A Human Question: 15th International AIDS Conference in Bangkok
Director: T. Jayashree
Duration: 01:00:59; Aspect Ratio: 1.366:1; Hue: 9.244; Saturation: 0.115; Lightness: 0.293; Volume: 0.142; Cuts per Minute: 16.955; Words per Minute: 43.403
Summary: Tracing the story of the global struggle to make HIV/AIDS drugs more affordable and available, A Human Question raises key questions of whether private ownership of knowledge can be at the cost of human life?
Access to medicine.
Press Conference on the situation of HIV/Aids in India
Tamil Nadu. Dr. helen Gayle
YRG Care Home
(Shots of audience member who asked question)
Suniti : (talks briefly about YRG Care).. Regarding prevention, yes, primary prevention we started when I was still with the government. We tried to do some sexuality education and since I was a microbiologist, they said, no, no, your job is in the lab and not with the students, and that's when I took an early retirement, and we started the first sexuality education programme in India . We got the help of a girl from Australia for this, and today the UNICEF has taken over the model we had produced, translated into four Southern languages, and it is being used for sexuality education in every school in Tamil Nadu - both government and primary schools. So there is sexuality education going on, and I'm sure that it's being done in other parts of...though in the beginning there was lot of embarrassment in saying the word s-e-x. So they said family, health, or whatever. But today people are involved in sex education and sexuality education. Now secondary behavior studies - yes, we do a lot of counseling for people who are already infected, and I think that's one of the best ways. And to bring these people out. Because 90% of them don't know they're infected, is to give awareness. And when you give awareness and people perceive they are at risk, and then they come up for counseling and if you find them positive, many of them say, "look, I didn't know I was positive and I got married and I transmitted the virus". So we need definitely to give awareness for people to perceive they're at risk, and definitely we do that.
Discusses starting Sex Education in schools and the initial problems she faced.
first sexuality education program in india
secondary behaviour studies
Audience member : You said there are drugs, first line and second line. So would it mean that it's important to get access to a wide choice of branded and generic drugs? If that's the case, the existing Indian excise duties place the drugs unaffordable, and are the expected changes in the patent laws in the drug sector going to push prices to unaffordable limits?
branded and generic drugs
first line drugs
Ashok : I'm not an expert on this topic, but my understanding is that the drug companies have asked for a reduction in excise duties on imported materials or chemicals that are used in the manufacture of drugs, and that's not something the government has agreed to, yet. I suppose it would make a difference, yes, because excise is significant. And my understanding about the trade treaties is that, yes, the cost of the generics made in India will go up after a few years when the treaties sort of kick in.
cost of generics in india
Discusses drug companies and the patent amendment.
Helene : Just to balance that, we don't know what the difference in price will be as more people get on treatment and whether or not drugs will be able to be purchased for less price because the government will be buying and procuring more. So I think a lot of that is going to be a sliding scale and we're going to have to see what happens after 2006, and some of these trade agreements kick in, and what other resources are going to be available.
Asks about the uncertainty of the HIV infection rates in India.
Audience Member : The one thing that I'm most curious about India, actually, is the uncertainty about the numbers of people infected with HIV. UNAIDS gave an incredibly large ___ on how many people are infected - 2.2 million to 7.9 million. There's a study in Chennai, actually, by John Hopkins, which shows that 0.2% of the women were infected in poor neighbourhoods. I'm wondering if (1) the claims that are made that you're a tipping point may be exaggerated, and (2) if there is such uncertainty, how does that affect how you do your jobs and actually getting models ready?
hiv infection rates in india
Discusses the study done from the center with Hopkins.
Suniti : The study you're talking about was from our centre with Hopkins, and that was the C-Poll study, where we were looking for a community in which we can try this model called the community popular opinion leader study, which was Geoff Kelly's study among the gay population in US. So the first community...we went around looking at different, and then we chose the slums in Chennai, and we did a pre-base line on about 30 slums and we found the prevalence of HIV was very low. In the men it was 0.6 and in the women it was 0.2, and so we moved then to sex workers and to wine shop patrons. Now that is the group we're working, we've finished our baseline, and our first year follow-up is starting on the 19th of July. If you say, are the numbers right, in India...it's such a diverse country, and the HIV infection is definitely in pockets, it's not widespread all over, so it's definitely not gone into all the general population. But in our sex workers and the wine shop patrons, it's quite high at 6% and 18%. And that bit didn't come out, I know, in the paper which brought out this 0.23% in the slum population. So the virus is present but it's not widespread, and it is in pockets in different parts of India, mostly in the six most prevalent states, I would say.
