Healing beyond medication

Even as Cipla bagged a large order for pediatric anti-retroviral (ARVs) formulations from the Bill Clinton Foundation, came the tragic news of the HIV positive parents who took the extreme step of killing their three children before hanging themselves. The trigger was the news that their youngest child tested HIV positive. Indian pharma companies may increase production capacities and exports of ARVs to the rest of the world, but medication cannot erase the social stigma attached to the disease.

It is now almost three decades since this retrovirus made its presence felt in 1979 in New York. This disease has never been like any other infection. It was first dubbed GRID, for Gay-Related Immunodeficiency Disease, because that gave a false sense of security that onlym 'high-risk' populations could be infected with the virus. It took only a few years for the virus to be the great leveler and researchers came to define 'high-risk' behaviour patterns. But even today, Indian society rejects HIV infected people. Be it the fisherman from Surat who contracted the virus in a Pakistani jail, and who was set free only to face rejecteion from his parents or numerous faceless and nameless cases who prefer to end a 'living death'.

This is clearly a case of social measures lagging medical research. While there are numerous NGOs to champion the AIDS/HIV cause and as many organisations that disburse funds for research and outreach programmes, the fact is that too many patients seem to fall through the cracks in the system. Are the funds being misappropriated? Why can not we ensure that pre-test counseling is followed, rather than being just a guideline on paper seldom implemented?

Medical ethics too is a grey area. The Adena-Associated Virus (AAV)- based vaccine trial, conducted at Pune's National AIDS Research Institute (NARI) ended on a controversial note last December, as it was later revealed that 15 days before the trial, the organisers already knew that the trial had failed in two other centres. Why was the trial allowed to continue? No doubt, there was a lot at stake for the agencies involved (National AIDS Control Organisation, NACO and International AIDS Vaccine Initiative, IAVI) but science must always weigh the human cost.

Moving ahead, Phase I trials of another vaccine candidate, this time a Modified Vacinia Anacara (MVA) vaccine developed in India, recently concluded in Chennai. Globally, a new concept of 'pre-exposure prophylaxis', which entails giving ARVs to uninfected people to build resistance to future risk of infection, is being tested. Almost canceling these findings, is the news that Nevirapine, used to prevent transmission of the virus from HIV infected mother to child, may actually give rise to drug-resistant strains of the virus in both mother and child.

It often seems that in the battle against HIV, for every step forward, we slip two steps back. As a recent article in The Economist puts it, the best way forward seems to be 'combination prevention', using prophylactics, changing behaviour patterns as well as trying new medication. The term dovetails with 'combination therapy', entailing a cocktail of ARVs, which rein in the spread of the virus better than a single ARV. Hopefully, Indian pharma companies which gave the world the first combination ARVs, will support counseling and rehabilitation efforts as well. Healing the psyche is sometimes more important than charting CD4 counts.

Viveka Roychowdhury
viveka.r@expressindia.com