Drugs sold over
the counter in India may fuel HIV

India needs to tighten control on the sale of prescription drugs to stem the spread of HIV, the Joint United Nations Programme on HIV/AIDS said on Monday. Many painkillers and sedatives are freely available over the counter in India without any prescription from doctors or hospitals, even though prescriptions are required by law. Some drugs end up injected into users' veins, and that is fueling an epidemic of intravenous drug use and HIV infection.

"The problem is the implementation of the law," said Suresh Kumar, who advises UNAIDS and the World Health Organization, at a news conference. "They are too few drug inspectors, and drug users shift to pharmaceutical preparations that are readily available."

Drug users, who no longer are satisfied by snorting or inhaling illicit substances, buy drugs from chemists without prescriptions (such as the painkiller Spasmoproxyvon), liquefy the powder, and then inject it into their veins. And they often share needles, a practice that has been shown to contribute to the spread of HIV.

Only 2.6% of India's 5.7 million HIV-positive people have been infected with HIV through intravenous drug use, but officials say that if intravenous drug use is not checked, it could fuel the spread of AIDS in the country with the world's highest caseload.

"Intravenous drug transmission may be small part of overall transmission, but it can be a turbo engine for accelerating the epidemic," UNAIDS regional adviser Swaroop Sarkar said at an Asian conference on HIV risk among intravenous drug users.

Many of India's estimated 200,000 intravenous drug users visit prostitutes, an activity that can expand the circle of infections.

Besides cracking down on illegal sales of drugs, experts said India also needed to prevent oral drug-users from switching to intravenous transmission.

Experts say that, for many drug users in South Asia, the gap between inhaling or snorting illegal substances and intravenous drug use is two to three years. Government and international agencies should use this period for stepping up prevention programs.

"This is a window of opportunity to intervene and prevent people from crossing over into injection drug use," said Gordon Mortimore, head of the Programme Management Office of the U.K.'s Department for International Development, India, which supports anti-AIDS programs. (Reuters)