December 01, 2006
India in Focus on World AIDS DayHealth and Medicine
THE VIRUS. The fever. The disease. The cocktail. The alphabet soup. The death. By any other red ribbon or name, today is December 1, World AIDS Day, and much of the day’s significant news on the topic comes, for better or worse, from India. (Photo: “An Indian sex worker wears AIDS symbols as she takes part in a rally in Siliguri,” AFP via Yahoo! News.)
For better, former US president Bill Clinton announced yesterday in Delhi a deal to dramatically reduce the price of effective treatment for children with HIV/AIDS. Among other things this is a fascinating example of a new approach to achieving health outcomes that combines public action with market tools. With funding from five countries, three European and two South American, the foundation has negotiated volume discounts on behalf of 40 destination countries. Thanks to the bulk purchase, the Indian generic manufacturers Cipla and Ranbaxy can sell single-pill tri-therapy drugs at 460 for a whole year’s supply. So the $35 million put up by France, Britain, Norway, Brazil and Chile ends up going a long, long way. $35 million! That’s NOTHING. Imagine if, say, the United States tossed in a little spare change from its daily Iraq expenditure. Grrrrr…..
Anyway, here’s a news story with details:
Only about 80,000 of the 660,000 children with AIDS who need treatment now get it, the United Nations AIDS agency estimates, and half the children who do not get the drugs die by the time they turn 2 years old. The United Nations Children’s Fund, or Unicef, has described children as the invisible face of the AIDS pandemic because they are so much less likely than adults to get life-saving medicines. …
Cipla and Ranbaxy Laboratories, Indian generic drug manufacturers, will be providing pills that combine three antiretroviral drugs into a single tablet, a formulation that is easier to transport, store and use than multiple pills and syrups. The combination tablets also need no refrigeration, an important advantage in poor countries lacking electricity, and can be dissolved in water for babies and infants too young to swallow pills.
Sandeep Juneja, the H.I.V. project head for Ranbaxy, said in a telephone interview that the company was able to provide the lower prices because of the larger volume of sales and because the Clinton Foundation, buying on Unitaid’s behalf, would consolidate many small purchases. He explained that the market for pediatric AIDS drugs was relatively small, fragmented and spread thinly across many countries.
“It would be a nightmare handling those small orders,” he said.”Imagine 40 to 60 countries buying a few hundred bottles individually, with no way to predict how many bottles would be needed.”
The new prices for 19 pediatric AIDS drugs are on average 45 percent less than the lowest rates offered to poor countries in Doctors Without Borders’ listing of AIDS drug prices, and were more than 60 percent lower than the prices the World Health Organization reported were actually paid by developing countries, the foundation said.
On the other hand — and here’s the “for worse” part — even the most abundant supply of inexpensive drugs can’t overcome poor distribution networks and, even worse, bonehead ignorance, especially when it comes from the people in charge of administering AIDS programs. Here’s a horror story this week from rural Gujarat:
Eighteen impoverished Indians with AIDS died in one district in western India in the last two months because the nearest state supply of free drugs is hundreds of kilometers away, an HIV advocacy group said on Tuesday.
“The absence of a regular supply of anti-retroviral (ARV) drugs has claimed 18 lives in the past 60 days,” said Umashanker Pandey of the Kutch Network of Positive People in Gujarat state.
Pandey told Reuters the deaths highlighted the failure of India to reach much of its HIV-infected population, the majority of whom live in rural and small-town India.
The 18 patients had been either too poor or too sick to make the journey every month on an overnight train to Ahmedabad, the state’s main city, to receive treatment and pick up their government-supplied drugs, he said.
D. M. Saxena, the head of the State AIDS Control Society, confirmed that 18 people with AIDS had recently died in and around the large town of Bhuj, and said he was looking into the matter.
But Sujatha Rao, head of India’s National AIDS Control Organization, said she had seen no evidence that the deaths were caused by AIDS.
“I can’t understand why an overnight train journey would deter them,” she said. …
NACO considers Gujarat to be a “moderate prevalence” state. It estimates there are 102,684 people with the virus, but only 7,599 cases have ever been reported in the state as of October this year.
The Gujarat Network of Positive People says a true estimate is closer to 200,000 infected people.
Meanwhile, a study of 252 Indian truckers finds that over 40 percent have passed an STD to their wives, and that many believe that AIDS is a white man’s disease from which they are racially immune. Only 11 percent use condoms.
The struggle continues.
siddhartha on December 1, 2006 09:37 AM in Economics, Health and Medicine, News · T·r·a·c·k·b·a·c·k address · Direct link · Email post
This just illustrates that combating ignorance is the far more difficult part of the struggle, as opposed to securing treatment.
Out of curiosity, does this pill have to be taken on a strict schedule like most ARVs? How are folks going to ensure compliance?
Also, how do you encourage people to get tested? When so many people believe the urban myths about HIV transmission, it is hard to get people to identify the behavior or to change it. In some developing countries, high prevalence rates show that testing does nothing to change people's behavior. So then what do you do?
Increasing prevalence rates also usually reflect better survival rates, though.
I mean, you may have meant that prevalence rates are higher even accounting for that, but I wanted to point that out just in case.
I cringe when I think of those innocent women infected by their trucker husbands, it would really stink if they eventually are ostracized by their villages and condemned. I agree with Sriram, education would prove to me more effective, however I would add in some bitch slapping cos I can imagine the holier than thou Indian trucker male taking so easily to wearing a glove.
A couple of years back we had a rumor in SA that if you slept with an Indian girl you will be cured of aids. Laughable, but there was an increase in brown violence. On another note, I bow my head in shame:
http://news.bbc.co.uk/2/hi/africa/5319680.stm
If you die, there are fewer seropositive individuals in the population. If you survive longer, it increases the prevalance rate since the ratio of HIV+/gen_pop increases.
Prevalence is just a measure of how many cases there are in a specific place. So the more people who are alive with a disease, the higher the prevalence.
Incidence is usually a better indication of activity for epidemic infectious diseases since it measures the number of new cases. But HIV/AIDS is complicated because it takes longer to go from infection to morbidity and mortality, and even after it converts to AIDS, you can manage and live with it for years before succumbing (as long as you get care). So prevalence is an important number to look at, but it's hard to draw conclusions from that number alone.
