AIDS in India: My Favorite Topic

September 22, 2006 at 9:15 pm (Michael's Posts)

The case of AIDS in India is one I have studied and worked on in Delhi and is one that I have a few insights on. The thing that needs to happen is to change the local attitudes towards AIDS. The attitude of the public health people who propagate the opinion that AIDS ought not to be treated (the opinion that Sarah Kimball was picking up on in her look at the situation) is firmly based in the deep fear of facing the underbelly of Indian society in the form of the most formidable infectious disease. Indians are very reluctant to admit that their society harbors such ills as prostitution and intravenous drug use and for a long time, there was a campaign of denial by public health officials stating that AIDS did not even exist in the country. With this kind of attitude, it is very difficult to envision any enthusiasm for a program that would work with such a stigmatized disease. Indeed, many Indian doctors refuse to even touch AIDS patients. The question that Sarah raised in her post today (HIV/AIDS: The Case Not To Treat) about resources possibly not being allocated to such a cause is based in an understanding of the situation as one of great resource scarcity. Which, in India’s public health world, is definitely the case. Truly, it is the case in most public healthcare situations. Public health appears to be a great exercise in resource triage.

But we must also critically examine the social attitudes that underpin the assessment of how many resources can be allocated to a certain cause. If one looks at the AIDS crisis in India (and it is a crisis) through the lens that it very well could reach extremely threatening proportions in the next decade (and may already have reached those proportions but it is hard to tell because of poor epidemiological coverage in the impoverished North), resources can be MADE available.

However, if the situation is assessed through the lens that AIDS ought not to exist in India at all and that if we simply hope hard enough, it will take care of itself, those resources inevitably look better somewhere else. This, unfortunately, is the prevalent attitude in many of the upper echelons of the Indian healthcare system and is definitely the one that prevails in hospital management. A brief story: I went to talk to an Indian hospital manager about their AIDS program and the conversation was quickly steered away by my host to a much more benign topic. I was informed on the way out that AIDS is not discussed. There was a quarantine program some time ago and there was something about individual doctors having differing policies, but that was all I was to know. From my reading, doctors often turn away AIDS patients or charge them exorbitant sums for taking up their stigmatized cases. In order for those cases to be addressed with the resources they deserve, the attitudes of Indian healthcare workers and policymakers must change.

My point in this post is that these public health resource-allocation situations are not simply a matter of resources but also attitudes. In the case of AIDS in India, it is my studied opinion that the attitudes must change before much action can be taken. Resources will not be allocated in the ratio that they are needed until this happens. The most important thing for AIDS in India now is the work of changing attitudes towards AIDS.


1 Comment

  1. NubNogmouctot said,

    This look interesting,so far.
    If there’s anyone else here, let me know.
    Oh, and yes I’m a real person LOL.


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