AIDS initiative: Sound in policy, but weak in research
— DELHI LETTER
AMBIKA SONI, who shot to fame as a Sanjay Gandhi crony, joined the Congress in the Seventies and was initially in charge of the party’s international relations from where she went on to head the Youth Congress. After lying low for several years, she staged a comeback in the Congress and is today among the most powerful persons in the party’s echelons. A confidant of Congress president Sonia Gandhi, she is presently AICC general secretary in charge of Jammu and Kashmir besides heading the party’s media department and the Congress president’s office. Excerpts:
Q: Let’s begin with Punjab, your home state. The Congress recently witnessed a prolonged spell of bitter infighting. And now a controversy has erupted over the nomination of former Chief Election Commissioner M.S. Gill to the Rajya Sabha.
A: The Congress is a mass-based party. It has a variety of opinions and perspectives...there are bound to be differences in the perceptions of its members, that is only natural. But the differences are not so severe as to impact the electoral viability of the party. This is particularly so now when we all know and are aware of the tough battle we are faced with. I am sure, Congressmen across the state will put aside their differences now that the elections are round the corner. I don’t think the BJP-Akali combine has any reason to feel optimistic. As for the Rajya Sabha nominations, there is bound to be disappointment when there are so many aspirants. But the leader has the prerogative to decide on the nominations. Earlier too, eminent persons from outside the party have been nominated. I am sure, Congressmen will realise that the party will benefit from the experience of such persons.
Q: Is it true that senior Congress leaders do not want to contest the Lok Sabha elections and would rather opt for the Rajya Sabha?
A: This isn’t true. I was very keen to fight from Hoshiarpur and had also started doing the groundwork for it. But I am afraid, I won’t be allowed to contest. The party has put in place an apparatus for the management of the ensuing elections. I guess, I am a cog in this apparatus. Those working at the AICC are expected to facilitate the functioning of the election machinery. For instance, Ghulam Nabi Azad who is in the Rajya Sabha is in charge of a crucial state like Andhra Pradesh. Similarly, Ahmedbhai is needed here. There are also other issues to be looked into. Mr Arjun Singh has another four years to go in the Rajya Sabha. If he contests the Lok Sabha, his seat in the Rajya Sabha will not come to the party. Why single out the Congress. Look at the BJP, none of its leaders from the Rajya Sabha are contesting. This is because Rajya Sabha members do not have the pressure of looking after a constituency and can devote more time to party work. That itself is a full-time job and quite a huge responsibility.
Q: BSP leader Mayawati has decided not to ally with the Congress. What went wrong?
A: I cannot say what were the hitches, if any, in finalising an alliance with the BSP. Every party looks to its own interest first before taking any such decision. Mayawati obviously decided that in her party’s interest, it is better to go alone. But it is as if we were sitting idle waiting for this alliance to materialise. We had begun the process of screening candidates for all the 80 seats of Uttar Pradesh and soon you will have the list from UP. True, a four-cornered contest does help the BJP, at least that is the popular perception. But, in our assessment, the electorate is determined to keep the BJP out. In the last Assembly elections in UP, they were expecting to do very well but they ended up coming third. Then they formed a government by hook or by crook. Even the BJP’s own internal surveys gives them little hope in UP.
Q: Is the Samajwadi Party an option for the Congress in UP now that the BSP is ruled out as an ally?
A: I am not in a position to give details as I am not aware of the discussions being conducted by the leaders handling this issue on behalf of the Congress president. They will have a better idea about this. But Mrs Sonia Gandhi herself had recently stated that if an alliance in UP works out, well and good....otherwise we will fight on our own. The fact is that Mrs Gandhi did try to get all secular forces together.
Q: Is there a possibility of a post-poll alliance with the BSP?
A: How can I say now? As I said, each party has to decide for itself. We felt that in order to take on communal forces, all secular forces should come together. We made an effort in that direction but this is a continuous affair, the endeavour goes on...it does not stop overnight.
Q: It is not just UP, but you are also facing problems with your allies in Bihar while an alliance in Jharkhand does not appear to be working out either.
