August 2007 Edition
Ramesh Venkataraman
THE National Aids Control Programme -3 (NACP3) document which hundreds of us worked very hard to contribute to, was finally launched. So were the new HIV estimates for India which said numbers of those affected were less by 50 per cent. Everyone, except those who will eventually take the plan to the last mile, were present on the occasion. And they agreed in quiet compliance. There wasn’t even token representation from the positive people’s networks. Civil society representation of any significance was entirely missing. This was certainly not by design, I’m sure, but it is an oversight that no one will apologise for.
The key messages were from NACP3 were:
The HIV case load for India is 60 per cent less than estimated earlier.
- These numbers have emerged, the government said, from better methodology, namely a mix of sentinel surveillance data from the enormously expanded number of sites and the recently concluded household survey data of 100,000 people surveyed from six states.
- These lower estimates do not signify a sharp decline in the HIV epidemic; this is on the basis of ‘back calculation since 2002’. So it is clear that the ‘epidemic is not on the wane’ and it is not the result of equality based good programming at this point in all states. (Although it seemed that the minister was not averse to receiving kudos for ‘curbing’ the epidemic from the uninformed)
Eventhough the NACP3 budgets and planning was done on the basis of the earlier estimate of 5.2/5.7 million people, nothing changes in the plan, budget and strategy despite this 50 per cent cut in estimates. Everything, it is said, will go on as before, as if these new numbers were never arrived at nor announced. To many of us this sounds a bit incredulous. Take a look at the above messages again. I find something terribly amiss, something seriously contradictory, more being unsaid than said. Three additional documents that were handed out for public consumption are worth reading as a study in suboptimal communication regarding this important numbers issue: the Q&A on AIDS India, an appropriately slim fact sheet by UNAIDS, a press release by UNAIDS and NACO.Each document outdoes the other in displaying lesser transparency about the way the new numbers were reached. Now newspaper headlines have taken the obvious and easy message: ‘the HIV epidemic in India is not that bad after all’ or ‘HIV epidemics on the wane’. Was this the message intended by the government and UN agencies? This can result in a reversal of the gains made so far and therefore be disastrous to the rights of those vulnerable and affected, especially women. As Pallava Bagla said in an article in this forum: don’t be misled by numbers.“It may be premature to start celebrating that number of people infected.” HIV prevalence and incidence data has always been a source of lively and sometimes pointless debate. In HIV calculations, it is said, the best data can be suspect. But even the ‘best data’ by itself, does not make life better for ordinary people. It never has. But bad data can make thelife of ordinary people full of painful suffering. The worry is, for instance, that decisions in the name of ‘public health’ that disregard individual human rights may be taken – like mandatory testing.
Clearly there has been no public debate on the methodologies used before this announcement – and that is tantamount to holding back information of public interest. The most important part is of the impact or fall out of such an announcement at this point of time. The ‘message’ that the new numbers have sent out into the public domain needs to be monitored closely. In many quarters themessage is, ‘We always told you so, HIV is not as big a problem in India as you make it out to be’. That is turning the wheelbackwards and can be potentially dangerous. As of today, the numbers and the explanations behind them seem totallyunconvincing. And to all the marginalised, disadvantaged people and others vulnerable to HIV, the people with the virus, thewomen widowed, the orphans and the lay and committed HIV worker, the numbers hold the threat of a death knell in future– of cutting back investments, commitments, political will – in keeping people affected by HIV alive and the vulnerable, especially women,free from HIV. The government says everything will remain the same: the same thrust, same funding, same inclusion, sameinterventions, same commitment, same high prevalence states – but the only thing that has changed is that now there are 50 per cent lesser people affected – only 2.5 million! But despite whatever NACO might say, with a previous admission of 0.9 per cent prevalence, it took more than 10 years to get political and social will for a slight semblance of a rights based, equality response to HIVcontrol with just about adequate funding (even though many still feel AIDS is over funded). In a country beset with exclusion, poverty, inequality, crime - 0.36 per cent of national adult HIV prevalence is nothing serious to worry about for our planners!
Is this admission not going to hit the people who lead to stop and re think their seriousness? How will the government sustain thislevel of involvement or funding, social or political will in future with an open admission of apparently lower numbers? If the AIDSprogramme can work on predictions, allow me to make a prediction on behalf of civil society. What will suffer first is treatment ofthe affected, then the rights of positive people and those poor and affected by HIV, then their meaningful involvement, then womenand children, and finally the same high risk groups who will be more stigmatised. AIDS workers have always said vulnerabilityand not numbers should not be the mainstay of responding to HIV. But the public did not buy this. The new numbers alsohold the potential threat of increasing a new wave of stigma among the general population who are already saying ‘what wealways knew has now been proven right; HIV only happens to sex workers and truck drivers and the like; not to people like us’.Everyone has battled the ‘us and them’ situation – trying to convince the person on the street that he/she was vulnerable to HIV andAIDS – in order to push voluntary testing, prevention and early treatment. Now the tables are turned. This is grossly compoundedbythe fact that the government has openly said it will put maximum resources on prevention with high risk groups. When the social will and understanding gets warped, money is less.
What happens to that young, teenage girl, just married, in a town,who gets HIV from her husband and everyone now wants her stoned to death or thrown out?
What happens to the orphans,children and mothers who desperately need lifelong nutrition and treatment?
Has the health care system, including primaryhealth care clinics or local governance systems been geared to deal with exclusion?
What happens to migrants who are affected?
Who is going to benefit from these new figures?
Ramesh Venkataraman is Asia HIV and AIDS coordinator, ActionAid International
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