Some stats from India's National AIDS Organisation (NACO) on free drug distribution:
Troubling discourse continues in the conservative regions of the country:
http://in.today.reuters.com/news/NewsArticle.aspx?type=topNews&storyID=2006-12-01T195745Z_01_NOOTR_RTRJONC_0_India-278587-2.xmlExactly. It's a similar situation to the fact that US soldier deaths in Iraq are relatively low, but casualties are high. Because a wounded casualty is one who would have died were it not for the field hospitals and medevacs and the like. That's why the rate of amputees and other disabled folks is going to be rising in the US population in coming years, not that anyone is ready for that.
Also, increased testing will almost ALWAYS show increased incidence and prevalence, since the whole point of doing the testing is to find more cases.
The question is how well those cases are being treated (or at LEAST isolated) if they're being treated. If you find out someone has AIDS but you have no ARV drugs or condoms on hand, you're not helping him or her that much.
Thanks Ennis and Neal. Given the long disease trajectory of HIV/AIDS, though, do you think that's [survival] is a useful interpretation of the prevalence rate? Particularly given declining life expectancies? (which, I know, are confounded by a number of factors)
Shireen, is there any evidence/following on take-up? I'm really curious about this, because if folks don't comply you have the dual problem of having "wasted" a bunch of money, but also in fostering multi-resistant strains if individuals are not strict with their compliance.A very, very, very dangerous secret, which the Indian Govt. is trying to keep under wraps.
A friend of mine (Major D), left the Indian army last year, following six years of active duty in Kargil and Poonch (both across the border from Pakistan).
He revealed - "anywhere between five and ten percent of Army personell (mostly Jawans/Privates) are HIV positive.
These (most in their early twenties) guys are away from their families/wives for years, leading extremely high pressure lives.
On home visits, just like the truck drivers,they carry the HIV contracted from prostitutes and pass it to their unlucky spouse.
Given the Indo-Pak relations, you can all surmise, the very nasty situation this could lead to..
Siddartha..very timely post.
A Billion++ people,increasing liberal lifestyle, 'spare money' for entertainment of all sorts(thanks to economic growth),growing mobility of people within the country,failing or already delapidated public health services and finally, no information/mis-information/little-information : make it a daunting task to successfully tackle the curse of AIDS in India.
But all is not lost. Gossiping..the age old 'mode of communication' has come in handy in rural places. Dad who worked (now retired & volunteers) in Publich Health Services, is amazed at how illiterate women in these rural areas grasp the seriousness of this illness, its mode of transmission and how to prevent or reduce the probability of getting it. All accomplised through good old 'gossiping'. Its helps the volunteering public health officials, as these women have often pointed, specific and action oriented questions. Obviously, even if this is helping, its clearly not enough. Additionally, people use 'Street plays' ( Nandita Das does it as well), to educate the masses in villages on this deadly illness.
Much remains to be done.
The methods of the last decade from the usual suspects are not working - but let's do more of the same just to see what happens!
>>United Nations AIDS agency estimates
>>the nearest state supply of free drugs is hundreds of kilometers away
>>50,000 people in the country get free HIV drugs from the government
Because...
>>too many people are waiting to start initial treatment.
As anyone who has lived in India knows, if you put a board up that says "FREE ", there will be a long line for it within an hour. It does not matter if the in question is used shit-bucket.
Volume discounts are certainly a welcome step.
>>Tell people to keep away from adultery and immorality.
Why is this such a troubling discourse? Apart from those innocent folks who gets AIDS due to bad blood transfusion and HIV+ mothers, all cases have their roots in adultery. Truck drivers, army jawans, Rich yuppies all get it through adultery. So why mince words about calling a spade a spade?
Of course, the spouses of those adulterers are victims too, but with marriage comes shared responsibility for all good and bad things that happen to a couple. One cannot happily accept the husbands's stock market gains to be a result of mutual understanding in risk taking (and spend it on a necklace) but not take acceptance for the husband's philandering to a lack of mutual understanding. You take the good and the bad.
M. Nam
is that picture "allmixedup" :)
A couple of years back we had a rumor in SA that if you slept with an Indian girl you will be cured of aids.
In Botswana, it is the virgin (therefore, increase in rape cases), and getting pregnant.
And you thought I was bad...
This is what happens when no one wants to talk about sex but everyone wants to do it and people in India do it more often then other country on the planet. You cant kiss on TV, but feel free to bring 10 children into the world using 10 different positions from the Kama Sutra. That's right India, forget the poor in the country and just concentrate on those fancy call center's and lets see how far you go.
Once again, Siddarth (thanks, btw) draws our attention to one of the most important issue facing south asia and the globe.
And, once again, the apathy, evidenced by the number of comments, is sad.
Here I assumed that the lefties were more in tune with such things?
Sorry, I mean - SiddarthA
In case you havent seen the documentary.
Beauty and the Brothel: Prostitutes and AIDS in India
What about this? Does anyone ascribe significance to it?
Doesn't the volume of comments usually correlate more with disagreement?
I mean what can you really say about this article (unless you're on the front lines fighting the epidemic yourself). AIDS is bad. No shit. It is important, and I'm very glad it was posted, but there's not much one can really add to this.
Does anyone know the prevalence of AIDS transmission through rape? In war torn countries like Sudan, rape is a common effect of war and I'm wondering if the numbers for rape are higher in countries that are at war, particularly civil wars?
That article's reference to caste was ****ing annoying! From now on, everytime I have to address inequality anywhere, I'll say "Like the race system in America ...."
>>the apathy, evidenced by the number of comments, is sad
There is apathy because there's no incentive to solve the problem.
When it took ten years to get a telephone connection in the 80's, there was similiar apathy because there was no incentive for anyone to do anything about it. Only in the 90's when the government opened up the markets did the private players came in to solve the problem within five years. They made a nice profit, but nobody complained. Everyone is happy.
The only people who have an incentive to try and solve the AIDS problem are the Clintons and Gates of the world who are seeking the Nobel Prize or some other fancy recognition that cannot be bought with money. No medical company has incentive to solve this problem because making money off of AIDS drugs is a no-no.
Give the incentive, and watch what happens within a decade.
M. Nam
Correction RE: 25
I meant numbers for AIDS might be higher in countries that are at war.
M.Nam -
Unless you are you suggesting, we handover the AIDS awareness campaign to a for profit company, I don't know what else can be handled by the private sector?
Except drug research, ofcourse.
p.s. i am an ardent free marketeer.
Neal,
"Doesn't the volume of comments usually correlate more with disagreement?"
