| | Notices | Welcome to the PaGaLGuY.com MBA forums. You are currently viewing our boards as a guest which gives you limited access to view most discussions and access our other features. By joining our free community you will have access to post topics, communicate privately with other members (PM), respond to polls, upload content and access many other special features. Registration is fast, simple and absolutely free so please, join our community today! If you have any problems with the registration process or your account login, please contact us at info [at] pagalguy.com | English Resources Drop in with your Reading Comprehension, Verbal Ability, Logic and related queries. | | | |
has no status.
Certified PaGaL
Status: Offline Posts: 1,565 Join Date: Jun 2006 Location: Gurgaon Groans: 100
Groaned at 51 Times in 31 Posts
Thanks: 3,796
Thanked 5,323 Times in 997 Posts
| RC Digest for CAT 2007 -
23-03-2007, 12:57 PM
One of the Keys to CAT 2007 will be the ability to read fast and absorb faster!!!
With this aim in mind I will be posting passages everyday for reading from different topics and also post relevant links.
ALL THE BEST!!!
Regards
Tanveer
p.s It would be a really helpful excercise if, after going through the paragraphs we tried to think what kind of questions could come from the paragraph and list them down and post them here.
Last edited by writetotanveer; 23-03-2007 at 01:59 PM.
| | | | | The Following 2 Users Say NO Thank You to writetotanveer For This Un-useful Post: | | | The Following 171 Users Say Thank You to writetotanveer For This Useful Post: | 0000 (07-04-2007), abhi.perot (05-06-2007), abhichin (02-08-2007), abhishekuit (04-09-2007), abhi_g1 (08-04-2007), Absolute (25-03-2007), achin123 (10-05-2007), agg.gautam (20-07-2007), agrawalansh (10-04-2007), AKASHDEEP3 (19-10-2007), Akshat84 (10-08-2007), ami_goel (03-04-2007), anubhav_1986 (23-06-2007), anupam_288 (12-05-2007), anupsinh (05-04-2007), apps_2k3 (20-06-2007), archiserrao (25-07-2007), arindam83 (02-05-2007), arunk8186 (12-11-2007), arunm (27-09-2007), athipathi (19-08-2008), aviva (29-05-2007), Ayyappan (03-04-2007), bankebihari (05-05-2007), bantepro (09-05-2007), Basilisk (26-07-2007), beldcat (24-03-2007), bellthecats (15-04-2007), bhartiya (20-07-2007), bhokalivarun (25-05-2007), bindlishsonia (28-03-2007), BlUeStArR (03-06-2008), buddyakash (22-06-2007), CATcherintherye (24-03-2007), Che_Guevara (07-05-2007), choprasudhanshu (18-06-2007), chotakamal (01-08-2007), c_mon_chatty (03-04-2007), Darth Maul (14-09-2007), deepak_nanhu (27-03-2007), devdas2020 (26-07-2007), divya krishn (14-12-2007), drgrudge (21-11-2007), dsotm_floyd (06-07-2007), duftry (19-06-2007), eclectic (11-09-2007), fire in my bell (03-10-2007), freakinmaniac (05-04-2007), gamodg (05-02-2008), gaurishankar (18-09-2007), genius@making (10-08-2007), getintoiimb (05-04-2007), govind_sharan (06-09-2007), harrysk (16-10-2007), harshad83 (30-04-2007), HarshaRocks (06-04-2007), hemant.bhalke (11-05-2007), howler (02-04-2007), hunny_1983 (09-05-2007), IAYF (13-07-2007), iimaaspirant (30-03-2007), iimbhakt (10-06-2007), impero_romano (20-04-2007), imroot (04-09-2007), inzaneabhi (06-08-2007), jaikishen (02-04-2007), jeevan18 (03-04-2007), jhaji (23-03-2007), jhontyb (28-04-2007), jigar_desai (18-08-2007), JOURNEYTOTHEIIM (04-04-2007), justlikethat (23-03-2007), jyotsna07 (04-06-2007), k10kamat (17-10-2007), karanmaroo (21-07-2008), kavita_iet (13-05-2007), krisheer (16-06-2007), krsh.vik (05-04-2007), kulkarniy2k (05-04-2007), loudy107 (19-08-2007), MachiaVelli (26-03-2007), mann_sonu (29-07-2007), manshul.goel (11-07-2008), maulin (29-04-2007), mayankim (26-06-2007), mbain2007 (16-10-2007), medulla (16-07-2007), miles (07-04-2007), minkuvg (04-09-2007), miteshkum (06-04-2007), murugank (13-04-2007), myownniche (07-05-2007), nandan2000 (24-07-2007), navinchaudhary (05-05-2007), neetugw (15-05-2007), nishant_rungta (23-03-2007), no signal (19-08-2007), Obsessed_bout_mba (15-07-2007), oliveLEO (07-05-2007), orchid (04-04-2007), Outclassed (08-05-2007), panwar_akanksha (09-05-2007), parameswar05 (04-02-2008), parulrautela (07-08-2007), patriot123 (07-08-2007), pavan252 (07-07-2007), Plumber (27-03-2007), popoye (28-09-2007), pr!yank (16-12-2007), prats_9 (17-04-2007), pulverize (05-07-2007), r11gupta (23-09-2007), rahulworld (23-03-2007), rani_das (03-04-2007), reachmonil (23-03-2007), RISING (23-03-2007), rustyguy (24-06-2007), samm_dude (24-05-2007), sangeethapai18 (16-06-2007), sarsij (29-05-2007), sasasa (18-07-2008), sastry751 (17-04-2007), satishmedos (23-11-2007), saurabh.gulati (13-04-2007), saurabh20_manit (14-04-2008), sb29 (03-04-2007), screwdriver (15-08-2007), sdpkm.dee (14-05-2007), seshadri.r (23-03-2007), shabadp (01-09-2007), shenoyvarun86 (08-05-2007), shivakanthm (18-05-2007), ShreeMaya (23-05-2007), shudh (03-04-2007), shyamnaren (31-03-2007), sid_dharth (23-03-2007), sisir4uonly (27-10-2007), sohan shetty (22-08-2007), spkris (24-07-2007), SrinivasEppili (02-07-2007), ssumcy (27-06-2007), sub.paras (17-08-2007), subhrch (08-08-2007), sudhanshubadola (18-02-2008), sudipta12 (02-01-2008), suman singla (10-08-2007), sunll (18-10-2007), SUPER XERO (06-10-2007), swap2007 (11-07-2007), tatimatla (10-05-2007), theultimate1 (14-08-2007), the_performer (30-03-2007), the_phantom (23-03-2007), tirthodreams (29-03-2007), Topgear (05-07-2008), tuxilogy (24-04-2007), unleashthebeast (23-03-2007), varshita (16-06-2007), varunthelibran (02-04-2007), vendetta (15-05-2007), vibhu1.618 (19-06-2007), vikram_k51 (25-03-2007), vinayklin (19-07-2007), vineet.nitd (26-03-2007), virajmehta2007 (10-05-2007), VisionPlusForU (01-07-2007), visusankar (29-05-2007), visuwithsmile (02-05-2007), vyomb (19-06-2007), whoiscnu (27-05-2008), Yuri Andropov (18-05-2007) | | | | |
has no status.
Certified PaGaL
Status: Offline Posts: 1,565 Join Date: Jun 2006 Location: Gurgaon Groans: 100
Groaned at 51 Times in 31 Posts
Thanks: 3,796
Thanked 5,323 Times in 997 Posts
| Topic: Philosophy -
23-03-2007, 01:01 PM
SOCRATES The most interesting and influential thinker in the fifth century B.C. was Socrates, whose dedication to careful reasoning transformed the entire enterprise. Since he sought genuine knowledge rather than mere victory over an opponent, Socrates employed the same logical tricks developed by the Sophists to a new purpose, the pursuit of truth. Thus, his willingness to call everything into question and his determination to accept nothing less than an adequate account of the nature of things make him the first clear exponent of critical philosophy Although he was well known during his own time for his conversational skills and public teaching, Socrates wrote nothing, so we are dependent upon his students (especially Xenophon and Plato) for any detailed knowledge of his methods and results. The trouble is that Plato was himself a philosopher who often injected his own theories into the dialogues he presented to the world as discussions between Socrates and other famous figures of the day. Nevertheless, it is usually assumed that at least the early dialogues of Plato provide a (fairly) accurate representation of Socrates himself. In the Euqufrwn (Euthyphro), for example, Socrates engaged in a sharply critical conversation with an over-confident young man. Finding Euthyphro perfectly certain of his own ethical rectitude even in the morally ambiguous situation of prosecuting his own father in court, Socrates asks him to define what "piety" (moral duty) really is. The demand here is for something more than merely a list of which actions are, in fact, pious; instead, Euthyphro is supposed to provide a general definition that captures the very essence of what piety is. But every answer he offers is subjected to the full force of Socrates's critical thinking, until nothing certain remains. Specifically, Socrates systematically refutes Euthyphro's suggestion that what makes right actions right is that the gods love (or approve of) them. First, there is the obvious problem that, since questions of right and wrong often generate interminable disputes, the gods are likely to disagree among themselves about moral matters no less often than we do, making some actions both right and wrong. Socrates lets Euthypro off the hook on this one by aggreeing—only for purposes of continuing the discussion—that the gods may be supposed to agree perfectly with each other. (Notice that this problem arises only in a polytheistic culture.) More significantly, Socrates generates a formal dilemma from a (deceptively) simple question: "Is the pious loved by the gods because it is pious, or is it pious because it is loved by the gods?" (Euthyphro 10 a) Neither alternative can do the work for which Euthyphro intends his definition of piety. If right actions are pious only because the gods love them, then moral rightness is entirely arbitrary, depending only on the whims of the gods. If, on the other hand, the gods love right actions only because they are already right, then there must be some non-divine source of values, which we might come to know independently of their love. In fact, this dilemma proposes a significant difficulty at the heart of any effort to define morality by reference to an external authority. (Consider, for example, parallel questions with a similar structure: "Do my parents approve of this action because it is right, or is it right because my parents