HEALTH-INDIA: Government Upset by UNAIDS Figures

By Ranjit Devraj Reprint | | Print |

Ranjit Devraj

NEW DELHI, Aug 8 2000 (IPS) - The Indian government has again joined issue with international AIDS agencies, disputing what it says are “exaggerated” figures of HIV-infected people in the country.

Stung by criticism from opposition lawmakers in Parliament, who cited HIV statistics for India put out by UNAIDS, Health Minister C.P. Thakur has accused U.N. agencies of mis-reporting facts and creating confusion.

“I am at a loss to understand how there can be so many different estimates by different U.N. agencies,” an anguished Thakur told reporters at a specially called press conference Monday.

He said he would “appeal to the U.N. agencies to realise the importance of these figures, which are about human subjects.”

Thakur said the National AIDS Control Organisation (NACO), which is supervised by his ministry, generates epidemiological data from field studies and it would be “advisable” for U.N. agencies to use these figures.

The government’s main objection is to figures in the latest UNAIDS report on the global HIV/AIDS epidemic, which show that 310,000 Indians died of AIDS in India in 1999. However, the report did not explain how the figure was obtained.

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 Indian AIDS agency also objected to the latest UNAIDS finding.

“We arrived at the number of 3.1 million using an internationally accepted model based on experience in various parts of the world,” said Gordon Alexander, a senior UNAIDS official in India.

According to Alexander, while there was room for discussion on the figures, the idea was to “emphasise the need for prevention and support and a care system for HIV patients.”

Official Indian estimates for the year put the number of AIDS deaths to a modest 11,000, though some experts have questioned the reliability of this figure.

The health minister admitted that these were projections. “We have to develop a proper model for estimation of AIDS deaths based on the number of infections in the country,” he said.

“It is not always easy to get actual reports on deaths as the cause of death is always recorded as due to opportunistic infections like tuberculosis, meningitis, pneumonia , etc.,” he explained.

Thakur said that NACO has estimated 3.5 million reported HIV infection cases in the country, but there was a gulf between reported cases and estimated cases.

“It is internationally acknowledged that 90 percent of HIV infections are asymptomatic and only 10 percent are reported,” he said.

The UNAIDS report estimated between four and five million cases of HIV infections in India.

An even bigger embarrassment for the government was caused by a report tabled in Parliament two years ago that spoke of 8.3 million HIV- infected people in the country.

However, at Monday’s press conference, NACO director Prasada Rao attributed that figure to a “typographical error.”

Epidemiolgists have long argued that if India did have hundreds of thousands of HIV-infected people, there should have been many more cases of people afflicted with diseases that mark the final phase of full- blown AIDS.

Rao said there was no evidence of this happening anywhere in India.

Some public health groups have a different explanation for the confusion over AIDS statistics.

According to Purshottaman Mullolli of the Joint Action Council (JAC), the “conflicting statistics” could be “attributed to…a deep conspiracy to inflate figures in order to justify the expending of all too readily available loans from the World Bank.”

An umbrella grouping of non-governmental organisations (NGOs) working in the areas of human rights and HIV, the JAC is campaigning against a NACO programme that targets so-called high-risk groups, leading to their social ostracisation.

“The fact is that far from alleviating problems, a scare is being created in the country,” he said. This has led to the import of expensive AIDS-related medical equipment even as basic health services in the country are starved of essential supplies, he added.

The scare has also led to unethical medical practices, such as doctors insisting on compulsory HIV tests for patients, and refusing to treat those found positive.

Thakur, himself a qualified medical practitioner, said the government was aware of such unethical practices.

According to Thakur, NACO’s AIDS education campaign has made people more aware of the dangers of sexually transmitted diseases (STD)s and reproductory tract infections (RTI)s.

A NACO campaign in December last year examined 45 million men and women, in the 15 to 49-year-old age group, for STDs and RTIs. Of these, 1.8 million were actually treated for these ailments, Thakur said.