A: The alliance with the JMM just hinges on one seat. Mr R.K. Dhawan is handling this. As for RJD chief Laloo Prasad Yadav, we already have an alliance with his party, it is a time-tested alliance. In fact, he has been the most vocal advocate of a strong secular front. Mrs Sonia Gandhi has also often stated that there has to be some give and take in the larger interest of ousting the BJP-led NDA. She has said that if we have to give up something, why not...after all we gave up our claim on Pondicherry? In the case of Bihar, this time there are more forces in the fray and lesser seats as opposed to the last time when Jharkhand had not been carved out. On the whole, I think the Congress has been able to forge stable, cohesive alliances.
Q: How do you rate the Congress party’s prospects in the coming Lok Sabha polls?
Very good. After December, there was some demoralisation in the Congress. But the BJP, on winning the three assembly elections, gave the impression that they had won the Lok Sabha elections. They then went on to create a hype about their achievements. But the pace of the Congress campaign picked up slowly and steadily. Our expose of the NDA government’s failures and the scams which surfaced during its regime, all had an impact. Where are they today? Their Deputy Prime Minister L.K. Advani is forced to go on a rath yatra. This was a direct fallout of Mrs Sonia Gandhi’s Jan Sampark programmes. Although Mrs Gandhi remains our star campaigner, the Congress also has strong leadership in the states. This is in sharp contrast to the BJP who only have five leaders who are being constantly juggled around.
AIDS initiative: Sound in policy, but weak in research
THE Centre’s latest AIDS initiative is in keeping with the spirit of the “feel-good” times. The government is moving quickly to beef up the health of 1,00,000 HIV-positive people by providing them free anti-retroviral therapy (ART) through the coming financial year. Apparently, the goal is to cover numbers any way. But public health policy cannot be based on populism. It must ride on strong rationality, especially when the cost is expected to be above Rs 200 crore a year.
On the face of it, the policy sounds good. Examine it a little, and one will find its looseness and lack of attention to detail. It is not based on adequate field research in the country. The infrastructure required in terms of equipment and trained doctors is missing. Against this background, rushing into the area of treatment and care is dangerous as it can lead to the emergence of drug-resistant HIV strains and a more virulent epidemic.
Consider the facts. For those new to the field of AIDS, ART increases a positive person's span of life. In the West, deaths due to AIDS have fallen by half since the advent of protease inhibitors, a top-end variety of ARTs. In Brazil, mortality due to AIDS decreased by 80 per cent when ART was given free to all who needed it. At Rs 20,000 a year per person for the “minimum combination of drugs” put together in one tablet a day form, the least expensive ART is out of reach of India’s poor. Only 5 per cent of those needing ART are able to access it, according to estimates.
It is to improve this access that the policy of providing free ART to 1,00,000 people is being launched. Based on the World Health Organisation’s postulate that in a mature epidemic, 10-15 per cent of the total people living with HIV/AIDS (PLWHAs) require ART at a point in time, experts reckon that of India's 4.5 million HIV-infected people, 4-7 lakh people would require ART. But the government’s commitment (due to paucity of funds) is to treat one lakh people. So, how will this one lakh population be selected?
Two ridiculous criteria have been adopted. One is belonging to a high- prevalence state. Six states, where more than 1 per cent of the general population is estimated to be HIV-positive per the sentinel surveillance conducted in 2002, are eligible. These are Andhra Pradesh, Karnataka, Maharashtra, Manipur, Nagaland and Tamil Nadu. The rationale for leaving out states where prevalence is low is missing. Why should a person in Punjab, a low prevalence state, be denied treatment when his counterpart in Kerala can avail himself of it? People will demand an answer. The other criterion stipulates that children and women detected to be with HIV during pregnancy will be top priority, followed by terminally ill patients. The logic, in part, is somewhat dubious.
Children are an emotional choice, not a practical one based on hard economics, suggest public health specialists. About 90 per cent of children with HIV get the infection from the mother during birth. They are born with the virus. Even with ART, they rarely grow to an age when they can be fully productive members of society. Also, increasing the life span of a positive child and not his father's wouldn't really help the child!
Why terminally ill people with CD 4 counts of less than 200? A study conducted by YRG Care in Chennai showed that PLWHAs with CD 4 counts of less than 200 lived 19 months longer when given ART. But ART can yield much better results if given early to patients.
