India to expand its free antiretroviral therapy to cover all with HIV-AIDS.

NEW DELHI -- India will expand its antiretroviral therapy distribution program to people with HIV and AIDS.

By April of 2004, the government expects to begin providing free antiretroviral therapy to all HIV-positive new parents, all children under 15, in the six states with the highest rates of HIV and AIDS. Eventually, all people in those states with full-blown AIDS are to be treated.

Until now India offered antiretroviral treatment on a limited basis to prevent AIDS transmission from mothers to babies in childbirth.

The government must still reach a final agreement with the country's pharmaceutical companies, which manufacture generic versions of antiretroviral medications, to reduce their prices, as these companies recently agreed to do in Africa and the Caribbean.

The government still has to allocate funds to pay for drugs for as many as 100,000 people, in the first year. It also will have to reorganize and strengthen its public health system to provide for far broader testing, and train doctors and nurses to monitor the dosage and effects of antiretroviral therapy. Doctors in India prescribe anti-retroviral therapy, but at $1 a day, which is too high costs too high for most people. India's per capita income is less than $500 a year.

Most of the financing for India's programs to prevent or treat AIDS comes from outside donors like the World Bank and the Bill and Melinda Gates Foundation.

Recently, Cipla, Ranbaxy Laboratories Ltd. and Matrix Laboratories fourth Indian company, Hetero Drugs Ltd., and a South African company, Aspen Pharmacare Holdings reached an agreement with the William Jefferson Clinton Foundation to provide the drug to four African and nine Caribbean countries for about 37 cents per patient per day.

Sushma Swaraj, India's Union Minister for Health and Family Welfare, said she would approach the Finance Ministry for the money. The Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria also has agreed to provide India with $100 million over five years for prevention, treatment, voluntary testing and counseling, although technical disagreements have delayed the signing of a final agreement. The fund's director, Dr. Richard Feachem, said that it was possible that more of the money could be committed to treatment to support the new venture. But that reducing the price of the drugs would be critical.

Under the agreement, the companies will increase production in return for a guaranteed customer base. The companies will supply the therapy to at least 1.5 million patients during the next five years, and the price of their raw materials will be pre-negotiated with the government. They will sell directly to the foundation or the governments, rather than middlemen, and be paid immediately.