E-DRUG: India launched free ARV program
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[we hear a lot about ART in Africa, and cheap ARVs from Indian
manufacturers. But what is happening in India itself for its millions of
HIV+ people? Here an insight into the issue. Copied as fair use. WB]
With AIDS spreading relentlessly, India launches free drug program
7 clinics open, but supplies of antiviral drugs are woefully inadequate
Sabin Russell, Chronicle Medical Writer
Friday, April 2, 2004
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New Delhi -- Down a dark corridor on the ground floor of this city's
Lok Nyak public hospital, Room 32 beckons with a glow of bright lights,
fresh paint and the promise of free antiviral drugs for a handful of
India's poorest AIDS patients.
Here and at six similar sites in this nation of 1 billion citizens, the
Indian government Thursday took its first, tentative steps toward
distributing AIDS drugs to 100,000 people.
At the new Lok Nyak AIDS clinic, there are enough drugs for only 200
patients, and doctors launched the program today with medicines for
only six. Made of combinations of generic copies of the costly
antiviral drugs that prolong the lives of AIDS patients in the United
States, the medication will cost the Indian government about $1 a day
for each recipient.
Bharat Vhushank, an emaciated 45-year-old photographer who is
struggling with both heroin addiction and AIDS, was among the fortunate
six . "It is a good feeling,'' he said, of the moment when he first
swallowed the pills that may save his life.
During the past six months, Vhushank has battled pneumocystis
pneumonia, oral yeast infections, bouts of fever and the loss of nearly
40 pounds from his already painfully thin frame.
It is the same list of opportunistic infections and maladies that have
killed more than 20 million people with AIDS around the globe in the
past two decades. The AIDS-related afflictions once were commonplace in
San Francisco's gay community, and killed nearly 18,000, before
combination drugs dramatically slowed the pace of dying.
Coincidentally, South Africa also launched its own free drug program
Thursday. With more people infected with HIV than any other country,
South Africa promises to have the world's largest program. Both India
and South Africa are part of a global effort to achieve the World
Health Organization's "3-by-5" goal -- treating 3 million AIDS patients
in the developing world by 2005.
In ceremonies marking the launch of India's free AIDS drug program,
hospital and state government officials called it a day of hope, but
they were also candid about their fears.
"An unmitigated disaster is looming on the horizon,'' said S.P.
Agarwal, the chief health official for the small northern Indian state
of Delhi, home to 14 million, including about 1.5 million in the
nation's capital.
Less than 1 percent of India's vast population is infected with HIV,
the virus that causes AIDS. But with 1 billion people in the country,
it's still 4. 6 million individuals. Already, India is second only to
South Africa among the list of nations with the most HIV infections.
Many experts believe that the official estimates are off by half and
that there are already 10 million HIV infections in India. Left
unchecked, it is widely predicted that India could have as many as 25
million cases of HIV by 2010, just six years from now.
Within India, the epidemic is concentrated in pockets, where infection
rates are rising ominously. Close to 80 percent of India's infections
are believed to be transmitted heterosexually. It is a formula
suggesting the start of a generalized epidemic in the world's second
most populous nation.
Delhi itself is not considered among India's six "high prevalence"
states, all of which are to the south. But it is the only state in
northern India participating in the start of the national AIDS
treatment program, and that has officials there worried.
There are an estimated 29,000 HIV infections in Delhi and 862 cases of
advanced AIDS. With medicines this year for a mere 200, health
officials worry that, as word spreads about the free drug program,
struggling Lok Nayak hospital will become a magnet for AIDS patients
throughout northern India.
"People from neighboring states will be flocking to us, and that will
be a problem,'' warned Arun Baroka, project director for the Delhi
State AIDS Control Society, which handles the federal money and runs
the local program.
During the first phase of the Indian government program, the drugs will
be distributed with priority first to mothers who are HIV positive and
who participated in a program that gave a short course of drugs to them
during childbirth. Although the program can cut in half the number of
infants who contract HIV from their mothers, without lifelong
treatment, those mothers will eventually die of AIDS.
The second priority will be to give the drugs to HIV-positive children
who are below the age of 15, and the third priority will go to what the
government calls "full-blown AIDS cases,'' like those of Bharat
Vhushan.
Initially, many of those who get the free treatment may be among the
estimated 15,000 Indians who currently get antiviral drugs through
private charities. At the Lok Nyak clinic, Raijni, a nervous 32-year-
old widow whose husband died of AIDS, was one of the first six patients
to enroll in the program. She has been taking drugs for a year, funded
by a private group. "The medicine worked,'' she said. Now, she has the
prospect of keeping her health without depending on the private donor.
Sabin Russell is traveling in India on a grant from the Kaiser Family
Foundation. E-mail him at srussell@sfchronicle.com.
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