Petition aims to maintain cheap drugs

writing

(This article appeared on Nature’s news site on January 15, 2007.)

Court case in India threatens to derail generic medicines.

Free for all? Patent laws can make or break generic drug production.

The international humanitarian group Doctors Without Borders (Médecins Sans Frontières, or MSF) is ramping up their fight against the Swiss drug giant Novartis, urging the company to drop a lawsuit that could make it much more difficult for Indian companies to produce cheap, generic drugs.

With the case expected to come up for hearing on 29 January, MSF is pumping up efforts to collect signatures on a petition against the suit. Already they have tens of thousands of names, but are aiming to get many more. A win for the pharmaceutical company, they say, would deprive the world’s poorest people of affordable medicines.

Indian companies are known for making low-cost copies of expensive medicines, particularly AIDS drugs. More than half of the antiretroviral drugs used in developing countries, and about 80% of those provided by MSF, are made by Indian companies. “India is the pharmacy for the developing world,” says Ellen ‘t Hoen, director of policy advocacy for MSF’s Campaign for Access to Essential Medicines. “We largely depend on India.”

Continue reading →

Finally: hints of HIV turnaround in South Africa

writing

(This Opinion column ran on Nature’s news site on November 3, 2006. You can see the original post here.)

It’s about time that this country hard-hit by AIDS promised help for the afflicted, says Apoorva Mandavilli.

HIV causes AIDS. That’s not news to you or me, but shockingly it has taken years for the government in South Africa — where about 1,000 people die of AIDS every day — to acknowledge that fact and pledge to provide medicines.

In the past few weeks, the country’s deputy president Phumzile Mlambo-Ngcuka has publicly promised to expand access to AIDS tests, antiretroviral drugs and prevention programmes to those who most need them.

That sounds sensible — if a rather obvious thing for a politician to say — but it’s a far cry from what South Africans had heard until recently.

Health minister Manto Tshabalala-Msimang has extolled the virtues of beetroot, lemon juice and garlic in fighting AIDS. At the international AIDS conference in Toronto this August, her booth prominently featured those items. Six years earlier, at the same conference in Durban, President Thabo Mbeki said he didn’t know anyone with AIDS and questioned its link to HIV.

It’s about time the government changed its tune. As the richest country in Africa, South Africa is in a much better position to combat AIDS than its poorer neighbours. But thanks to the government’s appalling neglect, it hasn’t seen any decline in the rate of new infections.

Continue reading →

Heroin boom fuels AIDS epidemic

Uncategorized

(I wrote this article for Nature from the XVI International AIDS Conference in Toronto. It appeared on Nature’s site on August 15, 2006.)

Sharing of needles accounts for a large amount of HIV transmission outside of Africa.

The flourishing drug trade in Afghanistan is fuelling the AIDS epidemic in that country and its neighbours in Asia, warns a World Bank report released at the International AIDS Conference in Toronto, Canada, this week.

More than 7.4 million people in South and Southeast Asia are infected with HIV, but the epidemic is vastly variable across the region. In many parts of India — which, with 5.7 million cases has more people living with HIV than any other country in the world — infections are driven by commercial sex work.

But in the predominantly Muslim countries of Afghanistan, Pakistan and Bangladesh, limited data suggest that HIV is primarily a problem among injecting drug users. More widely, drug users sharing infected needles is now thought to be responsible for nearly one in three new cases outside Africa.

Drug-injecting commercial sex workers could spread the epidemic into  the general population, warns Julian Schweitzer, director for human  development in the World Bank’s South Asia regional team. “This should be a cause of great concern for all the countries in that region,” he says.

Heroin capital

Afghanistan had negligible rates of HIV/AIDS until 2000. But since then, prolonged war and civil unrest have boosted drug use, says David Wilson, co-author of the report. The country has reclaimed its historical role as the world’s largest producer and exporter of heroin.

Afghanistan is estimated to have more than 900,000 illicit drug users, including 120,000 women and 60,000 children. Afghanis have traditionally smoked opium, but refugees living in Pakistan and Iran began injecting heroin. Of some 50,000 heroin users in Afghanistan, a negligible number of women but about 15% of male users are thought to inject the drug.

As a result, the prevalence of HIV/AIDS among injecting drug users in Afghanistan is now 4%.

The increased drug traffic from Afghanistan is likely to have an impact on nearby countries already struggling with HIV. In Pakistan, about 25% of injecting drug users are thought to be infected.

