THE TIME BOMB TICKS
- The world sees India and China as big HIV/AIDS threats
Jairam Ramesh
Looking for light
China and India evoke images of (i) the world's two most populous
countries; (ii) the world's two fastest growing economies that would
soon occupy second and third positions in world gross domestic product
rankings; and (iii) the destination of the world's blue collar and
white collar jobs respectively. But the dynamic duo have also acquired
a darker and more dubious reputation which they prefer not to talk
about. The world health community sees China and India as potential
HIV/ AIDS time bombs waiting to explode in the next two-three decades.
Bill Clinton's recent sojourns brought the issue of HIV/AIDS in the
two nations into global focus yet again. On November 10 at an AIDS
summit in Beijing, he called for stronger leadership to combat the
spread of HIV/ AIDS in China. On November 22 in Delhi, he secured the
involvement of three Indian companies — Ranbaxy, Cipla and Matrix — to
supply cheap drugs for antiretroviral combination therapy for HIV/AIDS
patients in Africa and the Caribbean.
There is no shortage of doomsday scenarios. Last month, while on a
visit to Beijing, the American health secretary, Tommy Thompson, said
that the rapid spread of HIV/AIDS in India and China could destroy
chances to contain or cure the disease. In November/ December last
year, writing in the sober but prestigious American journal, Foreign
Affairs, Nick Eberstadt provided new ammunition. In 2002, China is
estimated to have had about 0.85-1 million HIV/AIDS cases. Eberstadt
estimates that by 2025, this could rise to between 32 million ("mild
epidemic") and 100 million ("severe epidemic). The corresponding
numbers for India range between 30 million and 140 million on a 2002
base of 3.8-4.6 million. By the end of 2000, Chinese government
officials themselves now publicly talk of 10 million HIV/AIDS cases in
the People's Republic of China. Indian government officials are more
cautious in public but privately concede that India could also have
8-10 million HIV/AIDS cases by 2010. China is reporting an annual
growth rate of 30 per cent, while India's reported annual growth rate
of HIV/AIDS cases in 2002 was much lower, at around 15 per cent.
It is only in the past two years that the Chinese government has
acknowledged HIV/AIDS to be a serious issue. In late 2001, the world
media focussed attention on the very high rates of HIV/AIDS prevalence
in the central province of Henan. Henan is China's most populous
province, apart from being the home of Mao. The severe AIDS outbreak
here was apparently caused by blood-buying companies using unclean
methods. These methods have continued. Blood donations have become a
widespread source of supplementing incomes in many parts of rural
China. The breakdown of the rural commune-based health system over the
past decade and a half and massive urban migrations appear to be
contributing to the crisis.
Not surprisingly, provinces adjoining Henan like Anhui, Heibei and
Hubei are also suffering serious consequences. In other provinces like
northwestern Xinjiang, HIV/AIDS has been spread on account of
intravenous drug use. In provinces like Yunnan, Guangxi and Sichuan in
the south and southeast, resurgence of prostitution is being seen as
contributing significantly to the spread of HIV/AIDS. Yunnan is where
the AIDS epidemic was first noticed and it is estimated that it
accounts for almost half of all HIV/ AIDS cases, although this could
also be the result of better epidemiological monitoring.
Just last month, Li Liming, director of the Chinese office of the
United States Centre for Disease Prevention and Control, revealed that
almost two-thirds of HIV/AIDS patients were infected through
intravenous drug use and about one-tenth each through unsafe plasma
sales and .ual transmission.
India too was in denial mode for long. But since the mid-Nineties, an
active National AIDS Control Organization, with its counterparts in
states, has come into being. Unlike the Chinese programme, India's
programme is better organized and better funded. NACO has been
spending close to $ 50 million a year and this could increase to
around $ 80 million a year during 2004-2010. This excludes whatever
financial support organizations like the Gates Foundation are expected
to provide to nongovernmental organizations directly. But even with
the involvement of such organizations, NACO's investments will drive
the country's programme.
India's investment in AIDS control may appear impressive in relation
to the numbers for China which vary currently between $ 15-25 million
a year. But clearly NACO is substantially under-funded. One casualty
of the under-funding is antiretroviral therapy which is not used by
NACO since it costs around $ 1 per patient per year. Ironically,
Indian companies are global leaders in anti-HIV/AIDS drugs. Other
countries like Brazil, Botswana and now South Africa have made such
therapy an integral element of their AIDS control efforts.
India's HIV/AIDS incidence has distinct regional variations with
Andhra Pradesh, Karnataka, Maharashtra, Manipur, Nagaland and Tamil
Nadu being the high-prevalent zone where epidemic levels may already
have been reached, measured by HIV prevalence in antenatal women.
Manipur and Nagaland suffer on account of intravenous drug use like in
Xinjiang and Yunnan. That Manipur, Nagaland and Yunnan are close to
Myanmar and Thailand has surely impacted on widespread drug use
leading to high HIV/AIDS prevalence rates. India has also registered
some successes. A very high rate of condom use in Sonagachhi, for
instance, is widely heralded as a major breakthrough for NACO, as has
been the significant improvements in the blood supply chain all over
the country. Political leadership has provided momentum to AIDS
communication and control, especially in Andhra Pradesh and Tamil
Nadu. It has also helped that India's most populous states are low
HIV/AIDS prevalence zones, unlike the populous Chinese provinces.
Whether this has to do with cultural practices or poor reporting or
low urbanization or because of low in-migration is difficult to tell.
That low-prevalence must remain so since these poor, populous states
have appalling health infrastructure unlike the peninsular states with
high HIV/AIDS prevalence rates.
What about vaccines? Presently, a number of vaccines developed by
various companies like AlphaVax, Chiron, Aventis Pasteur,
GlaxoSmithKline, Merck, Therion, VaxGen and Wyeth are under different
stages of clinical trials. VaxGen's human clinical trials in Thailand
have just been announced to be a failure but hopes have not faded for
making a safe and efficacious vaccine available in the market by the
beginning or the middle of the next decade. Interestingly but not
surprisingly, many of the top researchers in the United States of
America are scientists of Indian or Chinese origin. David Ho, who
discovered drug "cocktail" therapy, is Taiwan-born, and Emory
University's Vaccine Research Centre, whose vaccine is under trial, is
headed by Hyderabad-born Rafi Ahmed. But neither India nor China can
afford to sit back waiting for such a vaccine even while they
participate in clinical trials themselves.
AIDS is no longer considered a health or a social or an economic
issue. It is now being reckoned as a "security" issue. The United
Nations security council and the UN general assembly have both debated
HIV/AIDS. The possibility of HIV/AIDS being used to check labour flows
into the West also cannot be ruled out. Both India and China face a
stupendous challenge. They can and must cooperate in mounting an
effective and credible response, learning from the success that one of
their close partner countries — Thailand — has had in this area. |