Not always.
Having spent part of my childhood in South Africa, AIDS was always talked about but that didn't seem to have stopped the explosion. I went back recently (3 years ago) after finishing school and did my rounds of Jo'burg, Cape Town and most of the Kwazulu Natal province. Jo'burg is suppposed to have 17% HIV positive among it's population. There I was at the bar, drinking my 6th Kilkenny's (does anyone know where to find a pint of Kilkenny's in NYC?) and looking at the no-prenup pretty ladies, and i thought, shiyit, better not mess around. With 1 in 5 positive, it's not worth the risk. Ofcurse, that 17% is heavily skewed toward the blacks, but you never know which white or desi chick had a little black fever.
There is a point to my flashback and that is I don't know how effective awareness alone is. As several have mentioned in comments, if you keep saying sex is bad, sex is taboo, but if you are going to do it, then use protection. That's mixed messages not very unlike what is happening here in the US between the conservatives and liberals. Indian society needs to be realistic. You ban child marriages, frown upon dating and mingling with the opposite sex, make professional success a pre-requisite for marriage which has pushed the average marrying age of men to 27 (in cities atleast).
From 13 to 28, there are a lot of people walking arround saving their sperms and eggs for that one person. Scary thought. Thank God for prostitutes. There are hormones raging out there people and while prostitutes themselves can be encouraged to use condoms, it's the pimps and brothel owners and bhais that have all the power. Educate them and better yet, legalize prostitution (gives them the incentive to keep their prostitutes in good shape and healthy, ROI and all) as many have suggested in the past but it seems to go against *indian culture*. Take a leaf out of Thailand's book, but don't follow it too closely. We don't want India becoming a sexual tourist destination.
MoorNam,
Adultery and immorality according to whom? What you perceive as an immoral, adulterous liason could be an experience that sustains someone else's mind, body and soul. But if you're comfortable casting the first stone, that's your prerogative.
Your exclusion clause leaves out women forced into prostitution.....
Poverty and gender inequality are powerful catalysts in the spread of AIDS. Recognizing this and empowering those affected seems to be a better form of advocacy than religious/moral edicts that alienate.
And tackling gender discrimination and poverty does not rule out the need for personal responsibility.
Camille,
Sorry I don't have additional information on the situation in India. MSF's data from South Africa, their longest running program, shows that 17.4% of people who have been on treatment for five years have had to switch to second-line therapy.
kritic writes:
>.Unless you are you suggesting, we handover the AIDS awareness campaign to a for profit company, I don't know what else can be handled by the private sector
Awareness creation of AIDS has been going on very well by the private sector.
Paper media, from the New York Times to the small Tamil newpapers carry articles about AIDS periodically. They sell their papers for a profit, and hence they make sure they include useful information for their paying customers.
TV media, from the NBC/HBO to Bengali channels have included AIDS themed serials and other programmes for the benefit of their paying customers. Even Saas Bahu serials have started incorporating this.
There have been a few AIDS themed movies as well as movies with stray (not straying!) character here and there who is HIV+.
So private sector is playing a very important role in AIDS awareness, because it makes fiscal sense to do so. The activists who attack pharmaceutical companies who try to profit from AIDS drugs remain mute when media profits from AIDS themed shows and movies. No wonder the incentive to find a cure is non-existent.
If the government takes the responsibility for creating AIDS awareness, fiscal ripoffs like this is what the taxpayer gets.
shireen:
>>adulterous liason could be an experience that sustains someone else's mind, body and soul.
Whatever. Just don't ask the taxpayer to pay for your drugs.
>>Your exclusion clause leaves out women forced into prostitution.....
Those pimps must be tried for murder.
M. Nam
It's one thing to deny to yourself that you have HIV after a positive test (and thus refuse treatment,) but what about the families of infected men who don't receive treatment based on this shameless ignorance? I think it's wonderful that Clinton has secured lower priced drugs to treat children, but how are they to be treated if their own father refuses to admit to his own disease, and therefore will not provide medications for his family?
Previous posts have led to few comments as well. I think it's less about apathy and more about the presumed inaccessibility of the topic. Everybody has an opinion on fashion, but people feel ill-informed or like they have little to say about AIDS.
BTW - I'm not at all convinced that our readership leans left. I think the comments do, but the commentors are just a small fraction of the people who read the blog daily.
" Everybody has an opinion on fashion, but people feel ill-informed or like they have little to say about AIDS."
Lack of knowledge about a topic has not prevented people, including myself, from commenting in many previous instances.
"I'm not at all convinced that our readership leans left. I think the comments do, but the commentors are just a small fraction of the people who read the blog daily."
Unless you personally know all or most of the people who read this blog, I fail to see how you can make that determination.
One of my old bosses' wife is head of the neuro department at Walter Reed, an Army hospital in DC. She actually had to take time off because there were so many patients coming in from Iraq with major head trauma that she was getting burned out. To add to the story, my cousin lives across the street from a Walter Reed housing center that was built in VERY short order because it's going to be housing assisted living patients who were Iraq veterans. So sad.
Apologies that my comment had nothing to do with World AIDS DAY.
Excellent and timely post, Siddhartha.
The issue of who bears the burden for HIV/AIDS is a troubling one, and as far as I think, entirely irrelevant to this discourse. Similarly, looking for immediate incentives for treatment, care and even prevention is exceedingly myopic.
Moornam, if you think that the state and the taxpayers do not have an incentive in curing and stopping the spread of HIV, and in treating AIDS, you are sorely mistaken. PC Chidambaram, the Indian finance minister recently outlined HIV/AIDS as a major risk factor that could impede India's GDP growth in the coming years. A quick look at the HR crisis in Central Africa is enough to warrant such fears. The reason the taxpayer needs to defray some of these expenses is because, for the most part, markets are often short-sighted to deal with large pandemics. It is the same reason taxpayer money should be spent to forecast tsunamis.
Secondly, let us not read too much into the motivations of other people who give to non-profits/charity lest our skepticism in these matters only reveal our selfishness and lack of empathy.
Thirdly, adultery is a personal problem and one that cannot be addressed along the lines of easy "you should have known better" commentary. Many of the jawans and the truck drivers that you cite lead extremely difficult and stressful lives away from their homes. Moreover, your lack of empathy for the women...
