HEALTH-INDIA: Serious Question of Accuracy in AIDS Statistics

By Ranjit Devraj Reprint | | Print |

Ranjit Devraj

NEW DELHI, Sep 1 2004 (IPS) - India’s National AIDS Control Organisation (NACO) claims to have halted the growth of new HIV infections in its tracks but newly released studies suggest that its figures may be unreliable and that worse could be in store if business continues as usual.

According to NACO’s latest available figures, the number of new HIV cases fell from 610,000 in 2002 to 520,000 in 2003 while the total number of those affected by the virus remained 5.1 million at the end of 2003 in a population of a billion people.

”The most important step is accessing evidence and providing accurate numbers so that nobody can challenge the statistics,” said NACO’s Director General Meenakshi Dutta-Ghosh.

But reliable statistics, not only on HIV/AIDS infections but other public health issues, have been largely a matter of conjecture in a country where 40 percent of births and deaths still go unregistered.

Since 1987, NACO has been estimating the total number of HIV infections by extrapolating data from two sources. Data for women comes from sentinel surveillance at about 200 antenatal clinics while data for men comes from about 166 clinics treating sexually transmitted diseases or STDs.

”The sample size used in this method is woefully inadequate for such a large population and readily lends itself to all sorts of manipulation not only by NACO but also a host of funders including the World Bank, bilateral agencies and donors,” Purushottaman Mulloli, chief of the Joint Action Council (JAC) an umbrella organization for groups working for the rights of HIV-affected people told IPS.

Mulloli has challenged the release of unreliable statistics by various agencies in the Supreme Court on the grounds that this was creating an AIDS scare in a country where the vast bulk of the population has to contend with far more serious and pressing public health issues without the benefit of insurance coverage or social security.

He has charged pharmaceutical giants with masterminding a strategy to inflate HIV/AIDS statistics with support from multilateral agencies to increase the sale of antiretrovirals that do not offer cures but instead create unsustainable dependencies in developing countries.

Antiretroviral drugs are substances used to kill or inhibit the multiplication of retroviruses such as HIV.

Hype or not funds have been pouring into India to fight HIV/AIDS in India.

Apart from the 57 million U.S. dollars available annually from the Bank and bilateral agencies, money has been coming in from major donors such as the Bill and Melinda Gates Foundation that has pledged 200 million dollars to fight the virus in this country.

The continuing controversy over HIV/AIDS statistics and NACO’s claims of success led to Union Health Minister Anbumani Ramadoss announcing last week that he would be calling for an ”external assessment” involving the highly-reputed Indian Institute of Management and McKinsey and Company – one of the world’s top management consultancy firm.

Ramadoss said although India had more than five million people affected by HIV, prevalence remained below one percent and lower than in countries like Thailand and South Africa.

NACO’s claims were made amidst a scathing attack on its functioning by the Comptroller and Auditor General (CAG) who revealed that the organisation had been able to utilise only 46 percent of more than 300 million dollars made available by the World Bank for a five-year AIDS control programme which ends in October.

The CAG also unearthed serious deficiencies including misuse of funds in key targeted interventions sponsored by NACO such as the promotion of condom use and improvement of STD clinics that play a key a role in providing statistics for sentinel surveillance.

While the World Bank provides most of the funding for NACO’s programmes, other major contributors include the British government’s Department for International Development (DFID) and the United States Agency for International Development (USAID).

Meanwhile, the World Bank has also called for better statistics on the current state of the epidemic in order to improve efficiency in planning exercises such as the public provision of free antiretroviral therapy (ART) that NACO began four months ago.

In a study called ‘HIV/AIDS Treatment and Prevention in India: Costs and Consequences of Policy Options’ and released on Aug13, the Bank said that it was ”unfortunate that estimates are unreliable in India today.”

The study drawn up by the Bank at the request of the Indian government, as it considers how to make good on a promise to have 100,000 people on ART over the next five years, admits that it makes ”generous use of assumptions” because of unavailable data.

In its ”baseline epidemiological projections” the Bank’s study said that without drastic policy changes HIV prevalence could rise from the current level of less than one percent to four percent of the population by 2033.

The study also said that if ”unstructured therapy” continued the number of people with resistant strains would grow faster than the number of people with non-resistant strains of HIV.

It projected that the number of people using unstructured treatment would grow from the current level of about 10,000 to about three million in 10 years and to 5.3 million by 2003 of which 3.9 million will be infected with resistant strains.

By 2003, HIV/AIDS would become the dominant cause of death in India, accounting for 17 percent of all deaths and 40 percent of all infectious deaths ”if there is no change in antiretroviral therapy policy and stagnation in prevention policy,” the study said.