Gay population in the US
c poll study
community popular opinion leader study
pre base line
six prevalent states
slums in chennai
wine shop patrons
Ashok : I'd just like to add to that, that two years ago, the government estimate of the number of people infected was 3.97. latest figure is 5.1. So that's an increase of 1.1 million in just 2 years. Now the notion of, are things going to get a lot worse, you only have to travel to about 25 to 30 districts which are in a very high state of epidemic by which I mean, anywhere from 3 to 8%, and you'll witness scenes which are actually quite alarming. So I think there isn't...at least we, as we go about this, don't spend a lot of time debating whether this epidemic is serious enough or whether it's plateau-ned out. But the good news is that it's not generalized yet. It's still largely concentrated in 20 to 30 districts, and I think we have an opportunity to work on prevention.
Talks about the infection rates as being concentrated still in some communities and the importance of prevention.
high state of epidemic
Asks about PSAS and how to reach rural communities.
Audience Member : I would like to know how the PSAs would be reaching out to the rural villages where there are no electricity and no TVs. I have recently done a stint in rural reporting in West Bengal where remote villages don't have electricity, but they do have generators and they do get videos and they do see Hindi films. They know who the latest heroes are. But the PSAs that the Heroes Project is undertaking, I don't know how they would erach the rural interiors.
Gere : Well, it's very interesting. You come from Calcutta? Well, my brother David Gere just had a presentation of a programme that he put together and then he showed it in Delhi soon after that. And what he did attacked exactly that problem. What do you do when there's no television, or radio, or even newspapers? Now newspapers eventually get almost everywhere, but even beyond that, how do you talk to people? He actually went back to the ancient forms of communication, and he started to contact theatre groups, dance groups, puppeteers, who went from village to village to village. And he found people who had committed themselves to doing this kind of communication specifically on HIV AIDS. And it was, I must say, masterful. And deeply moving. There was one woman who spoke at this, who had become part of this theatre group, the theatre group had come to her village. And she was delighted by this, the theatre group hadn't come there before, and she'd always had this idea that maybe she could be of service to her community, but also be in the theatre. Well, she begged her husband to allow her to go with the theatre to the next village, and they started performing there, and then went to the next village, and of course came back and forth, but it changed her life. Being unable to commit herself to a good cause, be in the theatre, it clearly made a huge difference in her community. So I think there's much work to be done in that way as well. Integrated with these other forms we're doing.
Talks about theater groups and his brother, David Gere involvement in a presentation of a program that does work with theater and HIV/AIDS.
Audience member : You mentioned that you're close to the tipping point in India. UNAIDS sometimes calls 1% prevalence the tipping point. And the new figures that UNAIDS put out range from 0.4 to 1.3 %. So are you there? Is 1% the tipping point in India? Or do you need to be higher than that?
hiv prevalence rates in india
Ashok : I'm not an epidemiologist, maybe Helene can answer it from that scientific perspective better. I can only tell you what we see on the ground. We see enough pockets - pockets are, in India, larger than countries in other parts of the world - we see, for example, 25 to 30 pockets each bigger than Botswana, where the epidemic is at 4%-5%. There's a district called Kopal in the state of Karnataka, where the epidemic's at 8%. And so I can't predict whether it's going to be 5 years from now, or 8 years from now, or 3 years from now, but there's enough evidence on the ground that the epidemic is progressing upwards.
Helene : Just to add to that, I don't think there's an exact science as to when do you call something the tipping point. But I think, as Ashok said, the bottom line is, the numbers are continuing to go up, that's a bad sign. We want them to go down. And therefore, until they start going down, I think we're going to have to do everything that we can to see what it's going to take to turn the epidemic around.
Gere : Can I just say, there's something I'd like to say, talking about my brother's situation before, that the group that he started before was called, Make Art, Stop AIDS.