...who contract HIV due to their partners philandering is astounding. One of the biggest problems HIV/AIDS NGOs have in India, is that conversations about sex are still very much a taboo subject. Many of the women in this case prefer not to talk to their partners about the risks of extra-marital sex, even if they might have some inkling of it. Add that to the patriarchal nature of Indian families, and you have a perfect ticking time-bomb.
ahhhhhhh--- need to take a deep breath.
i work for naz foundation (india) trust -- we tackle issues of hiv/aids in delhi (and do trainings and awareness across india) we care for 30 hiv-positive children who have lost their parents to the infection. we do whatever in gods name we can to try and prevent the infection and care for those already infected. www.nazindia.org
moornam -- who are you and where are you coming from? awareness is being done well in the private sector? are you joking? please read today's hindustan times, we have made over a dozen phone calls today, and recieved FAR more than that to correct the errors perpetuated by the media, and the vernacular makes far more mistakes. amd i love your characterization of innocent people getting aids from blood transfusions and their mothers -- because those who get it from sex are not innocent? they didn't try to express their sexuality and were limited by personal freedom and information. give me an f'ing break. i invite you to come to my office for just one week and see if you walk out with the same narrow minded ideas.
i respect sujatha rao (head of NACO) and belive that she is on the right track. she heads the national organization, she can't fix everything, but she can bring awarness where it is necessary. yes, treatment systems must improve for rural populations, but let's please look at the metros and breathe a sigh of relief that we are able to provide such a high level of care among ALL who are infected with HIV and living healthy lives with it. we are improving rural systems day by day, truly, and mother-to-child transmission is rapidly decreasing. we are leaps and bounds ahead of where we thought we would be -- we are still in a bloody mess but, on this of all days, let's look to the positive.
i know that i personally enjoyed my world aids day. i spent the day with our care home kids, we talked about world aids day, its importance, and a great many people in delhi chose to spend the day with our children to show that stigma is lifting... and these children benefit from the advances, not only in treatment and care, but in people's attitudes. world aids day felt like a triumph in my world, and clinton's announcement about pediatric medicine only made it better :)
"Thirdly, adultery is a personal problem and one that cannot be addressed along the lines of easy "you should have known better" commentary. Many of the jawans and the truck drivers that you cite lead extremely difficult and stressful lives away from their homes."
that may be, but there is no excuse for knowingly passing it on to your wife or blithely assuming you didn't contract it during your extra liaisons and then sleeping with your wife/girlfriend/partner or passing it on indirectly to your unborn children. especially when you are aware of the unfortunate and severe social stigma connected with the disease. i do understand that many people are just ignorant of the facts of HIV and how it is transmitted, which makes education all the more important. i'm not sure, but don't some countries have laws that make such behaviour akin to attempted manslaughter or murder? there was a case of someone stabbing people with an HIV-tainted syringe. i lived in a small country that, for a time, had a very high AIDS rate per capita primarily because of irresponsible and cavalier sexual behavior, in spite of the fact that there was a widespread HIV/AIDS awareness campaign. while we shouldn't cast aspersions or judge people's morality, there does need to be some sort of balance. my parents saw young girls, boys, men and women whose lives were ruined by their irresponsible partners or who had ruined other people's lives. the look on one young man's face when he found out he was positive broke my mother's heart. there needs to be a balance of practical education, material (healthcare) and emotional resources, empathy and, it may sound old-fashioned, some sermonizing, especially to younger people.
Agreed completely, WGiiA. Which is why you notice my insistence that we talk more about sex within the household. Ignoring it, and ducking our heads into the sand will not make it go away.
DDiA, agree wholeheartedly. sorry, i didn't mean to come across as an argument against anything you said.
And with respect to your comment on sex workers, it's not just pimps who should be prosecuted. Many women are trafficked (transnationally) into the sex industry against their will, but there are also many women who are relegated to the sex industry by poverty or through other means. Unless you address root issues of poverty and gender, you won't even begin to make a dent in the health practices of sex workers.
For the person who commented on the military having a high HIV/AIDS incidence, this is pretty common everywhere. Generally the three groups of men known to be "common carriers" are truckers, the military, and men who commute to work between the city and more rural areas.
Please refer to Kremer and Glennerster's book, Strong Medicine. This is the underlying text that spun off the idea of creating a global fund for HIV, Tuberculosis and Malaria. Basically it would award a "prize" that would cover R&D and some element of lost profits for drug companies in exchange for an AIDS, malaria, and TB vaccine. There's been a lot of talk about creating a fund, especially with respect to Gates and Clinton, for these illnesses, but not a lot of talk around how to incentive this given that the U.S. pharmaceutical industry is not going to suddenly grow charitable and start investing in "the greatest good" versus "the greatest profit"Is that the only way to make that judgment? I really hope you don't work in internet marketing.
Furthermore, look at what I said: "I'm not at all convinced that our readership leans left". Why do I need to talk to everybody who reads the blog to be skeptical of the idea that they all lean left? That's a very odd conjecture.
It's amazing how you jump to conclusions based on what I write. It's really quite impressive.
Oh, I also wanted to pull out the heartless economist in myself for a moment and also mention that high HIV/AIDS rates are potentially disastrous for developing economies. Not only do they (potentially) decrease GDP, they also take people out of the economy during their most productive years. Also, shortened time horizons (i.e. a shorter life span) also lead to changes in behavior that can include a lack of investment/savings and poor long-term decision-making. The most vocal opponent of these theories behind HIV/AIDS incidence and the macroeconomy is a guy at UChicago I can't remember off the top of my head, but I'll follow up.
Theresa,
I have complimented your efforts in past too.
One question: Why don't you accept credit cards for donations @ Naz India. Give online button is not active. Is it due to red tapism in India? Or just web malfunction?
I think a lot more people will be willing donate online.
Kritic,
Think it does in this case. Talk for yourself, why speak for other people? I was watching this thread and made no comment as dint have anything to say till you happened to speak for me!
MoorNam,
Those who cant, question the incentive of others! despicable
Camille,
I'm sure you were literally referring to a guy and not a gal but there is a Becker Fellow at U of C, Emily Oster, who has written about HIV/AIDS from economics perspective. She gets pretty beat up in the comments section.
I actually wasn't referring to Emily Oster (I really was referring to a UChicago guy, I'll have to look through my old class notes to pull up his name), but I had heard a bit about this also :)
Theresa,
You guys need to fix a few web navigation at Naz India.
I did find the foreign donation links but some of the urls/ buttons are mucked up. It should be easy, it will help you guys in the long run.
