HEALTH-INDIA: Free ARVs, a Ploy by Drug Firms to Pressure Govt?

By Ranjit Devraj Reprint | | Print |

Ranjit Devraj

NEW DELHI, Jul 1 2004 (IPS) - Kaushalya is convinced her unborn baby would be alive today if she was not compelled to abort it by the so- called ”HIV/AIDS mafia.”

Trouble began for Kaushalya after her husband Ranbir, who drove buses for the state-owned Delhi Transport Corp (DTC), died of tuberculosis in 1996 shortly after he tested positive for HIV.

Doctors refused to attend to Ranbir and advised her to abort the son she was then carrying ”for her own safety” – and this she had to do.

Ostracised and humiliated by the orthodox Hindu society she lives in, Kaushalya sought help from human rights activists to undergo further tests that revealed that neither she nor her three young daughters had HIV. The earlier tests were obviously defective.

Kaushalya has now remarried and is the mother of a healthy fourth daughter with her second husband.

Today, this frail but plucky woman, who lives in a village in Haryana state adjacent to Delhi, believes that no other woman must suffer the pain and humiliation that she underwent because of flawed HIV/AIDS policies and so-called government programmes to address the pandemic.

At the moment, Kaushalya is busy opposing a public interest litigation case before the Supreme Court that wants the government to provide free anti-retroviral (ARV) drugs – which slows down the multiplication of HIV – to all who need it through the public health system.

”These are (actually) private interest litigations – people like me who live in villages are never going to benefit form any government programmes – we are better off left alone,” Kaushalya told IPS.

Kaushalya’s argument – and that of sceptics like the non- government Joint Action Council (JAC) that is backing her – is that the real aim of the public interest litigation pushing free anti- retrovirals is to pressure the government into placing bulk orders for these drugs and thus bail out the pharmaceutical companies.

Responding to demands from NGOs and organisations of people living with HIV/AIDS, the government began in April a programme to provide free ARV treatment in six high-prevalence states of southern Andhra Pradesh, Karnataka and Tamil Nadu, western Maharashtra and north-eastern Manipur and Nagaland.

Under the programme, an estimated 100,000 people, starting with seropositive mothers and children below 15, are expected to be covered by the end of 2005, according to the National AIDS Control Organisation (NACO).

Kaushalya, for one, has no reason to have any faith in the programme. Haryana state, where she lives, is not covered though it includes the bustling urban centre of Gurgaon and the planned capital city of Chandigarh.

Community health experts also say that pushing ARV treatment in itself would not address the spread of HIV/AIDS.

They have said that introducing ARV treatment – which calls for close monitoring – through the ramshackle public health delivery system is a scheme that entails huge risks. This is especially so for a country like India, whose salient features include corruption, diversion of costly drugs into the black market and poor patient compliance with drug regimens.

Anti-retroviral drugs, usually a combination of at least three different anti-HIV medications, need to be taken on a regular schedule everyday for them to work and thus involve changes in lifestyles and daily routines.

Ritu Priya, the noted community health expert at the Jawaharlal Nehru University, says that ARVs can at best be an ”add on” to measures that can boost the immune system. She stressed that psychosocial support must be provided together with information on adequate nutrition and steps to prevent other infections.

She noted that HIV infection requires a long initial period of supportive and preventive measures with monitoring to assess when ARVs are to be started. Once ARV therapy is started, it requires continuous monitoring for side effects and drug resistance.

To add to existing problems, the continued availability of cheap generic drugs, the manufacture of which India is well-known for, is now in doubt since the country is mandated to conform to trade and intellectual property provisions under the World Trade Organisation from 2005 onwards.

According to the Lawyers’ Collective, a voluntary organisation, this could leave the government held to ransom by the national pharmaceutical industry.

Indeed, the public interest litigation that Kaushalya is challenging speaks about how pharmaceutical companies that are now producing generic AVRs both for domestic use and export are ”growing apprehensive about the sustainability of manufacturing because of lack of orders from the government and have indicated that they may abandon further research and even further production of ARV drugs.”

Arguments like these are meant to intensify fears around the pandemic in order to lead to more orders of ARV drugs to the benefit of drug manufacturers, critics like Kaushalya and other activists say.

In fact, the JAC petition challenges the very notion that there is an AIDS epidemic in India such as to warrant the declaration of a national emergency, as demanded in the public interest litigation filed by the Voluntary Health Association of Punjab.

NACO figures speak of an estimated 3.8 million to 4.5 million cases of HIV in India, while the cumulative AIDS cases nationwide (from 1986 to March 2004) number 68,809 known cases.

Some critics have said that this hardly constitutes an epidemic in a country of a billion plus people, large sections of which suffer more from problems like severe malnutrition and hunger.