Audience Member : Can you tell me whether either the trucker or the media project are going to deal with the issues of men having sex with men or men having sex with hijras, and there's been a study in Mumbai that shows that among men who are primarily having sex with women about 30% do actually have sex with other men or hijras. Can you elaborate on any evaluation component in any of these programs to see if they've been effective? To Dr Solomon, if you have comments on how to engage the public and private medical sectors. You've been a wonderful outspoken person from the health care sector, but I don't hear very many other physicians from India who speak out as you do.
Asks about the MSM community and rising infection rates in this group.
public and private medical sectors
study in mumbai
Ashok : Yes, very quickly, the MSM population not only with truckers, but generally, we find as we do our work, has been quite underestimated in India, and that's a very explicit part of our intervention. And evaluation to us is extremely important component, so we're very very particular that in the time frame in which you work, you should have as good attribution as you can, so we're putting a lot of effort into that.
Suniti : Regarding the other medical, yes in the beginning we had a lot of resistance, but we pushed and pushed. We pushed really hard, and now we've got a group of physicians to help us - we call them the consortium of consultants - in every field because you know HIV affects every part of the body, and gradually it's getting better than it was 10 years ago.
consortium of consultants
Audience Member : Getting back to the question of the government, Meenakshi Datta Ghosh, the new head of NACO, was quoted in the last few days as saying, there's no galloping epidemic in India. So how different do you expect the new government's stance to be? And what is the government's stance on prevention, specifically on condoms?
galloping epidemic in india
head of NACO
meenakshi datta ghosh
Ashok : I would also say there is no galloping epidemic in India. What we're looking out for is where is all this going to lead. At some stage rates are going to go up very very...___ alarming if I said today there's a galloping epidemic. As for the government's stance on prevention, I think you should really ask the government that, but it seems to be a pretty complete program.
alarming infection rates
government stance on prevention
Gere : I think the problem is, there's nothing in place yet to stop it from becoming galloping - that's the problem. We're all doing the best we can. We need real partnership from the government, and hopefully this government will do that. This is honestly the first government that...Mr Singh spoke about this before he was elected, and has included it in the budget for this new year, I must say I am told not at any higher figure than last year, but it is included. This is the problem - is that if you deal with it now as if it was galloping, we'd circumvent the problem later on. And the government has not, as of yet, really taken this on.
Helene : And just to add to that, the point about prevention is to get out in front of the epidemic, and I think we haven't seen too many places where we really put in place what's necessary until it's so obvious a problem that it's difficult not to. So I think we see in India the opportunity to actually have an effective aggressive response earlier on in the epidemic, to learn from the lessons from other countries, and hopefully be able to show an example of how you really can stop an epidemic while the rates are still going up, and have an opportunity to really turn it around.
Audience Member : Just want to address a question to Mr Gere. Can you tell us a bit about your commitment to India and your commitment to AIDS? I haven't really heard about your personal reasons for this, for your sudden appearance...
commitment to india
Gere : Suniti is saying she's heard it many times. She could probably tell the story herself, she's heard it so many times. First of all, I have a great love for India. And I have great hatred of AIDS. And my great hatred of AIDS comes from the fact that I've lost so many friends. And I was there at the beginning. It was generally my community that it began in, in the US. And the first deaths were friends, well friends of friends, and very quickly became friends. And even very recently I lost a very close friend, one of my closest friends. So this is a subject that has touched me for the last 23 years now. It's something that still touches my heart. And I found this whole congress here in Bangkok very moving to me, very...in mysterious ways I found myself tearing up. This is very much in the top of my mind and in my heart, and I find it welling up in surprising ways. Put that together with a great love for India, who I consider to be brothers and sisters of mine in the closest dearest sense, in a tender sense, and also my knowledge that it can be stopped now. There is a window of opportunity. If we do the work now, ironically no one will even know what would have happened. We would have stemmed the tragedy, which is perfectly fine with me. But the work has to get done. And I think it's one of the commitments I felt I could make with my life that would be meaningful. We're talking about probably saving, in the order of millions of lives with the work we're doing now. I think there's very few things in one's life you could do that would have that kind of impact.
Talks about why he is interested in this cause.
close friends dying of aids
india and aids
General shots of panel, especially Gere
Shots of convention centre, Bangkok streets
Streets from inside cab (night-time)
From inside cab (daytime)
Building, street, delivery boys
Inside centre, people checking in bags, Mcdonald's