Government says 50% lesser people with HIV- who will benefit from
this shift?
The launch of the final dip - is this the final blow
on commitment?. [Part 1]
NACP3, the programme whose document hundreds of us
worked very hard to contribute to, was finally launched. So were the
new HIV estimates
for the country, at close to 50% less than before. Everyone except
those who will eventually take the plan to the last mile to people's
backyards were present on the occasion. And agreed in quiet
compliance. Not even the usual token representation from positive
people's networks in decent numbers was seen, civil society
representation of any significance was entirely missing . This was
certainly not by design, I'm sure but an oversight that no one will
apologise for.
The key messages were:
1) The HIV case load for India is 60% less than
estimated before.
2) 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 6 states.
3) These lower estimates do not signify a sharp decline in 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)
4) Even though 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% cut in estimates.
Everything, it is said, will go on as earlier planned, 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 outdone 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'. "HIV epidemic
is on
the wane" Was this message intended by the govt and the UN agencies?
This can result in a reversal to the results gained so far and
therefore disastrous to the rights of those vulnerable and affected,
especially women.
As Pallav Bagla has said in his 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, never has. But bad data can make the life of
ordinary people full of painful suffering as decisions in the name
of `public health' that disregard individual human rights, in some
cases, 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.
Now the most important part - that of the impact or fall out of such
an announcement at this point in time. The `message' that the new
numbers has sent out into the public domain needs to be monitored
closely. In many quarters the message 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 wheel backwards and can be potentially dangerous.
As of today, the numbers and the explanations behind them seem
totally unconvincing. And to all the marginalised, disadvantaged
people and others vulnerable to HIV, the people with the virus, the
women widowed, the orphans and the lay and committed HIV worker, the
numbers hold the threat of a death nell in the furture - of cutting
back investments, commitments, political will - in keeping PLHIV
alive and the vulnerable, especially women, free from HIV.
The government says that everything else will remain the - same
thrust, same funding, same inclusion, same interventions, same
commitment, same high prevalence states - but the only thing changed
is that now we are told there are 50% lesser people affected - only
2.5 million!
But despite whatever NACO might say, with a previous admission of
0.9% prevalence it took more than 10 years to get political and
social will to have a slight semblance of a rights based, equality
response to HIV control 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 % of national adult HIV
prevalence (and only 2.5 million people affected) 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 govt sustain this level of involvement or funding, social or
political will, in the future, with an open admission of apparently
lower numbers?
If the AIDS programme can work on predictions - allow me make a
prediction on behalf of civil society - what will suffer first is
treatment of the affected - then the rights of positive people and
those poor and affected by HIV, then their meaningful involvement,
then women and children, and finally the same high risk groups who
will be more stigmatised.
AIDS workers have always said numbers should not be the mainstay of
responding to HIV - but vulnerability should be. But the public did
not buy this.
The new numbers also hold the potential threat of increasing a new
wave of stigma among the general population who are already
saying `what we always 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&AIDS
- in
order to push voluntary testing, prevention and early treatment. Now
the tables are turned.
This is grossly compounded by the other fact that the govt has openly
said it shall put maximum resources on prevention with high risk
groups mainly. When the social will and understanding gets warped,
money is less. What happens to that young, teen girl - just married
-
in a township whose got 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 nutrition and treatment -
lifelong? Has the health care system, including primary health care
clinics or local governance systems been geared up to deal with
exclusion of burden of equality based, rights based HIV response?
What happens to migrants who are affected? There are endless
questions.
Who is going to benefit from this shift?
Ramesh Venkataraman
Asia HIV and AIDS coordinator
ActionAid International
e-mail: Ramesh.Venkataraman@actionaid.org