India's National ART Programme to combat HIV would not have seen light of day if not for Sushma Swaraj

The first case of HIV in India was detected in Chennai in 1986. There was great amount of denial when it came to the initial news of the infection, but very soon the reality of the epidemic was staring us in the face. In 2001, around 6.1 million people in India had contracted HIV. It was the country with the largest HIV population in the world at that time. There is no cure, only lifelong therapy with anti-retro viral therapy (ART) — which is a cocktail of three or more drugs. There was no access for most to the lifesaving ART that was extremely expensive. The only developing country in the world that was distributing these drugs as part of its public health system was Brazil. For those of us who were working closely with people living with HIV/AIDS, Brazil was a distant dream. I had personally paid my respects at no less than 50 funerals between 2002 and 2003. We did not think ART would come to India. The reasons against it were that our numbers are huge, our country is large and diverse, our people are largely illiterate, and the drugs are complex requiring continued compliance. Furthermore, diagnostic facilities needed to be strengthened and the health system was not uniform throughout the country and so on. The drugs must be taken every day for life — without missing a dose. If doses are missed, then the virus becomes resistant to existing drugs, resulting in a much larger problem. The cons clearly seemed to outweigh the pros when it came to whether ART should be implemented. [caption id=“attachment_4696391” align=“alignleft” width=“380”] File image of former external affairs minister Sushma Swaraj. AP[/caption] Enter Sushma Swaraj. She was made Union health minister in January 2003 and continued until May 2004 when India went for the Lok Sabha polls. There was a big file sitting on her table with regards to ART. WHO advised her not to sign the file and warned that the ART programme had too many challenges for India. Implementation, it stated, would be a nightmare and 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 three million people with ART by the end of 2005 in low and middle income countries. WHO and several international technical health experts cautioned Swaraj not to proceed. The file sat on her table. It was under these circumstances that Swaraj went to Kollam for some function on 30 November, 2003. The story goes that an elderly gentleman broke the security cordon and presented his grandchildren Bency and Benson to Swaraj and asked what would happen to them when he was dead. He asked, “When are we going to get the life saving drugs?” Swaraj spontaneously hugged the children and her eyes went moist when doing so. Visuals of Swaraj embracing the children went “viral”. The next day was 1 December — World AIDS Day and the picture of Swaraj with the kids made the front page of most newspapers. Little did we know that she quietly signed off on the file that had been sitting on her table for over a 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, the BJP nominated Swaraj to contest against Sonia Gandhi in the 13th Lok Sabha election from the Bellary constituency in Karnataka. She lost by a very small margin. Bellary was a district with one of the highest occurrences of HIV 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 1 December, 2003, Swaraj kept her promise that she made to the women with HIV in Bellary and announced the National ART Programme. The rest is history. When the programme rolled out on 1 April, 2004, she was busy with the General Election that her party lost. It remains one of the largest and best implemented public health programmes in the world. What I learnt from this real life story is that women leaders sometimes make decisions with their hearts, and they are often very good decisions. _Sushma Swaraj's final rites to take place in Delhi today; follow latest news updates_