For example, in the West, where ART is recommended at a higher CD 4 count, it has increased longevity by six to seven years. Extending life when a person is in a terrible condition is not a happy option. The idea should be to help a person lead a better life when he is able, which is when his CD 4 counts (an indicator of immunity) are relatively high. Also, from a public health perspective, it makes sound sense to decrease a person’s plasma viral load by using ART early so that the risk of his transmitting the virus to others is reduced for the greater part of his life.
HIV is mainly a disease of the young. Even so, the prime years of 18-30 or 18-25 could perhaps define the “core” target population given first preference for treatment. These are the most productive years of a person when he needs to be helped to make his mark in society and plan for his family. Next, a second preference group, consisting of older children (not born with the virus) who can grow well into adulthood or 30-35 year olds, can be delineated, and so on. Alongside age, the immune status of a person should be a criterion. Early treatment vis-à-vis late treatment should be decided on the basis of empirical evidence.
Similarly, rigorous clinical trials and studies should determine the drug regimen that works best for the population as the first line of treatment, second line of treatment, etc. The current policy earmarks four fixed regimens as the first line of treatment but this has not been done on the basis of trials in the country. Positive people are demanding more drugs as the first line of treatment.
Doctors associated with the programme are concerned about its casual approach to diagnosis, treatment and evaluation. The policy says that a CD 4 count of patients, to determine if it is less than 200, will be done “if possible”. In the absence of this test, subjective analysis will be made and this is a difficult task, say doctors.
CD 4 monitoring is critical to ascertain a patient’s progress and adjust therapy accordingly. Treatment will be inadequate in the absence of this monitoring. Finally, evaluation of treatment to find out what proportion of patients goes back to work, etc. will be impossible without this test.
Indiscriminate prescription of ART leads to the birth of drug-resistant strains of HIV. Irregular intake of these medicines too has the same effect. Unless the target population is extensively attuned to the prospect of a daily, uninterrupted consumption of drugs and actively helped in this task along the lines of the DOTS programme, the backlash of the treatment bonanza could be severe.
In fine, continuous supply of the drugs is critical. This is difficult now because no one knows where the coming year’s booty of Rs 200 crore is coming from. National AIDS Control Organisation’s annual budget is about Rs 250 crore; it has volunteered no information on how it is going to double its bill and meet rising costs each successive year.
WILL Nafisa Ali be a match to firebrand Mamata Banerjee if the Congress sticks to its decision to field her from Kolkata (South) constituency to take on the Nationalist Trinamool Congress supremo? Both are in their forties but come from entirely different backgrounds. Nafisa is a former beauty queen, a swimming champion of yesteryear, a social-activism and an actress. Mamata hails from a middle class family of West Bengal and has come up in politics very hard way, having challenged the might of the Marxists. In 1984 general elections, she created waves when she defeated CPI (M) stalwart Somnath Chatterjee. Nafisa too made waves in altogether different spheres; she remained the National Swimming Champion from 1972 to 1974, was crowned Miss India when she was 19 years old and ended runner up at the subsequent Miss International contest.
Nafisa retains, since her beauty queen days, what has popularly come to be known as “1,001 watt smile” even though she has now dedicated herself to extensive care of HIV and AIDS patients. Her Care Home provides holistic care and support to the people suffering from HIV. Her service to AIDS patients has been widely lauded and she has also made a documentary — “United against AIDS”. Nafisa had variegated career but politics was a sphere she never touched. Why did she turn to the hurly burly of politics now?
Gujarat riots moved her deeply. She went to the worst affected areas and relentlessly took up the cause of the hapless victims. The Gujarat police slapped two cases against her for allegedly fomenting communal violence, but the ostensible reason was equating Chief Minister Narendra Modi with Adolf Hitler and Osama bin Laden. The charge of fomenting communal violence was contrary to truth. Far from igniting passion, she was courageously raising her voice for justice and calling for bringing to book the real culprits. The Gujarat High Court ultimately came to her rescue and ordered a stay in the two cases.