Ennis,
"It's amazing how you jump to conclusions based on what I write. It's really quite impressive."
It is you who reacted (#35) to my comment (#19), which was not aimed at you or any other Sepia writers.
Anyhow, If you or anyone else deems my comment offensive or over the top, I apologise.
And No, I never worked in internet marketing.... Or any marketing, for that matter.
kush,
we are just now (this week itself!) having our website fixed/revamped. we had a generous donor give us a small amount of money to pay a web designer to come in and get the whole thing up and running in a MUCH more cohesive and understandeable format. you will be the first to know when that new site is unveiled :)
for all: the best way to donate to naz india is to go directly to giveworld.org and look for our name under the "health and sanitation" category they provide -- from there you can donate and we will know of your donation right away.
"Not only do they (potentially) decrease GDP, they also take people out of the economy during their most productive years. "
i know that this is a very fashionable topic, but they say this about TB and Malaria, and the combo of the three can put someone out of work for the rest of their working years. hence the global fund for "aids, TB and malaria" the three most devestating infections.
Camille:
A friend of mine works for a Candian NGO that helps raise AIDS awareness in Punjab.
She has some horror stories to relate about the deep state of denial in that place.
She mainly blames it on the "macho punjabi culture".
Punabis Sikhs make up large numbers of Truck drivers and Army Jawans, who stay away from home for long periods of time. Upon their return, some of them infect their wives.
Most times these HIV infected women are shunned by their relatives and villagers. Forcing them to fend for themselves, alone, and evetually die a painful and solitary death.
Do you have any idea/thoughts on how this issue breaks down state to state or culture to culture in India?
Punabis Sikhs make up large numbers of Truck drivers and Army Jawans, who stay away from home for long periods of time. Upon their return, some of them infect their wives.
I think it would be interesting to know what percent of HIV infections can be blamed on this. Lets not forget that these truck drivers are getting the disease from someone. We need to address this with the highest risk populations("sex workers") who happen to be the vector. Any program that does not include them will fail.
We need to address this with the highest risk populations("sex workers") who happen to be the vector. Any program that does not include them will fail.
That is an equally tragic angle. Often, 14-15 year old "fairer skinned" girls from Nepal are kidnapped and made sex workers.
Also, Born into Brothels touched the whole thing very poignantly. BTW, Zara Briski has a new book coming out with special edition worth $ 1000.00, and another limited one $. 100.00. The book is going to be released in December.
The gay man's disease - *eyes water up*
legalizing and regulating prostitution is a must.. There is plenty of precedent in the se asian countries. prostitutes perform a valuable function in society.. make them legal.. insist that they use protection, have regular health checkups, in short, regulate the business. I find it hard to believe people dont know what AIDs is..They just assume that it wont happen to them, personally.. take bad bets.
i'm not so sure about legalizing prostitution. But if there is someway to regulate it without legalizing it would be good. By legalizing prostitution, you give it blessing. And i don't see what valuable function that prostitutes perform either(wrecking marriages?).
Sorry, this is a bit of a tangent, but it's disingenuous to say something like this because it comes down to a judgement on women in sex work. I wouldn't assign an inherent moral quality to it. Sex work goes wrong when people (usually women and children) are exploited and have no agency, not because sex work itself is a bad thing. As for wrecking marriages, sex workers don't wreck marriages; people who allow their marriages to be wrecked wreck their marriages (this is NOT an automatic blame on the woman in said marriages - usually turns out to be the man anyway).
AIDS, homewrecking... people always end up placing the burden of responsibility on women - women in sex work, at that, because they generally have the least amount of control over what's going on around them (which is not to say that they can't have agency and dignity in their profession, or that we should't recognize and respect those things whenever they are existent).
#60 - Your comments come from a well. Marriages don't get wrecked because of prostitutes (unless the married woman is the prostitute). I would go as far as to say that some have actually been saved because of them. Most young men in the cities atleast get their sex education and their first sexual encounter from prostitutes. You have peope walking 15-19 years without having sex before they get married...something's gotta give.
In Tamil Nadu, in the 70s or 80s, The then DMK govt. (Karunanidhi) wanted to legalize prostitution and they lost the elecetion. I remember the discussion in my household (i was too young to form an opinion) was about how K wanted to "nationalize women" and that was despicable. The next thing you know someone will enter the house and try and pay for sex with your wife. Utterly baseless argument and for a few years I parroted similar views because that's what I had heard my family say. Fortunately the teen years set, and I was compelled to challenege everyting my parfents ever said and think I was the better for it.
Think about it a little. Do you really find prostitutes that heinous, especially considering that most of them in India are forced into it or land in prostitution due to circumstances?
Before abrahamics, commies, lesbian-led sexual health NGOs in India, cockroach infested leftist blogs and Amitava Kumar started conspiring against assertive nation, before pseudosecular defeatist homosexual mentality took a grip on the saffron balls of Indian men, squeezing them till they reduced to size of peanuts, Vedic sperm could actually cure AIDS.
It is very noticeable that so called leftists on this site could not give many answers to this thread, proving they are actually the AIDS virus in human form, come to destroy immunity of assertive nations youth to Islamo-Abrahamic-Commie-Negro-Christo Fascisms influence and destroy our assertive confident testes by squeezing them subtly and seductively.
Thus our new slogan to awaken masses:
Sepia Mutiny: The AIDS of Hindu Nation!
LeftistCabal! Dont touch our balls!
Macho culture of Punjabi truck drivers can be handled easily it is also main culprit unlike remainder who are innocent.
Death to Faggots and HIV patients! Victory to Free Markets!
Hail Mogambo!
Sorry, this is a bit of a tangent, but it's disingenuous to say something like this because it comes down to a judgement on women in sex work.
yes, and the people who force them into it.
would go as far as to say that some have actually been saved because of them. Most young men in the cities atleast get their sex education and their first sexual encounter from prostitutes
Yes, their first sex education as well as their first STD's. The point is that you don't want to condone an atmosphere where females are looked at as sexual objects. The second you sell your body for money, your body becomes a commodity to be rented or bought.
Think about it a little. Do you really find prostitutes that heinous, especially considering that most of them in India are forced into it or land in prostitution due to circumstances?
