Break in Article 377 logjam to give push to anti-AIDS drive

Are you concerned that against the backdrop of the global financial crisis and the shrinking flow of funds to developmental causes, the battle against HIV could fall off the map? What is the agenda of the international UNAIDS delegation arriving here next week?

Yes, we are worried. The major issue that Michel would discuss is sustaining and possibly raising the funding for AIDS. With the global economic crisis shrinking funds for the developmental agenda and many health and developmental issues competing for scarce resources, we are concerned that HIV shouldn?t become a victim. Also, the AIDS programme is very successful?it is clearly working here and the numbers are coming down, which in fact takes the donors? focus off the cause. This is because they are questioning that since the impact is evident, why should they continue the funding. However, the underlying structural risks and vulnerabilities haven?t changed in India. We ought to move on with the project with the same intensity. A lot of MSMs (men who have sex with men), sex workers and migrant labourers pose new complexities before us. We do not want AIDS to meet the same fate which malaria did. Michel is coming at a time when we are trying to maintain the momentum globally. With the financial crisis, there has been a flat line in funding, particularly if you see PEPFAR in the US, and the global fund is also having difficulties replenishing its resources. Michel will also discuss the positioning of HIV in the general health structure strengthening agenda, with respect to the National Rural Health Mission and the National Urban Health movement.

A report recently released in Copenhagen by UNAIDS talks about how criminalising homosexuality by law has had an adverse effect on HIV. A landmark Delhi High Court judgement early this year decriminalised homosexuality. How do you think the nature of challenges will change if the Supreme Court upholds the Delhi High Court judgement?

I think the Supreme Court is likely to go with the Delhi High Court order, a superb piece of jurisprudence. Actually, it should have been done many years ago. Few courageous people in Naco and the ministry of health have laid the ground for this. With the break in the logjam of Article 377, things will start rolling faster. Along with the right information, people need products, condoms and lubricants. Therefore, we are working with Naco and the Hindustan Latex Ltd to develop a single-use packet, where a couple of condoms will be marketed with a small tube of lubricant. We believe this product will be one of the most important interventions. One has not been able to come out with such a product because of the legal angle involved in the issue. With this product, we will reach out to groups who will use it. Apart from conventional groups, there are other communities: 350,000 male prisoners living in an all-male environment. They do indulge in sexual activities among themselves.

In the past, when it was illegal, one couldn?t do anything about it. Now we can open the policy environment and look ahead. There are a series of innovative interventions that can be tried and many top prison officials are ready to pilot these projects. Although it is very difficult to get decent figures, according to estimates about 5 to 15% of female sex workers also indulge in anal sex and this is the second target group. The third issue is sex education. As the youth becomes sexually active, they need access to right information and knowledge. We know that there are probably 2.3 million men who have sex with men. During their childhood they had no information and if at they had any, all they were told was how their inclination was deviant, perverse and illegal. They were pushed into unsafe sex because of the lack of information. Now the environment has changed.

According to some estimates, the rate of co-infection between HIV and Hepatitis C is very high but we do not seem to have any national surveillance and statistics for this. With Hepatitis C detection costs around $1200-$2100 and involves a treatment for six months?which costs around $4000-5000?what is the way out?

People think that there is a very high level of co-infection. There have been a few small-scale studies on them. But there are no national level statistics on Hepatitis B and Hepatitis C. This is a global issue and when I was in the World Health Organisation, we were stuck with this. The statistics in this area are poor. Firstly we need solid information on how big the problem is, on whether it exists in India and the extent of its spread. In most countries, a large proportion of the problem lies outside the HIV issues. And yes, the detection and the treatment are very expensive and this is the reason why the major focus should be on prevention.