The incident changed the course of Nasifa’s life as the Gujarat experience further firmed up her resolve to fight injustice. A determined person, she decided to take a plunge into politics because she thought social activism was not enough to take up cudgels against oppression. She does not mince words in admitting that the two cases served as a catalyst for her plunge into the weird world of politics.
What future awaits her in politics? Apparently, she would oppose Mamata, who is the only non-Marxist leader to have a solid base of West Bengal. There was a time what she would call Mamata “my sister”. But now, she questions Mamata’s secular credentials. “Her image got a beating when she resigned from the NDA to protest against corruption but she joined the National Democratic Alliance again to get a ministerial berth”. Nafisa lives most of the time in Delhi and wanted to contest from one of the seven seats there. But a long discussion with Congress leader Pranab Mukherjee convinced her that Kolkata (South) would be a better constituency for West Bengal-born Nafisa.
She admits that she is not so fluent in Bengali but says “My heart is Bengali and every drop of my blood is Bengali”. People still conjure up her glamorous image but she is a serious person, shuns fancy dresses and usually dons snow-white Bengali sarees with red or blue colour border. Born to a Muslim father and Christian mother and married to a Sikh, an army officer, she embodies India’s rich cultural diversity, say her fans. Doubtless, Nafisa has been a versatile person, a committed social worker, a noted actress, and a dedicated housewife. Be it cyclone in Orissa or the earthquake in Gujarat, she participated wholeheartedly in relief work. She also made a documentary on Gujarat riots on the theme “Where did we go wrong?”
Initially, Nafisa was not a religious person but a visit to Lord Sri Venkateswara Temple in Tirupati and, later, a discourse by an architect-turned-Swami at Chinmaya Mission changed the course of her life. She was 37 when she went to Tirupati, got her head tonsured (to honour a wish come true), stood in front of Lord Sri Venkateswara and mumbled: “ I’m putting my life into your hands. Guide me, I need direction”. The discourse at Chinmaya Mission made her realise that she had shut spirituality out of her life. Now she reads Swami Chinmayananda’s books late into the night. “I have learnt the essence of spirituality in goodness, and the right way of living”, she
ON television not long ago I saw an interview between Sonia Gandhi and a senior Indian journalist. It was in the grounds of Anand Bhavan in Allahabad and how good the garden looked in the glitter of the late winter. And how well was Anand Bhavan kept at public expense. I wondered if Mrs Sonia Gandhi was aware of a description I had read some months ago of the deplorable reggle taggle condition of the home of India’s first President, Babu Rajendra Prasad, also propped by public funds.
In the newspapers a few days ago was an item about a delegation from Britain here to examine the state of some of the buildings put up by the Raj. To follow, probably, will be a grant for repair and upkeep which, no doubt, will be swiftly and silently accepted. Sad that our own heritage has to be kept standing by foreign funds. Just think of the beautiful upkeep of the cemeteries in foreign fields thousands of miles away from where men who fought the battles of World War II came from.
Whether we accept them gracefully or not the British left India a number of gifts: a judicial system with pending suits stretching to the stars and millions of litigants spending their last rupees in courts, another gift was elections which stopped all governmental work for months and money was spent in basketfuls of crores, deviated from funds for people to eat and live.
Another gift is what the North Indians call “kirkit”, a display of which has just ended in Karachi and Rawalpindi. Everything went well, and our journalists have slobbered over thousands of tons of newsprint and hours of electronic drivel. But the media in both countries are a dangerously wayward and dangerously predictable — one unpopular umpiring decision or one item of verbal abuse shouted from the ringside and there might be countrywide riots, mayhem, and the spilling of blood.
That is why it is enormously important for Pakistanis and Indians to be able to say “its only a game,” which they have so often failed to do. Not that only Indian and Pakistanis are guilty. British football fans have transmitted countries fear. European spectators have shouted racial abuses time and again. India, too, has seen the homes of losing players attacked.
In world football and rugby the winning team is cheered by millions if it wins, if not ... The seeds of communalism were planted when we were young in schoolboy minds during battles between Mohammedan Sporting and Mohun Bagan in Kolkata. India vs Pakistan was not the same as La Martiniere vs St Xaviers or St Thomas vs Royal in Colombo but it did easily go up notch to community.
