Battling the pandemic

THE FIRST-EVER meeting of the United Nations that was devoted to discussing a public health issue has concluded with the adoption of a Declaration of Commitment on HIV/AIDS. The targets laid down in the declaration are not binding on the members of the U.N. and the intolerant were successful in spending valuable time in making the delegates argue about whether or not the statement should refer to prostitutes and homosexuals. Still, the meet was important in that it concentrated the world's attention on HIV/AIDS. The foundation has now been hopefully laid for a world- wide and co-operative battle against this pandemic.

In the declaration, countries have agreed on 2005 as the target year to reduce the prevalence of HIV among young adults in the most affected countries by 25 per cent and to do so by 2010 in all countries. By 2005 countries will also develop comprehensive programmes to take care of HIV/AIDS patients with a variety of measures, including the provision of inexpensive anti-retroviral drugs - the medicines that enable the HIV-infected to lead fairly normal lives. The larger emphasis in the charter is on prevention as against care, although the weeks preceding the meeting saw much attention focussed world-wide on the cost of highly active anti-retroviral therapy (HAART). Yet, prevention and care need to go together. As Brazil has demonstrated with its highly successful HIV/AIDS programme even a relatively poor country can adopt a twin-approach to control the spread of infections and provide care to the infected. The Brazilian programme has also shown that a commitment can overcome even powerful obstacles. It could not have been a coincidence that the U.S. chose the week of the U.N. meeting to announce that it was dropping its WTO complaint against a Brazilian law that could be used to lower the prices of patented medicines. While the U.N. conference was not expected to see decisions on funding the global fight against AIDS, it was not surprising that there was a great deal of dissatisfaction with the current level of pledges (one million dollars) compared to the target of $7-10 billion that the U.N. Secretary-General, Mr. Kofi Annan, had suggested in April. A group of scientists, including representatives from the coordinating body, UNAIDS, recently estimated that a universal global prevention and care programme would cost $9.2 billion annually. This is likely an over-estimate. But as that study made clear even this is not an outlandish amount for the global community because it will mean only a 10 per cent increment to current annual levels of overseas development assistance by the advanced countries.

There is a view that too much attention is being paid to AIDS even as other diseases and poverty issues in the developing countries are being ignored. What makes HIV/AIDS special at this point of time is the virulence with which this irreversible and incurable infection is now spreading in Africa and will soon in Asia as well, in the process threatening to decimate an entire generation of young adults. A special situation therefore does deserve special attention, although it does not mean that either issues of poverty or diseases like malaria, tuberculosis or diabetes can be ignored. The Indian approach to the U.N. meeting was, sadly, only mainly one of how to obtain a part of the resources in the global fund. Although India is home to the world's second largest HIV population, there is no urgency either at the governmental or social level on prevention and care. Indian drug firms have developed the capability of producing HAART drugs at the lowest prices in the world. The tragedy is that there is not a single public health programme in the country, either at the Centre or in the States, that provides these medicines even for control of mother-to-child transmission of the virus. On prevention, vast sums of money are being spent, but there is little that the National AIDS Control Organisation can show other than questionable statistics that point to the virus spreading more slowly.

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