approve of it?" or "Does the College forbid this activity because it is wrong, or is it wrong because the College forbids it?") On the second alternative in each case, actions become right (or wrong) solely because of the authority's approval (or disapproval); its choice, then, has no rational foundation, and it is impossible to attribute laudable moral wisdom to the authority itself. So this horn is clearly unacceptable. But on the first alternative, the authority approves (or disapproves) of certain actions because they are already right (or wrong) independently of it, and whatever rational standard it employs as a criterion for making this decision must be accessible to us as well as to it. Hence, we are in principle capable of distinguishing right from wrong on our own. Thus, an application of careful techniques of reasoning results in genuine (if negative) progress in the resolution of a philosophical issue. Socrates's method of insistent questioning at least helps us to eliminate one bad answer to a serious question. At most, it points us toward a significant degree of intellectual independence. The character of Euthyphro, however, seems unaffected by the entire process, leaving the scene at the end of the dialogue no less self-confident than he had been at its outset. The use of Socratic methods, even when they clearly result in a rational victory, may not produce genuine conviction in those to whom they are applied. Because of his political associations with an earlier regime, the Athenian democracy put Socrates on trial, charging him with undermining state religion and corrupting young people. The speech he offered in his own defense, as reported in Plato's Apologhma (Apology), provides us with many reminders of the central features of Socrates's approach to philosophy and its relation to practical life. Plato's description of Socrates's final days continued in the Kritwn (Crito). Now in prison awaiting execution, Socrates displays the same spirit of calm reflection about serious matters that had characterized his life in freedom. Even the patent injustice of his fate at the hands of the Athenian jury produces in Socrates no bitterness or anger. Friends arrive at the jail with a foolproof plan for his escape from Athens to a life of voluntary exile, but Socrates calmly engages them in a rational debate about the moral value of such an action. Of course Crito and the others know their teacher well, and they come prepared to argue the merits of their plan. Escaping now would permit Socrates to fulfil his personal obligations in life. Moreover, if he does not follow the plan, many people will suppose that his friends did not care enough for him to arrange his escape. Therefore, in order to honor his commitments and preserve the reputation of his friends, Socrates ought to escape from jail. But Socrates dismisses these considerations as irrelevant to a decision about what action is truly right. What other people will say clearly doesn't matter. As he had argued in the Apology, the only opinion that counts is not that of the majority of people generally, but rather that of the one individual who truly knows. The truth alone deserves to be the basis for decisions about human action, so the only proper apporoach is to engage in the sort of careful moral reasoning by means of which one may hope to reveal it. Socrates's argument proceeds from the statement of a perfectly general moral principle to its application in his particular case: - One ought never to do wrong (even in response to the evil committed by another).
- But it is always wrong to disobey the state.
- Hence, one ought never to disobey the state.
Last edited by writetotanveer; 25-03-2007 at 09:19 PM.
Reason: Error
| | | | | The Following 34 Users Say Thank You to writetotanveer For This Useful Post: | abhichin (03-08-2007), ankit_110185 (17-07-2007), anshaar (20-12-2007), anupsinh (05-04-2007), apoorv2310 (06-02-2008), archiserrao (05-07-2007), arindam83 (02-05-2007), Arun Paliwal (17-05-2007), ashish.66 (14-06-2007), beldcat (26-03-2007), bhartiya (20-07-2007), CATcherintherye (24-03-2007), dsotm_floyd (01-09-2007), gmalhotra86 (24-05-2007), g_nandagpl (17-04-2007), HarshaRocks (22-08-2007), jeevan18 (03-04-2007), k10kamat (17-10-2007), kunnalsingh (04-04-2007), madhaw (03-09-2007), manutdherewego (24-08-2007), naren31 (01-04-2007), popoye (28-09-2007), rani_das (03-04-2007), route_to_perdition (07-04-2007), satwik_204 (01-05-2007), saurabh20_manit (14-04-2008), shivakanthm (21-05-2007), sourabh_911 (19-06-2007), spkris (03-08-2007), sravanthinandur (11-05-2007), targetmba08 (24-07-2007), truly insane (11-07-2007), varunthelibran (02-04-2007) | | | | |
has no status.