I don't find prositutes heinous, but certainly the people who force them into it. Why legalize prostitution and let these guys profit more from it. I saw a documentary about girls from former soviet republic getting forced into it(kindo like the gals from nepal?). The girls work in the legalized Dutch world and earn nothing while the pimps are millionairs.
hey shruti: you seem to be the person to ask this question to. i've noticed the emergence of this term "sex worker," presumably b/c it is less offensive than "prostitute." where did this term start. it strikes me as more offensive than prostitute. no prostitute i know use the term ;-). seriously, i'm just curious, where did the term come from?
What about male prostitution?
What about male prostitution?
prostitution in all its forms is unjust. But i really don't think male prostitution is much of a factor. In the history of human kind females have been exploited a lot more in this way than the males.
This is going to be a long post. The inanity that pervades people's notions about AIDS/HIV deserves elaboration.
DDiA/Camille/theresa
>>HIV/AIDS as a major risk factor that could impede India's GDP growth in the coming years
This is a politician's soundbyte. He is telling you exactly what you want to hear. He knows that his target audience(of NGOs who survive on government's dole) will never stand up and ask: "Really? How can you objectively measure in Rupees and Paise the effect of X truck drivers, Y prostitutes and Z jawans having AIDS? Will you add up their salary and then divide by the net salary of everyone in India? Because that will come out to be such a ridiculously low figure that you will be ashamed that you brought it up. Or will you add up the purchasing power of...." But wait, the politician has left the stage.
>>It is the same reason taxpayer money should be spent to forecast tsunamis.
Tsunamis, earthquakes, volcanoes have warning systems, not a cure. Nobody is saying that the government should spend money to stop all earthquakes - just to forecast them. I have no problem if government money is spent on identifying high risk areas for AIDS: truckers, jawans, affairs etc. They have already done that. Newpapers, TV shows, movies are blaring loudly. Don't spend taxpayer money trying to find a cure or to prevent the disease. Have laws that regulate blood banks and implement them. Have stricter quality control standards for condoms. Mandate that hospitals use disposable needles that are actually disposed - not recycled. The government doesn't even do its job properly in these areas - and you want to give them more money for other things?
AIDS problem is more like dowry problem or caste problem or obesity problem. It is an individualist problem - a collectivist solution will not work for it, just as it has not worked for dowry or caste.
>.markets are often short-sighted to deal with large pandemics. global fund for HIV, Tuberculosis and Malaria
Tuberculosis and Malaria are highly contagious diseases. They are airborne and water borne. They can even be spread across different rooms with a common ventilation. They need to be tackled on a war footing because innocent people die every year from it - far far more than AIDS. That's where the money needs to be put in - not into a disease that's not contagious. You cannot get AIDS by talking to a coworker. You cannot get AIDS by shaking hands with a customer. You have to have an intimate relationship, or you have to get it through contaminated blood (even this is rare).
Prostitutes and STD's have been around since the begining of time.
Vatsayana has written about it in the Kamasutra. Indian society has always managed it very well. Ancient India was one of the few countries where prostitution was not considered immoral, but made into a caste/varna. The best singers and dancers belonged to this caste. Words like "exploited" and "prostitute" were not used in the same sentence. They were welcome in temples and social functions.
As to STD's, up to just fifity years ago, if you got an STD, you would most likely die. Only in the 1950's did medicine find a cure for it (and made a nice profit). Which is when the sexy sixties and swinging seventies took off with a bang. But Mother Nature was not sitting quietly. She had something much bigger planned starting in the eighties to put man in his place.
>>U.S. pharmaceutical industry is not going to suddenly grow charitable and start investing in "the greatest good" versus "the greatest profit"
I am not going to respond to socialist nonsense.
>>conversations about sex are still very much a taboo subject...talk about sex...
Again - how will this be implemented? How can you justify taxpayer money on something so vague and hazy? Who will implement this?
>>patriarchal nature of Indian families...are assuming that married women have a say ...impossible for a woman to deny sex to her spouse, demand condom use...lacks compassion and also common sense...this is NOT an automatic blame on the woman in said marriages - usually turns out to be the man anyway
I think I know why we talk past each other. You assume husband and wife to be individuals who have their own unique rights and responsibilities, and can go their own ways as and when they feel like it. I, on the other hand, consider them as a unit which has to make it or break it together.
>>moornam -- who are you and where are you coming from
It's not about me. I would love to talk about myself on some other thread!
You write:
>>we are able to provide such a high level of care among ALL who are infected with HIV and living healthy lives with ..we are leaps and bounds ahead of where we thought we would be
But the Naz website says.
>>Various estimates suggest that the number of positive children requiring care has increased tremendously.
Which of you is correct? Please make up your mind.
NAZ has existed since 1994. So have many other NGO's campagining against AIDS. But the problem has kept getting worse, year after year, in city after city and town after town.
What if I allege that you actually contribute to the problem? What if I allege that you have no intention of solving this problem, that you have no sympathy for these children, and that you are doing all of this because you want to keep getting money from taxpayers that can be siphoned off to make swanky websites that accept credit cards? What if I allege that one of the reasons you keep hammering against pharma companies is that if they suddenly come up with a cure with an AIDS pill that costs as much as Aspirin, you folks will actually have to find some other job to do? What if I allege that you have an interest in the explosion of this disease, because only then your contributions will increase. What if I allege that many of these NGO's are actually in the pay of foriegn interests who want to weaken India by diverting its health resources into AIDS rather than to Malaria, TB, Dengue fever, Elephentiasis, Cancer and a host of other diseases which are collectively at least fifty to hundred times more painful to India's GDP and productivity of its people? What if I allege at some of these NGO's had their funding from Pakistan ( this was found to be true - they have quietly shut down now)?
What if I allege that should you busybodies be gone from the scene, pharma will find a cure for it very soon. Sure, it will cost $200/- a pill in the begining, but over the years the prices will come down when the generics hit the market.
What if you are the problem - not the solution.
M. Nam
1) anyone consider mass circumcision as a possible solution?
2) economic development is the main way to fix this issue i think. western nations hit it more than african nations, but don't catch the bug as much. i suspect that westerners are more individualistic than africans, but that's just my hunch
Hmmm...if you're going to insist on calling a spade a spade, I'd like to point out that technically, adultery is sex outside the confines of marriage for someone who is married. Sex before marriage is fornication. So adultery per se is not necessarily to blame for AIDS.
