• UNAIDS has in its epidemiological factsheets, brought out regularly since '97, carried estimates of hiv/aids in India from '87 onwards. It shows an incredible jump in hiv/aids cases from just one in 1986 to 5.19 lakh in 1987 [one lakh = 100,000]. No one's sure where these figures came from. Both unaids and naco were non-existent at the time. Neither was any credible surveillance system in place in India.
  
  
• The 73rd parliamentary standing committee report on dreaded diseases, released in October 1998, put the number of those infected by hiv at 81.3 lakh. For the same year, the projection by naco and unaids was 40-50 lakh cases.
  
  
• In September 1999, the figure of 85 lakh hiv/aids cases in India was quoted in the UN General Assembly.
  
  
• The World Bank project appraisal document for proposed credit for the second phase of the national hiv/aids control project in 1999 made sweeping assumptions about the spread of the disease and the means to reduce it. One postulation was that one per cent of India's sexually active female population is involved in commercial sex work.
  
  
• In June and December 2000, unaids released hiv/aids data for India in 1999. It quoted 3.10 lakh aids deaths in 1999. The number of aids orphans was 5.58 lakh. Both figures were subsequently deleted in the revised update released in June 2001.
  
  
• NACO figures are at extreme variance. Cumulative deaths due to aids from 1986 to December 2000 was 1,759.

After the confusion over various projections, the health ministry introduced a new surveillance system in August 2000. The results were startling. The national average for hiv prevalence fell from 2.2 per cent to 0.35 per cent. Even more shocking were the revised figures for Manipur which was till then the target of most hiv/aids campaigns. From 18 per cent (highest in the country), the hiv/aids prevalence rate for the state fell to 0.4, one of the lowest in the country!

The erroneous calculations and faulty estimation has had a drastic impact on government priorities vis-a-vis financial outlay for the health sector. The aids scare meant that naco's campaign has been prioritised above health programmes for diseases like malaria, tuberculosis and kala azar. Even leprosy eradication has got stepmotherly treatment.

The second phase of the National hiv/aids Control Programme currently being implemented has a rich reserve of Rs 1,450 crore earmarked for it. Most of this amount has been sanctioned as credit by the World Bank and will have to be paid back from the public exchequer. Further, there is an even bigger share of funds directly flowing into the country from foreign donors to ngos.

Says Amit Sengupta, member of the Jana Swasthya Abhiyan—a network of over 1,000 grassroots ngos in the health sector: "Manipulating the figures suits both donor agencies and the ministry of health. The former because it allows them to push loans to combat the 'problem'. It allows agencies such as the World Bank to make domestic health policies 'captive' to their diktats and deflects criticism away from concerns that health problems in countries like India have accentuated as a result of the imf/wb-led economic policies. On the other hand, it is convenient for the health ministry because it allows it access to large loans."

There is also the bigger issue of the economics of combating the epidemic. "If one is to believe the claim that there are 35 lakh hiv/aids persons in the country, then annual treatment costs would amount to Rs 16,100 crore, according to the World Bank. Obviously, there is a vast market for creating the hiv/aids treatment infrastructure and enormous potential for the multinational pharmaceuticals to sell their drugs," says Purushothaman Mulloli of Joint Action Council Kannur (jack), which is leading the agitation against 'fraudulent' hiv/aids figures. Ramesh Sharma of the Gandhi Peace Foundation echoes the sentiment: "The entire campaign is being driven by multinational forces which are eyeing the huge market potential in the country."

Now consider the fact that unaids had reported 3.1 lakh aids deaths in India in 1999—which it later deleted. Dr Miller has this to say about the goof-up: "The mortality rate does need some scientific basis. We are looking at a number of alternatives to arrive at some accurate number. We would rather be late and right than be premature and wrong. We have been working with naco to get the correct figures. First thing would be to get the methodology straight and then derive figures based on that."

But naco officials blame unaids for projecting faulty figures. Notes Dr Mohammed Shaukat, deputy director (technical), naco: "By the year 1998, they (unaids) had calculated 41 lakh hiv/aids cases whereas our estimation was 35 lakh. unaids has its own mathematical models and their projections were based on mathematical guesses." If Shaukat is to be believed, the estimation of 5 lakh infections within a year after the first aids case was detected in 1986 by unaids could be at best guesswork for "sero-surveillance figures till '94 showed only some 50,000 infections."

Says Rami Chhabra of the Independent Commission on Health in India: "Flawed estimates in hiv/aids cases could result in scams of enormous public expenditures, vindicated through proclaiming success in 'infections averted' when such levels are not scaled in the first place. It is also leading to a scenario of fudged figures for 'sterilisation and births averted' in the family planning programme."

According to Chhabra, the worst impact is being felt on the Public Health Service (phs). "In the name of decentralised implementation, brand new registered societies in states, union territories and municipal corporations for hiv/aids have been formed. This compartmentalises the whole issue and creates a parallel infrastructure—highly resource-wasting and also less accountable," she says.

The only positive step in the anti-aids campaign is that everyone agrees that the figures in hand do not reflect ground realities. It is now for the health ministry to give its official stamp to what are the actual numbers.