Migrating virus

Bihar’s labour out migrants are one of India’s main carriers of HIV/AIDS — and the state government is infected with ennui

Ranjit Bhushan Patna

If HIV/AIDS is assuming alarming dimensions in India, it is indubitable that Biharis are one of its main carriers. Bihar produces more than 70 per cent of India's migrant labour population, who work all over the country, from the shipbreaking yards of Alang in Gujarat to the smoke-belching manufactories in Delhi and Mumbai. What is frightful is that there is a remarkably low awareness of the impact, spread and intensity of the disease in their home state.

In India, migrant labourers are one of the main carriers of the HIV virus. In Bihar, however, apart from some non-governmental organisation (NGO) initiative, there is little interest in identifying the problem. Health department officials say that they are overburdened by problems other than AIDS. In fact, government information on AIDS is so patchy that even basic statistics are unavailable with Bihar's health department. As for political commitment, AIDS was not even an issue in the recent Bihar Assembly election campaigns.

This is surprising, given that the latest data available with the National Aids Control Programme (NACP) and the National Aids Control Organisation (NACO) show that while Bihar is no Maharashtra or Andhra Pradesh in terms of the number of AIDS cases, it has begun receiving back a large number of probable HIV patients because of its peripatetic  labour. According to December 2004 figures, Bihar had 155 identified cases, compared with Maharashtra's 12,783 and Andhra Pradesh's 10,293.

Dr Dilip Sen, Director of Sen Diagnostics, working president of the Indian Association of Blood Banks and one of the most committed activists on AIDS in a region where interest in the subject is limited, says that the figures of AIDS victims are based on faulty premises. "The NACO figures are based on the state AIDS control societies, which obtain them from the voluntary counselling and testing centres (VCTC)," he says. "In Bihar, there are only two private laboratories, at Patna and Laheriasarai, that are recognised by the government. There are hundreds of non-government laboratories conducting HIV screening. Their records, however small, do contain some positives. They are not taken into account in the state's HIV statistics. How, then, do you arrive at an actual picture?"

This problem, although concentrated in Bihar, applies to the country at large. According to Sen, even without taking into account figures from private labs, the current official statistics of HIV incidence is nine positives per 1,000 persons. Even if that is accepted as true, and India's population being one billion (100 crore), the country incidence of HIV comes to nine million, while NACO puts the number at 5.3 million.

There appears to be a serious anomaly here. According to sources in the Union Health Ministry, positive cases up to the age of 15 are not taken into account. There are no reasons assigned to this deliberate downgrading, but it is clear that it brings down the numbers considerably. This flawed approach might have cost Bihar dearly.

The infrastructure designed for checking AIDS is poor in Bihar. For instance, laboratory tests to detect the intensity and progress of the disease are costly and out of reach of the average victim mostly casual labourers who have returned to the state infected with the virus. They, in turn, transmit it to their families, and thus the web grows more complex. According to female victims interviewed by NGO activists, once the husbands returned home after long periods at work, there was no way in which they could have refused sex with them.

"There is no question," one female victim told a local NGO. Her husband works in the diamond-cutting industry at Surat. It is for this lot that alternative healing is required. Tests like CD4, CD8 T cell counts and viral load tests are way beyond the purse of average patients. Some cheaper alternatives like total lymphocyte count, along with haemoglobin estimation, have been suggested, but there is neither a will nor a way to implement some of these proposals on the ground.

There could be much that is wrong. The state's response is lethargic. A NACP statement backs the charge: "Whereas states like Tamil Nadu, Andhra Pradesh and Manipur have demonstrated a strong response and high level of political commitment, many others like Bihar and UP have yet to reach those levels." Maybe, then, education about AIDS should begin with politicians.

The report is supported by the Project for International Health Journalism Fellowship Program, a colloboration of the Henry J. Kaiser Foundation and the Bill & Melinda Gates Foundation