India should change health priorities to tackle HIV

India could have between 20 and 25 million people infected with HIV by 2010, the highest number for a single country. However this figure has been contested by the Indian health minister. China, Ethiopia, Nigeria, and Russia are the other countries set to experience the next wave of the HIV epidemic. According to a report from the US National Intelligence Council, it would be difficult for any of the five countries to limit the growing epidemic by 2010 without major shifts in priorities. In all five countries, it was reported that risky sexual practices are driving infection rates upward, health services are inadequate, and the cost of education and treatment would be overwhelming. The report has also cautioned that, as the costs of antiretroviral drugs drop in these countries, drug resistant strains of HIV may spread, because of the inconsistent use of antiretroviral therapies and the manufacture of unregulated, substandard drugs. The cost of drugs used against HIV has dropped in India from 8000 rupees a month to 1600 rupees a month. But it is unfortunate that the doctors depend a lot on information from pharmaceutical companies to write prescriptions of antiretroviral therapies. According to the Indian doctors, the projections for their country seem exaggerated but concede that greater access to anti-HIV drugs could lead to faulty prescription practices that might set the stage for the emergence of drug resistant HIV strains. No audits have been done of antiretroviral prescription practices in India. Most cases only come to light when patients change doctors. Patients who had been prescribed single drugs, or combinations of two antiretroviral drugs, whereas standard guidelines recommend the use of at least three drugs. Also there appears to be a haste in prescribing antiretrovirals without appropriate communication with patients about the need for lifelong treatment and risks. The Indian government's own estimates put the current number of people infected with HIV at four million, and the health ministry had earlier this year announced a plan to achieve zero level of transmission by 2007. Some doctors have described that goal as unrealistic and unachievable. Recently Microsoft chairman Bill Gates pledged a US$100 million grant to slow the spread of HIV in India. This will hopefully help to achieve the objective of reducing transmission of HIV/AIDS and contain the spread of the deadly virus.