New Yorker Explores HIV/AIDS Epidemic in India, Role of Generic Drug-Maker in Treatment vs. Prevention Debate
In the Dec. 17 issue, the New Yorker examines the growing HIV/AIDS epidemic in India and explores how Yusuf Hamied, head of generic drug manufacturer Cipla, helped to spur an international debate over treatment versus prevention. The first AIDS cases in India were reported in 1986, and since then conservative estimates from UNAIDS and WHO place the number of infected at four million. However, Indian officials, including Prasada Rao, the head of the country's National AIDS Control Organization, have "consistently sought to minimize the extent of" India's HIV/AIDS problem, according to Michael Specter, the author of the New Yorker article. Rao called the UNAIDS/WHO estimates "too high and not based on any sound epidemiological evidence." The government has done little to publicize the disease, and messages about how the virus is transmitted are "almost completely absent" from Indian media, states Specter, who reports that the only HIV/AIDS television ads he saw during several weeks in India were made by Cipla and focused solely on new treatments. According to Specter, this lack of education, coupled with a highly migratory population and "deeply conservative" views about sex and the role of women, have furthered the spread of HIV. The low status of Indian women, whom Specter says are largely regarded as "relatively valuable farm animal[s]," is a major obstacle to HIV prevention in India. Most women are illiterate and marry early, and while wives are expected to remain monogamous, most of the women who contract the virus get it from their non-monogamous husbands. Social rules that prohibit women from visiting doctors without a chaperone and from initiating treatment without their husbands' permission further complicate treatment and testing. Poor health facilities and the overall poverty of the nation also contribute to the spread of the disease and prevent the government from funneling more resources into prevention and treatment.
A Generic Revolution
Because of the poverty of the country and the lack of access to AIDS drugs, Hamied and his company offered to provide generic copies of the expensive patented medicines for only a few hundred dollars a year per patient, both to India and to many other nations in the developing world. Cipla is able to legally copy patented drugs because Indian patent law only applies to the process used to make the drugs and not to the finished product. For this reason, Specter says, Cipla is regarded as "one of the great pirate enterprises of the corporate world" by many Western drugmakers. However, Hamied's offer struck a chord with the international public health community. Treatments that once cost thousands of dollars per patient per year "suddenly seem[ed] affordable," and Hamied and his offer were "embraced as a symbol of hope by activists who believe they are engaged in a global war against apartheid in health care," according to Specter. The call for large-scale treatment programs has been "so intense" that some public health officials have not "dared to say publicly what many believe: that it makes far more sense to try to prevent HIV than to focus on treating it." Many developing nations, India included, cannot afford even Cipla's price to treat thousands of people with HIV/AIDS. And many governments find "placing emphasis on any costly treatment is hard to justify when scores of health problems that could be cured cheaply and easily are so common." For his part, Hamied said that the offer was his attempt, as a drugmaker, to head off an "AIDS apocalypse" in his native country. "Maybe it's just a prayer to cling to, but we need the prayer. What else do we have to offer?" he asked (Specter, New Yorker, 12/17).