“We have the will, we want the money”, says Shatrughan Sinha, India’s new Minister for Health. Reiterating his government’s commitment to stem the rise in new infections and to provide basic care services, he sought commitment from high income countries to deliver on their promises.

Meanwhile, his own promises will be put to the test by his government’s recent decision to woo private participation in health care delivery. The push towards social marketing of health care products has already seen a dramatic and worrying decline in condom availability to vulnerable groups, particularly women and young people.

The prospects for providing antiretroviral drugs to people with HIV may be worse, unless the new minister exercises considerable influence within the cabinet.

Strapped for cash, and with competing priorities in an already miniscule health budget, the government appears to have few options. India needs at least US$500 million every year to provide ARV treatments. In 1999 the World Bank advanced $200 million to be spent on HIV and AIDS programmes by 2004, including ARVs. A significant contribution from the Global Fund might be the only way to ensure that health remains a public sector responsibility.

India is the world’s largest producer and exporter of generic drugs. Locally produced ARVs cost ten times less than the branded products available internationally. Yet most people who need them still can’t afford them.

Close to 4 million people in India have HIV. In many regions, infection rates of 1% and more are common. So far, the government has supported interventions to promote safer sex, STI services and blood safety. A mother to child transmission programme covering the country will be in place soon.

That still leaves nearly four million people with HIV with little to look forward to.

AIDS 2002 Conference News produced by Health & Development Networks/Key Correspondent Team