Certified PaGaL
Status: Offline Posts: 1,565 Join Date: Jun 2006 Location: Gurgaon Groans: 100
Groaned at 51 Times in 31 Posts
Thanks: 3,796
Thanked 5,323 Times in 997 Posts
| Topic: Leadership -
23-03-2007, 01:59 PM
For 15 years I lived in a monastic community as a Catholic priest. I now devote most of my time to Corporate America working on executive development, change management and organizational healing. Actually, the jobs have proven to be quite similar - except the pay is a lot better now. Employee surveys increasingly confront executives with three major issues: nobody trusts; employees don't believe in senior management; and workers are too stressed out to care. Problems with trust, belief and caring. In my monastic days, we referred to this quandary as a crisis of Faith, Hope and Charity. I believe the problems confronting leaders today are more spiritual than fiscal. It strikes me as a bit unfair to expect engineers and accountants to be masters of the spiritual domain. So here are nine fun ways to get you started. 1 - Become a better communicator by keeping your mouth shut. Communication improves when you learn to be quiet and listen. This is no small task in a dominant business culture that says the ones that speak the most (and the loudest) win. The more effective leaders are the ones who can let go of their need to defend, explain and justify - and simply be present to the pain and imperfection in the company. It's only after employees have said all they wanted to say (or "emptied" themselves) that they become open to hear anything that you have to offer. I find it downright saintly to find a leader who has some comfort level with silence. 2 - Eat lunch in the cafeteria. You can find out more about what's going on in your company by noshing with staff than by reissuing the Employee Survey. Just grab some cafeteria delicacy, plop yourself down at a table of co-workers, introduce yourself and say: "So, how's things going?" Resist the executive temptation to correct, solve, judge and reinterpret. Employees feel affirmed when you ask for their opinion and actually make room for a response. While you will hear some plain old moaning, you will also hear about practices that are frustrating employees and hindering operational performance. In a short time, perhaps just by making a few calls, you'll be well on the road to eliminating some unproductive behaviors ... as well as improving employee trust and hope - two spiritual qualities that directly hit the bottom line. 3 - Send hand written cards. Sit down and actually hand write a note to someone. Real pen; real paper - no E-mails. It's seldom done - and it's powerful. Spend the first 15 minutes of your day writing personal notes to people who are doing the right things. Saying thanks has become a lost art in the frenetic world of 24/7. It's a morale booster that costs pennies. You are not only responsible for the quantitative side of the business. You're also responsible for the qualitative piece. You're accountable for the "heart" of the company - its maintenance and healing. Valentine's Day has now become your domain. Use it by sending lots of Valentine cards; sign them "from someone who notices your good efforts." 4 - Say a Prayer. The work of a leader is spiritual: building trust; inspiring staff; fostering creativity. You'd be foolish not to ask for all the help you can get - and prayer is a good way to start. Prayer can also improve that much needed executive skill: humility. It's often only after you've arrived in a leadership position that you realize that you're really not "in charge" of much. Success, both personal and corporate, is largely dependent on people and things outside your control. Humility is merely the willingness to recognize it. Prayer also gives you a chance to apologize. It helps to say, "I'm sorry" to the Gods for things you, your employees and company have done wrong in the quest to succeed. Who knows, maybe the reason the company's in a slump is because nobody's apologized to the Divine? As a leader, it's now part of your job. 5 - Meet with coworkers in their cubicles. While you may be more comfortable having staff meet in your office, it's more valuable to leave and meet them where they are located. Leadership is not about your comfort, but that of employees. The rarefied air of the executive suite can become toxic. I also think of it as giving a sort of "home court advantage." An insightful leader meets people where they work, accepts them for their unique gifts. Also, the symbolic value of seeing you mingling with the troops improves trust. General Patton used this effectively and won many a battle by the loyalty his troops had for him. 6 - Spend quiet time with yourself. A leader's value is determined both by whom she is as well as what she does. Spending time doing nothing increases your awareness and creativity. You become better able to respond rather than react. Being still, even for a few minutes each day, provides the foundation for becoming less operational and more strategic. You see the bigger issues, the underlying conflict, the creative approach that will take the organization to the next level. The Gods bestow the gift of wisdom, not in the maelstrom of activity, but in the silence within. 