The Afghan government is negotiating with the World Bank to fund programmes for injecting drug users, to help people come off the drug or to use clean needles. The World Bank is also conducting a larger surveillance study, results of which are expected in 6 months.

References:

World Bank report- AIDS in South Asia: understanding and responding. (2006).

The coming epidemic

writing

(Reporting on this article was one of the most emotional experiences of my career. I met many, many sex workers, drug addicts, activists, truck drivers and housewives who had never heard the word AIDS before they were told they were dying from it. As someone born and raised in India, I found the many individual stories heartbreaking, and the denial of the officials deeply sad and scary. This article appeared in Nature in July 2005 as part of a special package on Indian science called Nature Outlook: India. A couple of years after the article appeared, the Indian government revised its numbers drastically downward. I’m deeply skeptical of its estimates, but haven’t yet been able to dig into the truth. You can download a pdf of this article.)

A staggering 5.1 million people are estimated to be HIV positive in India. Apoorva Mandavilli finds a country on the brink of a crisis.

Our son was born in June 1998. He was healthy but after eight months, he had diarrhoea and fever all the time. He was in the hospital many times. The sixth time, they diagnosed him with AIDS. That was when we found out that my wife and I have HIV. Our son died 12 July 2002. I also started to get sick. I didn’t take my medicines regularly; they didn’t tell me not to do that. Now my health has become worse. I haven’t worked in six months.We’ll be paupers. I don’t know what we’re going to do.

— Suresh, air-conditioning technician

Suresh is sitting in a small, dark room at an AIDS clinic in the southern Indian city of Chennai. This city is where the first cases of HIV in India were discovered in 1986 after a police sweep of sex workers. Nearly 20 years later, there are an estimated 5.1 million cases in India, a number second only to that in South Africa. The difference is that in India the epidemic has not yet peaked. According to the CIA, the number of cases in India could top 20 million by 2010.

Continue reading →

Seeking care

writing

(This is a sidebar to The coming epidemic, an article about the AIDS epidemic in India, and part of a special package on Indian science called Nature Outlook: India.)

When you’re trying to manage an AIDS epidemic and you have limited resources, preventing infection is the logical priority. But where does that leave those who are already infected?

Treating people with AIDS is not easy. At the very least, it requires trained medical staff and the resources to make sure patients take the drugs on time. Nobody knows that better than the doctors at Tambaram Hospital.

Built in 1928 as a sanatorium for patients with tuberculosis, the government centre is 45 km outside Chennai and has more AIDS patients than any other Indian hospital. There are often more than 900 inpatients for its 776 beds, so some have to sleep on the floor. Every hallway is flooded with patients who look skeletal, with shrunken limbs and sallow skin. Outside the wards, hairy black pigs roam beneath drying laundry, accompanied by the rancid smell of sewage.

The hospital was one of eight government centres that together were meant to roll out antiretroviral drugs (ARVs) to 100,000 people over five years. In the first year, which began April 2004, it treated fewer than 1,000.

“From the outside, you may think it is a low number, but for people working here, there are a lot of problems,” says S. Rajasekar, the hospital’s deputy superintendent. Despite repeated requests, he says, the centre has the same resources it did in 1993, when it had just two HIV-positive patients. In 2004, it saw 14,991 new patients and had 140,000 hospital visits from HIV-positive patients. “With just 25 doctors,” says Rajasekar. “Amazing, right?”

By June 2005, government centres, including Tambaram Hospital, had doled out ARVs to 8,000 people. In the same time, since April 2004, small private and non-profit clinics reached an estimated 30,000 sufferers. But these clinics are in a constant struggle for survival.

One such centre is the Naz Foundation’s orphanage in New Delhi. Of the 24 children there — ranging in age from 19 months to 17 years — 10 are on ARVs. Despite one child dying two years ago, only the oldest one knows that she is HIV positive. To spare the children from stigma, their status has also been kept secret from their teachers and neighbours.

One child’s monthly supply of ARVs can cost about Rs900 (US$20). The home was funded by the Gere Foundation until March 2005, but since then money has come almost entirely from small, private donations. “Care is something no traditional donor wants to fund,” says the centre’s director, Anjali Gopalan. “They see it as a black hole, as one donor told me. There’s no return on the dollar.”