So owners and practitioners of the media have a sensitive role. At the same time they have to give the public, in speech and writing, the entertainment of description and analysis of the highest class? In searching for class I was disappointed by the English papers. Not everyone can be a Nerville Cardus who used to be the Guardian’s Correspondent for cricket and music.
But some of our cricket correspondents earlier modelled themselves on Cardus and wrote well but the rest are humdrum. Of course writing in a foreign language is like climbing a mountain without oxygen. So I have been waiting to read the Bengali coverage of the Indo-Pak cricket. Radio is a neglected medium so we don’t hear any marvellous cricket broadcasting.
The game of cricket is bigger than its iconic figures who make copy-cat speeches tuned to the prevailing mood. These who dig up pitches or threaten assassinations lie in wait to fan the flames of false nationalism or religiosity. And the mandarins who today draft honey-dipped notes can, just as easily and quickly, despatch sour ones.
Unfortunately, the game has changed. If Don Bradman and our greats of today met we pray that they wouldn’t discuss investment and tax problems. The sponsors today control the life and times of our heroes of the screen and the field. School children who hang up portraits of the big in their bedrooms might think differently if they knew the facts.
Cronje might be dead but there are others like him equally charming and wristy. As in everything else the situation in Pakistan is the same except that the market there is smaller.
The opening has been heart warming, the photo-opportunities have been frequent and smile-drenched. Let us see if anything happens about the core.
I’m saddened, at this time, by the death in Lahore of my closest Pakistani friend. Ever since the last days of the Indian Struggle I have been continuously surprised by the failure of our leaders to conceive of a region stretching from Afghanistan’s mountains, Nepal, Bangladesh and Sri Lanka below. The Muslims, the most eloquent of them like Iqbal and Faiz Ahmed Faiz, to those who form the Jemaah Islamiyah in Malaysia, Indonesia and Brunei, seem to stop at an Islamic state whereas Rabindranath Tagore wrote of a region and society which covered Hindu Muslim and Buddhist civilisations.
Most of the senior officers and advisers of Subhas Bose (a devout religious man himself) were Muslim and one of photographs, I like of Gandhiji is taken in the Frontier — a small bird-like man in Khadi surrounded by giant pathans, his followers to the last.
I don’t like cricket chained with Kalashnikov and, however, enthusiastic the welcome, I don’t think the ‘core’ will be dented. But I know that the diggers up of pitches and those who threaten assassination are around and though they smile and smile they have the wrong message behind
THE week that’s just gone by was packed. In between the ongoing film star tussle between the Congress and the BJP, the focus was whether the feminist play, Vagina Monologues, would get staged here or would it suffer the same fate (no official permission) as was in Chennai. Here it did manage to go through red tape. It made waves in the Capital. Several hundreds saw it, commenting that it wouldn't have drawn even half that publicity if it was titled differently.
In fact, these past few days there couldn't have been more emphasis on the rights and needs of the woman. Yet, the reality is grim. The woman is actually not safe even in Delhi. The latest victim was the Australian tourist, Dawn Emelie Griggs, who was killed not far from New Delhi's International airport .Theories and sub-theories are being churned out but the fact of the matter is that this 59-year-woman was brutally murdered…
Women achievers The wife of the Mexican Ambassador to India, Alexandra Sanchez Gavito de Faesler, came out with her book on 30 women achievers of the country. The achievers include noted artist Arpana Caur and renowned dancer of yesteryear Mrinalini Sarabhai. The last time I had met Alexandra was a few months back at the home of the then Bangladeshi envoy to India, Tufail Haider. She had probably begun working on this project and over dinner she was rattling off the names and achievements of the women who would find a place in her book.
The wife of the Mexican Ambassador to India, Alexandra Sanchez Gavito de Faesler, came out with her book on 30 women achievers of the country. The achievers include noted artist Arpana Caur and renowned dancer of yesteryear Mrinalini Sarabhai.
The last time I had met Alexandra was a few months back at the home of the then Bangladeshi envoy to India, Tufail Haider. She had probably begun working on this project and over dinner she was rattling off the names and achievements of the women who would find a place in her book.
