Address by the Prime Minister SHRI ATAL BIHARI VAJPAYEE at the meeting on National Program for prevention and Control of HIV/AIDS New Delhi - December 12th, 1998

Since Independence India has acquired considerable experience in prevention and control of both communicable and non-communicable diseases. While we could successfully eradicate many deadly diseases like small pox and guinea worm and are on the verge of eliminating leprosy, we are now facing the problem of resurgence of serious communicable diseases like malaria and Tuberculosis.

While we thought we had eradicated malaria from the country, it has now come back in a highly virulent form of Malaria falciparum that is almost fatal. So far as TB is concerned, roughly about fifteen million Indians are inf3ected with the disease and every year more than 1.2 million are getting added. Hundreds of thousands die of TB each year.

However, the most serious public health challenge that the country is facing today is of HIV/AIDS that is just a decade old in the country. AIDS is a global problem, sadly, with a strong Indian dimension.

More than twenty out of hundred adults in Africa face death in the next four years. In another African country, life expectancy will drop from a high of 61 years in 1990 to only 41 years next year.

What is happening? What is happening is being compared by senior United Nations Public health officials to the bubonic plague that wiped out one-third of Europe’s population in the 14th century.

According to the South African Government, fourteen percent of their population of 32 million is infected with HIV, which leads to AIDS and death, and 1500 hundred more are daily diagnosed with the virus. President Nelson Mandela has, early this month, said, " Although AIDS has been a part of our lives for fifteen years or more, we have kept silent about its true presence in our midst", adding "We have too often spoken of it as someone else’s problem.

That is South Africa’s situation and there is President Mandela’s recent statement. I have taken the liberty of referring to Africa and quoting President Mandela because our situation is also alarming and could become frightening, and we too speak of AIDS as someone else’s problem. Look at our own AIDS situation.

The health ministry puts the figure of HIV infections in the country as of now at three million to four million. In some states, the infection rate is one percent of the populations. Since we have these three to four million infections today from a base of just a few infections in 1986, imagine what the scene will be in another twelve years from the base now of three to four million. I shudder even to contemplate the numbers. And mind you, currently there is no cure for HIV/AIDS.

Because HIV afflictions take till ten years in healthy circumstances to blow into AIDS and AIDS patients live till two more years, people do not take the virus seriously. In unhealthy conditions, the time frame is much shorter.

Another reason why people do not take AIDS seriously is because it is diabolical; one comes to know one is HIV positive only if one goes and takes an HIV test, the ELISA test. In the absence of the ELISA test, one could be carrying the virus fore six or seven years not knowing about it and passing it on to one’s spouse and the wife to the newborn through breast feeding, without any of them knowing. This is the crux of the problem.

However, these are just figures and figures do not convey the human tragedy that is taking solace in many parts of the country today.

A man or a woman has diarrhea or fever or weakness that medicines fail to subdue. He or she goes to a doctor. The doctor suggests a blood test. The person tests HIV positive. The test is repeated. The HIV infection is confirmed. However, it is too late. The person’s partner is already infected and the couple’s child is also infected from breast-feeding. The first infection is almost five or six years old. There is no cure. All three must die. And I know they die. How many such nuclear families are already condemned to death in our country today? How many will be condemned to death in the next decade? When HIV appeared in India in 1986, everybody thought that it is a Western disease that will be contacted only by sex workers in red light areas, gay men and infecting drug users. The consequences of that myopic view are now upon us.

In India, sexually transmitted diseases are already a serious problem and what is significant, full forty percent of such diseases occur in middle segment of our population. More significantly, persons already suffering from sexually transmitted diseases are more prone to HIV infection. What will this catastrophe mean to business and industry in, say, the year 2005?

Since the HIV/AIDS affliction is mostly in the productive age group of eighteen to forty, this could have grim consequences for our economy. Already, half of the new infections in India are in this age group. Business and industry must take a hard and urgent note of this reality and act to increase awareness about AIDS and spread the message about its prevention.

For AIDS is preventable. You cannot prevent a common cold, but yes you can prevent AIDS by taking precautions. HIV is transmitted through unprotected sex with an infected person, transfusion of infected blood and blood products, use of contaminated needles and syringes, and from an infected mother to her child via birth, and also through breast feeding by infected mothers. AIDS is preventable through awareness. Awareness is the key to prevention.

However, unless we put all our efforts to increase voluntary blood donation and meet the shortage of blood, we will not be able to achieve total blood safety in the country. I urge all of you to involve yourself in promotion of voluntary blood donation campaigns in your areas or constituencies and motivate the younger sections of society to make voluntary blood donation habit. Donating blood is a healthy habit. It is also a redeeming habit.

Millions of HIV positive persons and AIDS sufferers are afraid to talk or seek medical help because they are burdened with undue guilt and stigma. Million more Indians, hundreds of thousands of worried families want to know more about HIV/AIDS but are afraid to ask.

