India's HIV toll

a recently announced attempt by India's National aids Control Organisation (naco) and unaids to collect data on hiv/aids deaths in the country might prove futile. While countries like the us , Canada and Australia do collect such data, it is not clear how much ground reality can be captured by such an exercise in India, where hiv/aids is not a notifiable disease; most deaths due to the virus might be attributed to opportunistic infections like tuberculosis. Also, surveillance will likely be limited to government health establishments, though many patients are treated at private hospitals.

A high level meeting of health experts was recently held in New Delhi to formulate a methodology for the exercise. Three approaches, using indirect methods to assess the toll, are being considered. Mathematical models that rely on statistical calculation based on figures of prevalence and life expectancy of infected people living without treatment could be used. Another method could be evaluation of "excess mortality" in the 25-50 age group (known to have low mortality). This, too, would be a mathematical model, in which deaths due to normal causes would be discounted and those that can be attributed to aids calculated. The third method could be to use "verbal autopsy" -- families of people who died aged 25-50 would be questioned.

"Assessing mortality would help ...understand the magnitude of the problem and the severity of its consequences. Also, it will provide a good estimation of the number of people requiring anti-retroviral therapy (arv)," reasons Denis Broun, unaids country coordinator, India. But Tripti Tandon of hiv / aids unit, Lawyers Collective, a Delhi-based non-governmental organisation, argues: "This is still going to be only an estimate and will not solve any problem." There also does not seem to be any effort to include aids -linked deaths at private health care establishments in the estimate. To carry out the estimation, a group, led by naco and Indian Council of Medical Research, would be formed. The toll might be released in the coming 6-12 months.

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