PHA-Exchange> World Bank Report Examines India's Approach to tackling AIDS

[claudio at hcmc.netnam.vn]

http://bmj.bmjjournals.com/cgi/content/full/329/7464/476-e
 
BMJ  2004;329:476 (28 August), doi:10.1136/bmj.329.7464.476-e 

World Bank report examines India's approach to tackling AIDS
New Delhi Sanjay Kumar 

Only 2% (12 000) of the estimated 555 000 AIDS patients in India are getting 
antiretroviral treatment, says a new report by the World Bank. 
Moreover, the report says, more than half of the patients receiving 
antiretrovirals are not adhering to the regimen by the end of first year, 
mainly because of the high cost of the drugs and tests. Most of the treatment 
is in "unstructured" form—in other words, it is not conforming to the 
treatment guidelines issued by the World Health Organization. 
In the absence of strict adherence to a three drug regimen, most people 
develop drug resistant strains of HIV, which can spread. In Mumbai, 18% of 
individuals infected with HIV had resistance to at least one antiretroviral 
drug. As the percentage of people with resistant strains grows, inexpensive 
generic antiretroviral drugs currently available will cease to be effective, 
the report warns. 
Referring to the government’s estimate that 3.8 million Indians were HIV 
positive in 2002, compared with the current UNAIDS figure of 5.1 million, the 
report says that 30 of the 36 variables used in estimating HIV numbers are 
untested assumptions. Tinkering with a few of these would push the prevalence 
estimate to 4.8 or even 6.5 million people, it says. 
The study examines three policy options for providing antiretroviral drugs. 
The first is a minimalist approach in which the government strengthens private 
sector delivery of unstructured treatment and pays for physician training and 
laboratory tests while the patients pay for their own drugs. This would entail 
an expenditure of $100 (£55; €81) per patient each year. 
The second option is an intermediate policy of providing treatment to mothers 
who have AIDS and to their spouses. The third option is a policy of providing 
subsidised structured treatment to the poorest 40% of all AIDS patients. 
The expenditure on both these options would be nearly $500 a patient each year 
for drugs and clinic visits and an additional $100 a patient each year for 
laboratory tests. The total annual expenditure on providing treatment to 
mothers and spouses would cost $60m while providing treatment to the poorest 
40% would cost the government $774m annually. 
The current central health budget, however, is only $300m a year. 
The World Bank’s calculations have come under scathing criticism from health 
activists. "Why should there be just these three options at such inflated 
costs?" asks Dr Amit Sengupta, co-convenor of the People’s Health Movement-
India. 
"Drug prices, including antiretrovirals, are still very high in India because 
there is no transparent system in place for centralised bulk procurement of 
drugs in the public sector," said Dr Sengupta, adding: "There is great 
resistance to it [such procurement] as ad hoc drug procurement is a major way 
of making money by corrupt bureaucrats and politicians." 
The full report, HIV/AIDS Treatment and Prevention in India: Modeling the Cost 
and Consequences, is available at www.worldbank.org/in 
  







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