MF’s new venture M.F. Husain was here in the city for his new venture “Meenaxi: Tale of 3 cities”. He was here for the promotion of his latest film which is to be formally launched here on April 2. I had spoken to him, but was fussy about answering anything about the film. He sounded impatient and did not reveal his plans about the arrangements being made for the film launch day. Thankfully, it was his son, Owais, also the co-producer of the film, who spoke and filled up the gaps.
M.F. Husain was here in the city for his new venture “Meenaxi: Tale of 3 cities”. He was here for the promotion of his latest film which is to be formally launched here on April 2. I had spoken to him, but was fussy about answering anything about the film.
He sounded impatient and did not reveal his plans about the arrangements being made for the film launch day. Thankfully, it was his son, Owais, also the co-producer of the film, who spoke and filled up the gaps.
Writers’ meet The Women's Initiative for Peace in South Asia (WIPSA) is holding a meet of women writers from Nepal, Sri Lanka, Bangladesh and Pakistan shortly. The emphasis is on those writing on peace and tolerance. The take off is from O.P. Jain’s lovely writers’ retreat — Anandgram on Delhi-Gurgaon road. Subsequently, the sessions will take place at different venues. Those interested to attend could get in touch with WIPSA, C-25, Qutab Institutional Area, New Delhi-110016. WIPSA has founding members like Mohini Giri, Nirmala Deshpande and several others.
The Women's Initiative for Peace in South Asia (WIPSA) is holding a meet of women writers from Nepal, Sri Lanka, Bangladesh and Pakistan shortly. The emphasis is on those writing on peace and tolerance. The take off is from O.P. Jain’s lovely writers’ retreat — Anandgram on Delhi-Gurgaon road. Subsequently, the sessions will take place at different venues. Those interested to attend could get in touch with WIPSA, C-25, Qutab Institutional Area, New Delhi-110016. WIPSA has founding members like Mohini Giri, Nirmala Deshpande and several others.
From her to him Let’s talk about men. The two men I heard this week were said to be singers par excellence, signing melodies of the years gone by. No beating around the bush but midweek a programme stood arranged at the Foreign Correspondents’ Club by a well known art and culture society called Kundan (I think it’s named after Kundan Lal Saigal). One heard Indraneel Mukherji reliving the memory of Hemant Kumar for he sang in that strain. Also to be heard was Chandru Atma who is famous for singing K.L. Saigal songs. Moving ahead, I must mention that on May 31, the same music group will perform a live concert here in memory of Anil Biswas. And there are programmes lined up for the birth anniversary of Saigal on April 4. Sometime around May, 2004, the biography of K.L. Saigal, authored by Sharad Dutt, will be launched. Sharad Dutt is a well known media personality. He had earlier authored the biography of Anil Biswas “Ritu Aaye, Ritu Jaaye” which got him the National Film Award — Swaran
Let’s talk about men. The two men I heard this week were said to be singers par excellence, signing melodies of the years gone by. No beating around the bush but midweek a programme stood arranged at the Foreign Correspondents’ Club by a well known art and culture society called Kundan (I think it’s named after Kundan Lal Saigal). One heard Indraneel Mukherji reliving the memory of Hemant Kumar for he sang in that strain. Also to be heard was Chandru Atma who is famous for singing K.L. Saigal songs.
Moving ahead, I must mention that on May 31, the same music group will perform a live concert here in memory of Anil Biswas. And there are programmes lined up for the birth anniversary of Saigal on April 4.
Sometime around May, 2004, the biography of K.L. Saigal, authored by Sharad Dutt, will be launched. Sharad Dutt is a well known media personality. He had earlier authored the biography of Anil Biswas “Ritu Aaye, Ritu Jaaye” which got him the National Film Award — Swaran
Learn self-conquest, persevere thus for a time, and you will perceive very clearly the advantage which you gain from it.
— Saint Teresa of Avila
The spokes of the wheel are the rules of pure conduct: justice is the uniformity of their length; wisdom is the tire; modesty and thoughtfulness are the hub in which the immovable axle of truth is fixed.
— The Buddha
Good actions may procure a better frame of life, but salvation comes only through His grace.
— Guru Nanak
God’s activities are ever current. Whatever actions there are on the credit side of a soul, to that extent does God award their return.