In the larger scheme of things, this argument is reflective of the pea-brained policies of the Bush administration who advocate only supporting STD education programs that preach abstinence. While I'm not morally opposed to other people sleeping around, I agree that from a preventetive health perspective, monogamy makes sense. However, teaching abstinence to the exclusion of safe sex practices is just stupid, and as long as people blame "adultery" for AIDS, we'll continue with this counterproductive reasoning. Abstinence training, often taught in American schools, isn't enough.
I agree that people have jumped on the AIDS bandwagon while there continues to be no malaria bandwagon. However, I'm just glad that someone is paying attention to some disease that is a problem in the developing world. And if international attention to AIDS results in a stronger healthcare infrastructure in India, it will only help with tackling other public health issues.
#60
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i'm not so sure about legalizing prostitution. But if there is someway to regulate it without legalizing it would be good. By legalizing prostitution, you give it blessing. And i don't see what valuable function that prostitutes perform either(wrecking marriages?).
--
I am familiar with one country that has legalized prostitution and maintains very strict checks. In this place, all the pimps are regular businessmen (registered) and there is no place for criminals (unless the govt itself is considered such)and prostitutes are have relative degree of freedom. Basically their plan of action is to work for x number of years (x is in the single digits) and save for their future.. many of them are paid very well.. thats the reason why they consider this profession. The AIDs rate is almost zero in this country and most of it is drug/gay related... still there is the occasional hiv contracted abroad.. many young men in this country regularly visit prostitutes.. sex is simply a recreational activity.. there is no need to get uptight about it.
#72
Could you share the name of this country?
Netherlands
What percent of prostitutes in Neatherlands are from former Soviet Republic? Would be interested in knowing.
x number of years (x is in the single digits) and save for their future.. many of them are paid very well.. thats the reason why they consider this profession.
Whats your definition of paid very well? As in they are able to make enough money to live comfortably for the rest of their life? considering they only have x number of years to earn, a relatively good yearly income will just not do. For example, we all agree that Doctors are paid very well in U.S.A. But if they only had 9 years in the profession, most doctors will not have earned enough to sustain themselves. Ofcourse its all mute point, India is not Neatherland and will never be that open in our life time. But manditory sex education focusing on safe sex may be a good first step.
(apologies for the length!)
There is an excellent PBS Frontline series called The Age of AIDS. You can watch the entire program online. It discusses the scientific and political history of the spread of HIV in the western world, Africa and other developing nations. It is made from a primarily western perspective, but there is info on India found in the last chapter, part 2. Very well researched, very relevant and very informative. Please WATCH it! It is a great account of the government/community involvement and the practices/measures of different countries that have worked and are working, which can serve as good models where needed today. The bad models and mistakes... well, they are still happening, even in the western world... approaches and interventions that need to be changed are clearly highlighted. We need to pay attention to them and change!
As for the discussion on India specifically....
It has been well documented and is also mentioned in the PBS program (and in the latest AIDS epidemic update on Asia, pages 27-30), that key routes of HIV spread in the most affected states are via unprotected sex, via sex workers (moreover the sex worker to client to spouse transmission chain), via male homosexual transmission and via injection drug use. The same factors exist elsewhere but the social context of India is different.
I find that the lack of education about HIV/AIDS is critical in driving infection. There is evidence showing a reduction in HIV spread after education programs are implemented (study on a group of truck drivers funded by the Clinton Foundation). Education works, but in addition to awareness. Awareness alone, about what AIDS is and how it spreads, through commercials, films, billboards etc is not sufficient... people need knowledge to realize the reality of risk and how to protect themselves and their families this requires more specific and explicit dialogue that is difficult to have with the masses due to cultural barriers. It needs to be done in smaller centers and needs to reach men, women and teenagers as you can imagine this isnt going to be easy in India, for various reasons.
There is still great denial about the threat of HIV in India, and we are already passing the stage where the spread of infection needs to be nipped in the bud. Once it becomes a reality to the public, it will be too late . In 2003, projected numbers of HIV+ individuals in India by 2010 is 20 million without effective prevention strategies!!! As of the end of 2006, 5.5-6 million people are HIV+ in India (remember these are reported cases and does not account for unknown status).
There are some very good community based interventions in place by NGOs, especially those linked with and funded by NACO however, they are also restricted by various factors (lack of funding, lack of employees/volunteers, lack of tools). Other than social stigmatization and women inequality as social obstacles, I find that the problems India faces in efficiently and rapidly controlling the spread of HIV are rooted in lack of political leadership. The history of HIV shows clearly that the success of a country's ability to control the pandemic depends largely on how seriously and aggressively it promotes prevention and treatment programs, and most importantly how they implement and sustain them (watch PBS program for specifics). India is currently lacking in the implementation and has not really done much thinking about sustenance. There needs to be treatment, care and resources for those infected, but the bigger challenge for India is in controlling the rapid spread of the virus, to prevent the 20million projected mark.
Speaking of political leadership, the lack of education, knowledge and reality check also exists among the state MPs and cabinet ministers in India. At the international AIDS meeting this year, there was an evening session held about the HIV/AIDS situation in India. It was moderated by Sujatha Rao (NACO) and there were some known faces (like Sharmila Tagore representing UNICEF) and state MPs on the panel. I was present at the session and was very enthusiastic at the start, very positive about Indias efforts. After Sujata Rao's talk however, the MPs took stage and the session turned its focus from HIV to money and funding concerns. It was clear that the MPs did not know about HIV/AIDS in great detail and did not understand the urgent need for realistic strategies required in their respective states. The idea of government vs NGOs, neither trusting the other esp with regards to money, kept cropping up. To be fair there were only 4 MPs (Bihar, West Bengal, Assam and another one), but these states ARE affected by HIV (esp West Bengal) and the non-urgency of the government re AIDS is present. How are programs to be implemented by leaders that are uneducated about HIV themselves, and seem to care more about the money coming in than the issues? And anyone who has tried to get any official work done in India knows about the wasta and corruption issues. This isnt vocalized but it is a serious practical problem holding back progress.
If the politicans actually lead, oversee the development and implementation of prevention programs, change laws, improve infrastructure, the situation is bound to turn around. There was a request for NACO to arrange for a session with the state MPs this year to educate them about the AIDS situation nationally and state-wise, so that they know what to do with the funds allocated to HIV/AIDS. I havent heard about this happening so far but I really hope it does sometime.
Anyway, there was far more chaos at the meeting and I doubt people left with anything constructive. I thought I was in one of the notoriously roudy Lok Sabha meetings in India and left thinking how the f*ck is the country going to fix these problems in time?
