ART

Now for the most beautiful story I always tell at every training program for Health and Policy Planners/Makers:

Sushma and Bency/Benson

You may not know but the first case of HIV was detected in Chennai in 1986.There was great amount of denial to the initial news of the infection, but very soon the reality about the epidemic was staring us in our face.In 2001 around 6.1 million people with HIV were living in India. It was the country with the largest HIV population in the world at that time. There is no cure only lifelong therapy with ART called anti-retro viral therapy (ART) – which is a cocktail of 3 or more drugs. – There was no access to the life saving ART which was highly expensive HIV medicines. The only other developing country in the world that was giving these drugs in the public health system was Brazil.

So for us who were working closely with people living with HIV/AIDS, Brazil was a distant dream. I had personally gone to atleast 50 funerals between 2002-2003. We did not think ART would come to India. The reasons against it were our numbers are huge, our country is large and diverse, our people are largely illiterate, and the drugs are complex requiring continued compliance, diagnostic facilities must be strengthened and the health system is not uniform throughout the country, the health care system was ready for ART delivery and so on. The medicine must be taken every day lifelong – without missing doses. If doses are missed, then the HIV virus becomes resistant to existing drugs, so we will have a much larger problem in our hands. The cons clearly seemed to outweigh the pros when it came to whether ART must be implemented.

Enter Sushma Swaraj. She was made Union Health Minister in Jan 2003 and continued until May 2004 when India went for the general polls. There was big file sitting on her table with regard to ART. WHO adviced her not to sign the file and warned that ART Program has too many challenges for India. Implementation will be a nightmare and will lead to high resistance strains of the virus. But on the other hand there was the “3 by 5” strategy of the UN – to reach 3 million people with ART by the end of 2005 in low and middle income countries. WHO and several International technical health experts cautioned Sushma not to proceed. The file sat on her table.

It was under these circumstances that Sushma Swaraj came to Kollam for some function on November 30th 2003. The story goes that the grandfather broke the security cordon and presented Bency and Benson to Sushma and charged what will happen to them when he is dead. He asked, “When are we going to get the life saving drugs?” Sushma spontaneously hugged the children and her eyes went moist when doing so.

Sushma hugging the children went “viral”. The next day was 1st December – World AIDS Day and we saw the picture of Sushma with the kids on front pages of newspapers. Little did we know that she quietly signed the file sitting on her table for more than 1 year later that day. She obeyed her heart when every sound council and expert asked her not to.

Now for some back story – in September 1999, BJP nominated Sushma Swaraj to contest against Sonia Gandhi in the 13th Lok Sabha election, from the Bellary constituency in Karnataka. She lost be a very small margin. Bellary was one of the highest HIV prevalence districts in India at that time. When she went on a door to door campaign for votes the infected women and women’s network used to tell her – we will vote for you if you give us ART.

On 1st December 2003 Sushma Swaraj kept her promise that she made to the women with HIV in Bellary and announced the National ART Program. The rest is history. When the Program rolled out on 1st April 2004, she was busy with the general elections which her party lost. It is one of the largest and best implemented public health programs in the world.

What I learnt from this real life story – women leaders sometimes make decisions with their heart – and they are often very good decisions.

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