise its own AIDS control strategies, distinctly different from those that have shown encouraging results in countries like Uganda, Kenya, Zimbabwe, Burkina Faso and Haiti.

What makes the task of combating HIV/AIDS particularly challenging in India is the large and high population density, besides low literacy levels and even lower awareness about how the virus gets transmitted, and how it should be treated. Creating awareness about a complex disease among people who do not know the basics of health and hygiene cannot be easy. Worse still, awareness is the lowest among women, who constitute a vulnerable group. Besides, though the bulk of the new cases result from unprotected sexual contact, the infection is also spreading through numerous other means like intravenous drug use, transfusion of infected blood, and widespread recycling and reuse of infected medical material. Moreover, the negative attitude towards HIV/AIDS patients, not only by society at large but also by health service functionaries, makes the task all the more difficult.

If the problem is to be tackled effectively, recognition has to grow that India faces an epidemic; the state of denial must end. Then, a group-specific approach may work best, along with the creation of supportive infrastructure tailor-made for that particular group. Both the government and voluntary organisations could perhaps concentrate on dealing with such selected groups, such as sex workers and mobile segments of the population. The network for HIV/AIDS testing needs to be expanded several-fold. Besides, the supplies of antiretroviral drugs that have been found useful in preventing this disease, need to be suitably augmented to ensure easy availability. Unless an elaborate control programme is put in place, it may be difficult to halt, far less reverse, the spread of this epidemic.