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