The Great Indian AIDS Debate
There are many individuals and institutions engaged in different aspects of AIDS research and treatment in India. Not surprisingly, there is not always a meeting of minds. To get to the bottom of AIDS research in India and to learn how the region as a whole could benefit from the work done to date in India, Shanta Basnet Dixit interviewed some AIDS and STD specialists in Bombay and Delhi.
Dr. A.S. Paintal is the Director of the prestigious Indian Council for Medical Research (ICMR) in New Delhi, an apex body for medical and public health research in India. ICMR has pioneered procedures for screening and surveillance of high risk populations, and blood and blood products. However, ICMR has also been accused of coercively screening "captive populations" for the HIV virus and for not letting those screened know the results.
Dr. A. S. Paintal: I would have prevented the AIDS epidemic in India if they had let me stop foreigners entering this country in 1987. (12 of the 44 AIDS cases as of March 1990, and a higher proportion in 1987 were expatriates.)
Himal: What about the Indians that bring the virus from abroad?
Paintal: I would have tackled them in a second phase.
Himal: How can you go around alarming people by making unbelievable forecasts? You claim that by 1995 one third of all Bombay housewives will be infected by the HIV.
Paintal: Pardon me, the press misquoted me, I meant "one third of all pregnancies".
Himal: Even that, of course, you must be saying just for effect.
Paintal: You do not understand; there are 20 million people in the Bombay area and about 100,000 prostitutes, each having an average of 10 encounters daily, which gives a total of one million encounters every day. If 5 percent of all pregnancies are HIV positive now, don't you think by 1995 30 percent of the pregnancies will be HIV positive? I am not an alarmist. I am trying to save Bombay. The epidemic in Bombay will be worse than in New York, but I hope it does not get as bad as some of the African countries.
Dr. I.S. Gilade, treats sexually transmitted diseases (STD) and venereal diseases at J.J. Hospital in Bombay. He founded the Indian Health Organisation (IHO) in 1982, a non-profit organisation to work with groups that have been marginalised by society. A colourful character, Dr. Gilada is the most quoted among Indian doctors on AIDS. He goes to the red light districts, particularly Kamatipura, mike in hand, to educate prostitutes and their clients on the use of condoms for safe sex. Dr. Gilada is presently organizing a world congress on "HIV, The Future of an Epidemic", to be held in Bombay 7-9 December 1990.
Himal: Do you agree with Dr. Paintal's figures?
Gliada: The call to save Bombay is appropriate, but the situation is not that alarming. They have a habit of making issues out of nonissues in Delhi.
Himal: What has IHO done against the AIDS epidemic in Bombay?
Gilada: We were the first to start working on AIDS, especially in relation to prostitutes. IHO started work in 1987 when the government thought that AIDS was not a problem.
Himal: What is the seropositivity rate among prostitutes in Bombay?
Gilada: 30 to 40 per cent are HIV positive. 80 per cent of the prostitutes have at least one STD and 50 per cent have at least two.
Himal: How many clients does an average prostitute see?
Gilada: The average four years ago was five clients per day, now it has dropped to three per day.
Dr. J.K. Manlar is a specialist in Skin and Venereal Diseases, Grant Medical College, Bombay. He also operates the Municipal STD Clinic, the largest of its kind in Bombay, that has existed since the 1940s in Bellasis Road adjacent to the red-light district of Falkland Road.
Himal: Where should health workers from India and Nepal go to study AIDS?
Manler: Our situation is similar to that in Africa, so we should learn from Africa. I do not understand why our government is sending people to Australia for training. The spectrum of diseases in Africa is closer to what is found in India.
Himal: Do you agree with the figure of Dr. Gilada and others who say that 30 to 40 percent of the prostitutes are HIV positive in Bombay?
Manlar: Those figures are obviously blown up. I have kept my own records and which show that less than 50 per cent of prostitutes have one STD, and less than 30 percent have two. HIV positivity rates are much lower — among the visitors to J.D. Hospital, Zion Hospital and Municipal STD clinic it is less than 10 percent.
Himal: You have kept AIDS patients in the general ward of your hospital, and you do not seem to mind close contact.
Manlar: There is nothing wrong with that. After all, AIDS is just another STD and I am not at risk if I treat my patients as any others.
Himal: Does your staff have special training to handle AIDS?
Manlar: No. Any hospital that maintains, proper sanitary conditions should be able to take care of AIDS patients. All doctors are expected to appreciate that one does not Just get AIDS.
Himal: But your programme will backfire if there is even one case of HIV positivity among your hospital staff. (There has been one job related seroconversion in a young Bombay doctor)
Manlar: It is not necessary to have a separate AIDS ward or to make a big deal of it. You keep your American ideas to yourself, we cannot deal with AIDS from an ivory tower. Ninety-six per cent of Bombay doctors don't want to deal with HIV. I think their licenses should be cancelled.
Mahendra Trivedi who runs the Ayurvedic clinic at Falkland Road and caters primarily to Nepali prostitutes, is unhappy with whoever comes to work in his turf.
Trivedi: Gilada, Vinod Gupta (Founder of Savdhan, see box on page 29) and Geeta Bhave (Head of AIDS surveillance center at KEM Hospital, Bombay) are all opportunists. By working on the prostitute, they gain 95 percent of the time and the prostitutes only 5 percent of the time. I introduced each one of them into the red-light district. Gilada operates on the 10 percent work and 90 percent publicity principle. What is the use of going from kothi to kothi distributing condoms? These people know they can get all the contraceptives they want from us. There are 32 brothels that voluntarily use condoms.