They want almost foolproof confidentiality and anonymity. Victims of HIV/AIDS are seeking information in privacy. The extent of this quest for information in privacy about HIV/AIDS is demonstrated by the fact that the Central Government run HOTLINE on AIDS in New Delhi (Number 1097) received 21500 telephone calls in just the first fifty days of its starting in October 1997. My government has decided to make the AIDS Hotline number 1097 available in all cities and big towns of India toll-free.

Awareness is the only weapon we have today against AIDS. There is no single strategy for creating awareness. We must use every available medium of communication to spread the message across the country whether it is electronic media, print media and even the folk media.

Cinema is a powerful tool of mass communication and education. After this meeting a new Hindi film, Nidaan, is being screened. I have seen the film and it is a good film even without its subtle awareness message about HIV/AIDS. The awareness aspect makes it a powerful film.

Any campaign for awareness should not be the responsibility of governmental agencies alone. We must involve community leaders, NGOs and elected representatives of the people at various levels in this program.

My appeal to the members of Parliament is to take up the work of AIDS awareness on a priority basis in their constituencies. I would also urge the chief ministers of all the states to take up awareness campaigns personally by meeting Members of Legislative Assemblies, Chairpersons of Zila Parishads, Panchayats, District Collectors, municipal Corporation Chairpersons, NGOs and community based organisations.

As I have mentioned earlier, the section of the population most affected by HIV/AIDS are young people. They are highly impressionable and require proper education and awareness about reproductive issues including sake sexual behavior.

There is a debate as to whether children of this age group should be taught about reproductive health. Information about sexual and reproductive health and right sexual behavior can help the children in developing a necessary value system and face any eventuality, with courage and understanding.

I do not think we should hesitate to tell the children about the process of growing up and its implications. The growing threat of HIV/AIDS in the country points to the urgency of doing this sooner rather than later.

As the disease has spread in the last five years across the length and breadth of the country, we now have about three to four million HIV infected people in our midst. Many of them are still asymptomatic but sooner than later they will develop into full-blown AIDS cases. I hear distressing stories of AIDS patients being thrown out of their homes ostracised by their own families and society and even denied admission and medical care in hospitals.

These acts are practiced not just by ignorant people, but even by those who are knowledgeable and know how HIV/AIDS is spread or not spread. The medical profession has a special responsibility in this area.

It is the responsibility of people who are aware and who have the knowledge to fight against discrimination of HIV/AIDS – infected persons in the society. We should ensure that they have the same rights to education in schools and colleges to employment and for a rightful place in society. We must respect their privacy with sympathy and understanding.

There is pressure from certain sections of the community to go for mandatory screening of HIV/AIDS. Nothing can be more shortsighted than this.

The moment we start mandatory screening, the infected persons will not come forward to avail of even minimum amenities of care and support that are provided by the health care delivery system in the country. This will aggravate rather than solve the problem of HIV/AIDS in the country.

In the meantime, and since the government has now accepted the figure of three to four million infections currently, there is a need for a debate in the country as to the accuracy of these figures. We must accept the fact that a large number of our people are infected and that there is no cure at present and also that prevention is the only long-term remedy.

Only awareness can help prevention.

I am confident that India will be able to overcome this problem, provided we take it seriously from now onwards. We have demonstrated our inherent infrastructure strength in taking up a number of socially relevant programs; the latest being the polio immunisation campaign in which twelve to thirteen million children have been given polio drops in a single day.

There is no reason why we should not be able to control HIV/AIDS in India. It requires all out efforts by both the government and the community: let us make a beginning towards this goal today.

We also need to develop our own, type specific, anti HIV vaccine. There are ongoing major international efforts to identify the various strains of HIV and develop a type specific vaccine for cure and control. We must actively join this global effort. We must collaborate in currently promising research with other agencies worldwide to discover such a vaccine.

We have developed successfully a vaccine for Hepatitis B. Efforts are on to develop a vaccine for hepatitis – C also. There is no reason why we should not succeed in developing an HIV vaccine in India. We have the Indian Council of Medical Research, the Department of Biotechnology, the CSIR and other institutions doing excellent work on various aspects of vaccine development. We have to bring these groups together in a "Mission Mode" to synergise their efforts.

I would request the Health Minister who is present here today to take the lead and organise a national team to explore the possibility of developing an indigenous vaccine in the most cost – effective fashion and do this urgently.

In light of all that we know about this diabolical virus, and that currently there is no vaccine against it, India needs to act vigorously to dramatically enhance awareness. We also need to relentlessly search for an anti-HIV vaccine as a task of high priority and urgency.

In the meantime, we all will have to bring out the best in each one of us by way of compassion, understanding and love for those who are afflicted and already affected. India can do no less.

Thank you.