India: New World Bank Study Examines Funding Options For Treating HIV/AIDS

NEW DELHI, August 13, 2004—As the Government of India takes stock of its first four months of distributing free antiretroviral medications for HIV/AIDS, the World Bank has released a study of various public funding options for the months and years ahead, designed to help the government maximize the positive impact of the drugs on the growing epidemic.

The study, HIV/AIDS Treatment and Prevention in India: Costs and Consequences of Policy Options, focuses on ways the government can provide sustainable antiretroviral therapy (ART) to the greatest number of people while avoiding dangerous pitfalls such as the development of drug-resistant strains of HIV and a surge in risky behavior by people who mistakenly assume the drugs are a cure for HIV/AIDS.

“India must accept the challenge of treatment, take advantage of its national wealth of pharmaceutical and public health expertise and of the proffered assistance of international agencies,” wrote J.V.R. Prasada Rao, Secretary, Health, Ministry of Health and Family Welfare, India, in the foreword to the publication. “…using these resources, it must extend a therapeutic hand to its AIDS patients,” he said. However he advises against the improper use of the medications which could have negative effects.

According to the study, the country needs to collect better statistics on the current state of the epidemic to improve the accuracy of planning exercises, such as the public provision of ART. It also advises that improperly administered ART could have negative “spillover” effects such as resistance to drugs or lack of effectiveness due to failure to take the medication properly.

It suggests that efforts should be made to improve the quality of ART currently being provided by the private sector and to evaluate the costs and effects of alternative ART programs to identify which modes of treatment maximize patient adherence to a drug regimen in India.

The report stresses the importance of continuing to scale up measures to discourage high-risk behavior, such as sexual relations with multiple partners, failing to use condoms, and injecting drugs with shared needles, which in some other countries have been shown to increase once ART became available and fear about contracting HIV/AIDS subsided.

“If energy and resources for prevention start to decline, the results would be a reversal in progress made in fighting the epidemic in India,” said Peter Heywood, World Bank Lead Health Specialist and one of the main authors of the study.

“ART is a medical breakthrough, and it can improve quality of life for those infected, but it does not cure HIV/AIDS. In many cases drug resistance develops or the drugs fail because patients do not have proper medical supervision to stay with the regimen. HIV-positive people are also more likely to develop opportunistic infections which attack their weakened immune systems even if they are taking ART,” explained Heywood.

The Government of India had requested the study as it considered how to begin providing the medications as part of public health services. Consultations with others involved in fighting the HIV/AIDS epidemic have strengthened the study’s recommendations.

For more information on the World Bank's activities in India, please visit:

http://www.worldbank.org.in

To read the report, please visit: HIV/AIDS Treatment and Prevention in India: Costs and Consequences of Policy Options