The work being done by the NGO and community-based sectors keeps the hope going. I just hope that they can compensate for the lack of political leadership that is so obvious in some states.
Dear MoorNam, (comment #69)
I'm usually very dispassionate when I post here but, with due respect, some of your views seem pretty f@#ked-up. The 1st of your 2 most f@#ked-up* observations is:
The italicised comment may be socialistic, but (unlike certain types of knee-jerk socialistic rhetoric) it is hardly nonsensical. The instances where the for-profit pharma industry has been primarily responsible for the control and eradication of a pandemic comparable to HIV-AIDS, where said eradication came about through the following mechanism:
Step 1) The in-house development of one or a series of pathbreaking drugs driven solely by the profit motive, the profit stemming from a very high initial price pegged by its "rational market demand"; and
Step 2) The trickle down of the above fruits of profit-driven R&D once these products pass into the generic domain;
are almost unknown!! The containment, during the middle of the last century, of a number of tropical diseases of pandemic proportions came about not because profit-seeking pharma corporations, driven by the incentives of a vast potential market, came up with the therapies that worked the best. Rather, the therapies that worked the best were, with one or two exceptions, developed at state-funded laboratories and teaching hospitals by teams that were spurred by the sheer intellectual challenge. The reason that these therapies could be passed on to the target populations so speedily is because the relevant agencies didn't have to spend a decade negotiating with profit-driven drug companies on what a mutually acceptable sale-price would be. Until I see three or more reports of pharma corporations being chiefly responsible, via the above Step(1)-Step(2) mechanism, in mitigating large-scale human misery - where the said reports are not "studies" commissioned by the principals (!) - I shall be forced to assume that you are merely being ideological.
And, dude, ToomarNam, this is not just f@#ked-up, but waaay f@#cked-up*
It doesn't matter a iota what you "consider"; whether you consider a couple "a unit which has to..." etc., etc. What you want to do is spend time in villages and semi-urban areas in countries like India to see what the family dynamic is, as opposed to your idealised, prescriptive perception of it. I refer you to #44/Sentence:3 by Camille, to which you seem to have no response!
* Please don't assume that I'm calling you f@#ked-up. I usually give your comments more seriousness than many of your interlocuters do. It's some of your views that I'm calling f@#ked-up, in the hopes of shaking you up into introspecting more on the issues above.
BidiSmoker (#17)
I'm compelled to agree with you ;-)
Genius.
Pure genius.
Please, by all means, allege away. What if I ignore public health research and the experience of development practitioners in favor of my conspiracy theories? What if I brush away the comments of everyone on this thread who takes issue with my completely skewed, un-reality-based depiction of the HIV/AIDS epidemic in India by calling them names, devaluing their perspectives, and assuming they are generally ignorant? What if I blame them for being the cause of the problem? Then, why don't I accuse them of being heartless for not dedicating their lives to working on other acute/deadly diseases in the third world without any knowledge of their backgrounds, work experiences, or views? And finally, why don't I label their arguments "socialistic" and "nonsense" so that I can avoid having to engage intelligently with anything that challenges my narrow worldview and definition of how the world should work.
Grow up.
-----------------------------------------
Back on topic...
Regarding all the talk of regulating vs. legalizing vs. neither the sex industry, I honestly don't think that this will change, help, or be a realistic solution. I definitely felt different until I worked in an area with a burgeoning sex industry (on the border, frequented by truckers, in the "developing world"). I don't know how the Netherlands works it out, but my gut would say it's much better to help women own their own incomes, to work on campaigns towards bolstering attitudes towards women and women's legal protections, and to fund health education campaigns/programs/projects. I don't have any "proof" or whatnot to back that up, mostly because hardly anyone evaluates the efficacy of their development projects, but just destigmatizing HIV/AIDS alone could potentially make a huge difference.
chitowndesi
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Whats your definition of paid very well? As in they are able to make enough money to live comfortably for the rest of their life? considering they only have x number of years to earn, a relatively good yearly income will just not do.
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the country is singapore (and malaysia to some extent as well at least in the border towns like johor baru). most of the workers are from neighboring countries (malaysians etc.), have profession cards, have monthly checks etc. its not an aspect of singapore that is advertised (like the netherlands or thailand).. there is zero violence in this trade, condom use mandatory. without this legalizaton, the hetero hiv rates would go up tremendously as the men from singapore would go to other more "dangerous" countries in larger numbers. as for earnings.. 5000 USD per month is not exceptional and the high end would be more than twice or thrice that. But even assuming 2000 USD per month as the average, that is enough to have a substantial savings (for Malaysia). Its not that these workers are going to retire.. A common pattern is to use some of these savings to start another business that is legit in malaysia/thailand/etc.
obviously its unrealistic to enforce this on a country wide basis in India. Perhaps what might work is the equivalent of a special trade zone.. i.e where legitimate sex is traded and more importantly regulated very strictly, targetting the high risk groups.
GB:
Your statement...
>>The containment, during the middle of the last century, of a number of tropical diseases of pandemic proportions came about... developed at state-funded laboratories and teaching hospitals by teams
... has been sub-consciously responded to by Sumiti who writes:
>>If the politicans actually lead, oversee the development and implementation of prevention programs, change laws, improve infrastructure, the situation is bound to turn around.
Let me try once more...
The cure, prevention, vaccinations etc of the early/middle part of last century were tackled on a war footing by leaders of all advanced countries because of ... war!! The smallpox virus could be used as a biological weapon by the Nazis, so the British had to find a cure for it quickly to protect its country. The influence virus could be used by the Japanese so the Americans had to discover a cheap vaccine to protect its soldiers and civilians.
The politicians of India or the US (or anywhere else) have no incentive to find a cure for AIDS because it does not affect them. They call up their expensive doctor and tell him: "I'm sending my son/daughter over to you. Can you give a pep talk about the birds, bees and AIDS? Thanks. Yes - I'll see you at golf this weekend." It's the same case with rich and upper middle class everywhere. They don't care, and frankly, they shouldn't have to care. They make sure that their family is fine and well informed. End of story.
Because AIDS is neither airborne nor waterborne. Pakistan's agents cannot mix the AIDS virus in New Delhi's water supply to cause a genocide. If they could, the establishment will find a way to cure AIDS faster than you can find a parking spot on Black Friday. Bangladesh's agents cannot mix the AIDS virus into the air-d