San Francisco Chronicle - April 2, 2004
Sabin Russell, Chronicle Medical Writer

Here and at six similar sites in this nation of 1 billion citizens, the Indian government Thursday took its first, tentative steps toward distributing AIDS drugs to 100,000 people.

At the new Lok Nyak AIDS clinic, there are enough drugs for only 200 patients, and doctors launched the program today with medicines for only six. Made of combinations of generic copies of the costly antiviral drugs that prolong the lives of AIDS patients in the United States, the medication will cost the Indian government about $1 a day for each recipient.

Bharat Vhushank, an emaciated 45-year-old photographer who is struggling with both heroin addiction and AIDS, was among the fortunate six . "It is a good feeling," he said, of the moment when he first swallowed the pills that may save his life.

During the past six months, Vhushank has battled pneumocystis pneumonia, oral yeast infections, bouts of fever and the loss of nearly 40 pounds from his already painfully thin frame.

It is the same list of opportunistic infections and maladies that have killed more than 20 million people with AIDS around the globe in the past two decades. The AIDS-related afflictions once were commonplace in San Francisco's gay community, and killed nearly 18,000, before combination drugs dramatically slowed the pace of dying.

Coincidentally, South Africa also launched its own free drug program Thursday. With more people infected with HIV than any other country, South Africa promises to have the world's largest program. Both India and South Africa are part of a global effort to achieve the World Health Organization's "3-by-5" goal -- treating 3 million AIDS patients in the developing world by 2005.

In ceremonies marking the launch of India's free AIDS drug program, hospital and state government officials called it a day of hope, but they were also candid about their fears.

"An unmitigated disaster is looming on the horizon," said S.P. Agarwal, the chief health official for the small northern Indian state of Delhi, home to 14 million, including about 1.5 million in the nation's capital.

Less than 1 percent of India's vast population is infected with HIV, the virus that causes AIDS. But with 1 billion people in the country, it's still 4. 6 million individuals. Already, India is second only to South Africa among the list of nations with the most HIV infections.

Many experts believe that the official estimates are off by half and that there are already 10 million HIV infections in India. Left unchecked, it is widely predicted that India could have as many as 25 million cases of HIV by 2010, just six years from now.

Within India, the epidemic is concentrated in pockets, where infection rates are rising ominously. Close to 80 percent of India's infections are believed to be transmitted heterosexually. It is a formula suggesting the start of a generalized epidemic in the world's second most populous nation.

Delhi itself is not considered among India's six "high prevalence" states, all of which are to the south. But it is the only state in northern India participating in the start of the national AIDS treatment program, and that has officials there worried.

There are an estimated 29,000 HIV infections in Delhi and 862 cases of advanced AIDS. With medicines this year for a mere 200, health officials worry that, as word spreads about the free drug program, struggling Lok Nayak hospital will become a magnet for AIDS patients throughout northern India.

"People from neighboring states will be flocking to us, and that will be a problem," warned Arun Baroka, project director for the Delhi State AIDS Control Society, which handles the federal money and runs the local program.

During the first phase of the Indian government program, the drugs will be distributed with priority first to mothers who are HIV positive and who participated in a program that gave a short course of drugs to them during childbirth. Although the program can cut in half the number of infants who contract HIV from their mothers, without lifelong treatment, those mothers will eventually die of AIDS.

The second priority will be to give the drugs to HIV-positive children who are below the age of 15, and the third priority will go to what the government calls "full-blown AIDS cases," like those of Bharat Vhushan.

Initially, many of those who get the free treatment may be among the estimated 15,000 Indians who currently get antiviral drugs through private charities. At the Lok Nyak clinic, Raijni, a nervous 32-year-old widow whose husband died of AIDS, was one of the first six patients to enroll in the program. She has been taking drugs for a year, funded by a private group. "The medicine worked," she said. Now, she has the prospect of keeping her health without depending on the private donor.

Sabin Russell is traveling in India on a grant from the Kaiser Family Foundation. E-mail him at srussell@sfchronicle.com.

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