[NEW DELHI] The Indian government started this week to supply free antiretroviral drugs to 100,000 HIV-positive patients in six high-prevalence states.
Many have welcomed the move, which was announced last year on the eve of World AIDS Day, for seeking to provide AIDS drugs to those who urgently need but cannot afford them.
But some experts fear that the country's weak public health system is ill-equipped to handle the programme, and that the initiative may backfire as a result.
The Affordable Medicines and Treatment Campaign (AMTC) – a national initiative of Mumbai-based lawyers, nongovernmental organisations and people living with HIV/AIDS, which campaigns for free antiretroviral drugs – has applauded the programme for shifting the emphasis from prevention-focused strategies to those that combine prevention and treatment.
In particular, the AMTC says that programme will help reduce the stigma and fear that surround HIV by portraying it as a treatable condition.
But both the organisation and some public health experts are concerned that patients may develop drug resistance if antiretroviral provision is scaled up too hastily without ensuring a continuous supply of the medicines, and the comprehensive management of HIV-positive patients.
"If false expectations are raised, or if the possible side effects, duration of treatment, need for monitoring, and so on are not properly communicated, the programme may falter in no time," warns Ritu Priya, associate professor at the Centre of Social Medicine and Community Health at the Jawaharlal Nehru University in Delhi.
Patients may develop drug resistance, or show cross-reaction with anti-tuberculosis drugs, she warns. And other important parts of supporting HIV-positive people – such as treating opportunistic infections, and providing adequate nutrition and psychosocial assistance – could be sidelined.
According to a representative from the Delhi Network of Positive People (DNP), past experience of government programmes suggests that schemes on paper rarely translate into practical reality. In the past, for example, patients have not been warned about the side effects of the drugs, or about the need to take them throughout their life, he says.
Consistency of funding and drug supply is also uncertain, and the government has not given details of how it proposes to increase its voluntary testing facilities to help give more people access to the drugs.
In the first phase of the programme, antiretroviral drugs will be given to HIV-positive mothers who have participated in the national prevention of parent-to-child transmission programme (PPTCT); HIV-positive children; and people with AIDS who seek treatment in government hospitals. Costing an estimated US$100 million a year, the programme will initially cover 15 centres in six states where HIV prevalence exceeds 1 per cent of women attending antenatal clinics.
The second phase of the programme will include antiretroviral provision at all government hospitals with medical colleges, and the third phase will include all district hospitals in these states.
Another concern expressed by the AMTC regards the restrictions on those eligible for free drugs under the programme. "A miniscule [proportion] of women living with HIV/AIDS have access to the PPTCT programme," the organisation points out, adding that in rural pockets with high prevalence of infection, most women give birth at home.
The much-touted programme began on a low key, and networks of HIV-positive people have complained they are still unaware where they can access the free antiretroviral drugs.
According to the National AIDS Control Organisation, the programme will lead to a 100-fold rise in public sector provision of antiretroviral drugs, and a 50-fold increase in the number of people having access to such drugs in government hospitals. More than 4.5 million people in India are now thought to be HIV-positive.