India may be emerging as a major exporter of cheap anti-retroviral drugs, but it ironically does little to provide affordable treatment for tens of thousands of people living with HIV/AIDS in this country.

"The drugs are out there and can even be bought across the counter at most drug stores, but most sufferers just don't have the money to buy them," Irfan Khan, coordinator at one of the city's four care homes, told IPS. Khan says that of the 300-odd patients attended to over the last four years by the Naz Care Home, which is funded by the Richard Gere Foundation, less than 10 percent have had access to anti-retrovirals because of their high cost and lack of government support.

The Indian government spends about Rs.600 a year on each person under health care, and it has been estimated that the per capita expenditure on HIV/AIDS is less than a dollar. This leaves most people saddled with large out-of-pocket expenses towards health. According to Khan, costs for first-line treatment with a typical combination of Lamivir and Retrovir are half of what it was around three years ago. But even that, at around 30 dollars a month, is beyond the reach of most people who need these drugs.

On Aug 30, World Trade Organization (WTO) member countries agreed on a waiver that would allow poorer countries to import cheaper generics made under compulsory licensing. India's pharmaceutical companies, which are among the world's biggest producers of generic drugs, stand to gain enormously from the change. "It is time that the government steps in to take advantage of the waiver so as to benefit those who desperately need to be started on the drugs or, if they are already on them, have a chance to continue with treatment," said Khan.

At the moment, the only patients who receive anti-retrovirals and other medicines and care free are government employees. But the actual beneficiaries are only a small percentage of the over four million people living with HIV/AIDS in India, as estimated by the government's National AIDS Control Organization (NACO). A NACO policy document clearly says that the government cannot support anti-retroviral treatment for the general public because of prohibitive costs, the indefinite period of treatment and the need for supportive investigation to monitor the progress of the disease.

"The entire AIDS policy of the Indian government remains restricted to the preventive approach and the government continues to refuse treatment so that millions of HIV-positive people are left to die"

- Shruti Pandey,
Human Rights Law Network.

Independent estimates made by the Lawyers Collective's HIV/AIDS unit place the cost of annual treatment with anti-retrovirals at around $1,000. But it says major overhauls in the health delivery system are needed before it can take on such issues as constant monitoring of those under treatment. Although the prices of essential drugs have traditionally been controlled by the Drug Price Control Order (DPCO) ever since the country embarked on a policy of liberalization of drugs, the medicines under that list have been steadily reduced over the years.

There is little chance that anti-retrovirals being covered by the price-control rules due to resistance from pharmaceutical companies, which would like to see the DPCO removed altogether.

"The entire AIDS policy of the Indian government remains restricted to the preventive approach and the government continues to refuse treatment so that millions of HIV-positive people are left to die," said Shruti Pandey an activist for the Human Rights Law Network that is based in the capital. She pointed to a worldwide trend to provide treatment to AIDS patients within the public health system, recognizing that the pandemic affects the poorest strata of societies the most.

Many countries in the developing world, including Brazil, Argentina, Mexico, Cuba, Mauritius, Taiwan, Uganda and South Africa, are already providing free and universal treatment with anti-retrovirals. Brazil, where the government has since 1996 been providing universal access through the public health system to all people living with HIV/AIDS, is among the countries planning to take advantage of the WTO waiver to import cheap, anti-retrovirals from India and from another major producer of generic drugs, China. But in India, which took the lead in reducing the global prices of anti-retrovirals by offering treatment with generic drugs at $350 a year or less than five percent of prevailing prices, the government is yet to act to meet the needs of its people with HIV/AIDS.

This year, the Global Fund to Fight HIV/AIDS, tuberculosis and malaria, which is supported by the World Health Organization (WHO), provided India with $100 million for fighting HIV/AIDS. Another $100 million came from the Bill and Melinda Gates Foundation. On top of that, many point to worrisome HIV/AIDS trends in India, citing projections showing that the country could have 35 million people with HIV/AIDS by 2015 if the present trends are allowed to go unchecked.

Activists like Pandey and Khan are now pinning their hopes on notices issued by the Supreme Court to NACO and to state governments against a petition filed by the Punjab Voluntary Health Association, which has demanded the provision of free and equitable access to anti-retroviral treatment. Pandey said while the replies by the state governments to the notices were being awaited, the intervention of the apex court already promises, for the first time, amelioration of the suffering of those with HIV/AIDS in India.