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Monday, December 01, 2003

AIDS and India

There is a nice Amy Waldman story in today's NYT on India's plans to provide free AIDS therapy. As she notes:

By April of 2004, the government hopes to begin providing free antiretroviral therapy to all H.I.V.-positive new parents, all children under 15, and eventually, to all patients with full-blown AIDS in the six states with the highest rates of H.I.V./AIDS. The decision amounts to a significant policy shift for India, which has not previously tried to offer antiretroviral treatment on any significant scale, though it does provide drugs to try to prevent AIDS transmission from mothers to babies in childbirth.

But several obstacles must be overcome by spring. The government must still reach a final agreement with the country's pharmaceutical companies, who manufacture generic versions of antiretroviral medications, to reduce their prices, as these companies recently agreed to do in Africa and the Caribbean. The government has yet to identify "budgetary support," the money to pay for drugs for as many as 100,000 people, the number it estimates would be served in the first year. It also will have to recalibrate its weak public health system to provide for far broader testing, and train doctors and nurses to monitor the dosage and effects of antiretroviral therapy.

India is estimated to have at least 4.6 million people with H.I.V. — the second highest number in the world, after South Africa. More than 600,000 new cases occurred in 2002.

Doctors in India prescribe antiretroviral therapy, but at $1 a day, it costs too much for most people. India's per capita income is less than $500 a year.

People often underestimate the danger that AIDS poses to India. An article in last Dec's Foreign Affairs magazine (now unfortunately unavailable online) made a very pursuasive argument of how AIDS is not just a humanitarian tragedy, it has the potential to spread into a pandemic and destroy the economic potential of three pivotal countries, India, China and Russia.

I had written a little bit earlier about the problems that India faces in fighting AIDS. I am very glad that we are finally responding to the crisis; though from what I read between the lines, we seem to be indulging in a bout of pennywise, poundfoolishness:

For two weeks, the companies and government have been in what one participant called "back-breaking" negotiations over those issues. Ms. Swaraj has made clear that she would like the companies to provide lower prices in India than those agreed to with the Clinton Foundation. "That's only natural because these are companies based in India," she said. Industry representatives say the government needs to understand the business imperatives of companies that have become Indian success stories and wealth creators. The Clinton Foundation agreement, they say, has left them a small margin of profit that will allow their businesses to keep growing and appease shareholders. To go any lower, they say, will require concessions from the government, like exemptions on sales and excise taxes.

Ms. Swaraj announced at a news conference Sunday — the day before elections in four important states — that an agreement with the companies had been reached, but privately industry and government officials said negotiations were continuing.

In an entirely different context, in my home state of West Bengal, the state government is indulging in similar shortsightedness and a deal to offer computer literacy to school children is now in danger of falling through ...

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