Asia Times: AIDS scare reducing basic health funds: critics


	July 5, 2000	atimes.com

India/Pakistan

AIDS scare reducing basic health funds: critics
By Ranjit Devraj

NEW DELHI - A new UN report showing over 300,000 AIDS-related deaths in India last year, has revived charges that Western donors are neglecting bigger public health problems in the country.

The Indian government's World Bank-funded National AIDS Control Organization has questioned the findings of the UNaids' (the joint UN Program on HIV/AIDS) ''Report on the global HIV/AIDS epidemic - June 2000.''

The Indian AIDS control body, better known by its acronym Naco, has again protested at what it claims are highly exaggerated AIDS statistics on India. ''There is no basis for these projections and the UNaids headquarters in Geneva could not explain how they reached these estimates,'' said Naco Director Prasada Rao. According to Naco, which works under the Ministry of Health, the number of AIDS-related deaths in 1999 was 11,000.

Meanwhile, some are worried that such figures will lead to even more spending on AIDS/HIV control in India at the cost of more pressing public health problems.

This is not the first time Naco has disputed UNaids figures on India. Six years ago, Naco officially questioned the basis on which UNaids calculated that India then had 1.75 million people infected with the AIDS virus. The latest UNaids estimate puts the number of those infected with HIV at 3.7 million. However, UNaids admits that India's epidemic is highly diverse. ''While some states show almost no HIV infection, others have reached adult HIV prevalence rates of 2 percent and above,'' says the latest report. An official at the UNaids office in the Indian capital said the latest statistics were ''projections based on our knowledge of how long it takes for HIV to spread in a given population''.

But critics say these figures are as unreliable as Naco's which are not based on an actual body count or proper certification of the cause of death. They point to the absence of hard supporting evidence and any baseline data that can be used to make reliable projections. Naco uses blood samples picked up at blood donation camps and ante-natal clinics which are then tested for HIV. The results form the basis of the estimate of HIV spread in the country. But some experts say the method is highly unreliable.

When UNaids chief Peter Piot was in India in March, he was asked why the HIV/AIDS spread in India was not as large as projected by his organization. Despite a more than 30 percent incidence of sexually transmitted diseases (STDs) in the country due to unsafe sex, there is no corresponding HIV incidence. According to Piot, India could be on the threshold of an AIDS/HIV epidemic and could soon see an Uganda-like situation of sudden spread.

However, some health experts question the large government and donor spending on what to them is a non-existent disease in a country with serious public health problems caused by germs that were wiped out long ago in other parts of the world. According to noted economist Jeffrey Sachs, who was in India in April as chair of the Commission on Macroeconomics and Health set up by the World Health Organization (WHO), India is heavily burdened by vector and water-borne diseases and respiratory illnesses such as tuberculosis. Sachs said India's economic reforms, begun in 1991, led to successive cuts in the federal health budget which almost crippled the public health delivery system. In sharp contrast, funding for HIV/AIDS control has grown. Tuberculosis control got $18 million last year against $55 million for HIV/AIDS. India is estimated to have one-fourths of the world's tuberculosis cases.

''People are beginning wonder why AIDS seminars are being conducted in the middle of a malaria outbreak in (the northeastern border state of) Assam or during famine-like conditions in (western) Rajasthan (state),'' said Mira Shiva of the Voluntary Health Association of India (VHAI).

Three years ago, a report of the Independent Commission for Health in India consisting of well known public health experts, warned that ''excessive funding (for HIV/AIDS) has clearly influenced the direction of health policy in India.'' The report noted that external funding for communicable diseases may not match India's public health priorities and that the content of a program is influenced through foreign funding. Ute Schumann, a health consultant to the European Union with several years experience of Indian health services, used the 1999 World Health Report to show that India now has a policy of financing disease control which is heavily skewed in favor of HIV/AIDS.

Those who think that the AIDS/HIV program is hijacking the nation's real health agenda, were encouraged when the powerful Prime Minister's Office ordered a review of Naco's strategies earlier this year. The review was ordered after a leading NGO, the Joint Action Council made presentations to show how strategies promoted by Naco and UNaids were based on data gathered using questionable methodology.

''There does seem to be an attempt to hype up the figures and cause an AIDS scare (in the country),'' a senior bureaucrat in the prime minister's office had then observed.

(Inter Press Service)

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