Scrambling to treat their patients, doctors at some clinics use medicines that are past their expiry date; others bring free drugs they are given in the United States or elsewhere. Staff at the YRG Care Clinic in Chennai last year began asking people to donate just $10 each. “It’s always beg, borrow, steal, donations, fundraise. That’s how we get funds for care,” says Suniti Solomon, who runs the YRG. “We cannot save the millions out there. The government has to do that.”

The epicentre

Uncategorized

(This is a sidebar to The coming epidemic, an article about the AIDS epidemic in India, and part of a special package on Indian science called Nature Outlook: India.)

In Bangalore, the bustling capital of the southern state of Karnataka, people drive shiny new cars, work in gleaming new buildings and carry mobile phones. Just a few hundred kilometres north, the residents are poorer than many in sub-Saharan Africa. In Bangalore, dubbed India’s Silicon Valley, the land is green, but here it is brown and dry. This is the home of one of India’s two AIDS hotspots.

“Someone’s got to wake up to the fact that there are two Karnatakas,” says Ashok Alexander, director of Avahan, the Bill & Melinda Gates Foundation’s AIDS programme in India.

Driven by poverty and unemployment, women from northern towns such as Bijapur and Belgaum travel across the border to work as prostitutes in the richer cities in the adjoining Maharashtra state. When they return home, they bring the money they’ve earned — and HIV. On a map (right), the districts along this ‘AIDS corridor’ are immediately visible. “This is the epicentre of the whole Indian AIDS epidemic,” Alexander says.

He has discussed his theory with several people in the government. “We entirely agree with him because those pockets are surely high-prevalence,” says S. Y. Quraishi, director-general of the National AIDS Control Organization.

Yet until Avahan — meaning ‘call to action’ in Sanskrit — was launched in April 2003, Karnataka was largely ignored by AIDS groups. Most donor agencies ‘adopted’ other high-prevalence states: the US Agency for International Development earmarks its money for Tamil Nadu and Maharashtra, for instance, and Britain’s Department for International Development champions states such as Andhra Pradesh.

Avahan has already spent more than US$17 million working with sex workers, truck drivers and drug users. It is also backing research on migration patterns in the corridor, large-scale surveys to measure behavioural changes and mathematical models that chart the epidemic’s course. “We’re going to be here as long as it takes to make an impact,” says Alexander.

AIDS care ignores children

writing

(This article was published on Nature’s news site on 13 July, 2004. I reported this from the XV International AIDS Conference in Bangkok.)

Companies fail to design drugs for kids.

Around 700,000 children were infected with HIV in
2003.

Bangkok – The global fight against AIDS is not addressing children, the very group that is hit hardest by the pandemic, says the medical charity Médecins Sans Frontières (MSF).

In recent years, there has been considerable progress in developing diagnostic tests and anti-AIDS drugs for adults. But doctors lack the simple tools needed to diagnose and treat children infected with the virus.

“Children are a discriminated minority, they are a marginalized community,” David Wilson, medical coordinator of MSF in Thailand told the XV International AIDS Conference in Bangkok.

In 2003, an estimated 700,000 children under the age of 15 were newly infected with HIV. Most of these live in sub-Saharan Africa.

Continue reading →

AIDS epidemic set to escalate in Asia

writing

(I reported this article for Nature from the XV International AIDS Conference in Bangkok. It appeared on Nature’s news site on July 12, 2004.)

Leaders urged to take immediate action.

Around 7.4 million people in Asia are already living with HIV.

Bangkok – A massive AIDS epidemic is spreading rapidly in Asia, and is sneaking below the radar of governments in the region, experts warned on 11 July.

Speaking at the XV International AIDS Conference in Bangkok, scientists urged Asian governments to scale up prevention and treatment efforts by providing sterile needles, condoms and antiretroviral drugs.

“This conference must be a wake-up call to Asian leaders,” says Peter Piot, executive director of the Joint United Nations Programme on HIV/AIDS. “They’re starting to respond, but sometimes too timidly.”

An estimated 7.4 million people in Asia are already living with HIV. Unlike in Africa, where the disease has spread into the general population, the Asian epidemic is driven largely by intravenous drug users, sex workers and men who have sex with men, according to a
new report released by the network known as Monitoring the AIDS Pandemic (MAP).

“That pattern has held in virtually every country in Asia,” says Tim Brown, an epidemiologist at the East-West Center research organization in Bangkok, and a member of the MAP network.

Continue reading →