7 - Visit art museums. Leadership is not only a science. It's also an art. What better way to develop this aspect than by spending time with the "masters?" Tell your staff that you'll be gone for the day. Remind them that they're in charge. Then take off and walk the corridors of your local museum. Even if you never took an art appreciation class, you can still amble among these solemn halls and ask yourself fun questions like: How can my organization be more creative? What can I do to reward more risk taking? What are some unmet needs that might expand the business? And, my favorite question, what would I do if I knew I wouldn't fail? 8- Increase tolerance for opinions that drive you wacky. The future never arrives as you expect. Breakthroughs show up as irritating distractions to your defined business goals. Leaders with vision seek out discordant voices and surround themselves with people who challenge basic assumptions and traditional ways. Experiment with expanding your sense of humor so that you can play with those who see the world differently. Being able to question commonly accepted business practices and living with the ambiguity that this produces is the fertile ground for divine revelation. 9 - Work on the impossible. One of the things I learned in the monastery was: just because something is impossible, doesn't mean you don't have to work on it. (Why else would I have been required to take the vow of celibacy?) Some of what a leader is required to work on will not be accomplished in his lifetime. That's what vision, brilliance and legacy are about. To those overwhelmed by this task, I give you the words of my old religious superior: if you think you're too small to be effective, then you've never been in bed with a mosquito. It is your task to explore and initiate impossible efforts that will serve the next generation. You have an executive responsibility to take politically incorrect stands in service of the long term corporate common good. Practicality and common sense be damned when it's clear what implausible work needs to be accomplished. The poet Theodore Roethke said it well: "What we need is more people who specialize in the impossible." Worried that this will negatively impact your career? Don't. Since the work is "impossible" everybody will have very low expectations - so even making a little progress makes you look like a star. Likewise, because most of your peers will run headlong away from this challenge, you'll have little competition ... and the Gods just may come to your assistance giving you great surprise and success. Finally, mixing God and mammon makes good business sense. Employees have many God given talents that they want to contribute, if someone would just lead the way. Thomas Aquinas, the medieval saint, once said: "Without work, it is impossible to have fun." The world of business is undergoing a radical transformation that is inviting the spiritual assets of the workforce into the hallowed halls of commerce. Now go and do what any self-respecting leader should! Put yourself out in front of this transformation ... and take credit for starting it all. And be sure to have some fun while you're leading the charge.
Last edited by writetotanveer; 23-03-2007 at 02:07 PM.
| | | | | The Following 20 Users Say Thank You to writetotanveer For This Useful Post: | abhichin (03-08-2007), ankit_110185 (17-07-2007), anshaar (20-12-2007), anubhav_1986 (22-06-2007), archiserrao (05-07-2007), beldcat (26-03-2007), bhartiya (20-07-2007), CATcherintherye (24-03-2007), duftry (19-06-2007), in210223 (27-05-2007), maheshtk_21 (16-06-2007), midhun murali (26-06-2007), naren31 (01-04-2007), popoye (28-09-2007), rani_das (03-04-2007), route_to_perdition (08-04-2007), satwik_204 (01-05-2007), saurabh20_manit (14-04-2008), snaptrix (29-05-2007), virajmehta2007 (02-05-2007) | | | | |
has no status.
Certified PaGaL
Status: Offline Posts: 1,565 Join Date: Jun 2006 Location: Gurgaon Groans: 100
Groaned at 51 Times in 31 Posts
Thanks: 3,796
Thanked 5,323 Times in 997 Posts
| Topic: Management -
23-03-2007, 02:37 PM
| | | | | The Following 19 Users Say Thank You to writetotanveer For This Useful Post: | abhichin (03-08-2007), apps_2k3 (20-06-2007), archiserrao (05-07-2007), arunk8186 (12-11-2007), bhartiya (20-07-2007), full2fun2sh (17-04-2007), harrysk (16-10-2007), HarshaRocks (22-08-2007), iimaaspirant (30-03-2007), midhun murali (26-06-2007), murugank (02-04-2007), rani_das (03-04-2007), route_to_perdition (08-04-2007), satwik_204 (01-05-2007), saurabh20_manit (14-04-2008), sb29 (03-04-2007), shivakanthm (18-05-2007), shyamnaren (31-03-2007), virajmehta2007 (02-05-2007) | | | | |
has no status.
Certified PaGaL
Status: Offline Posts: 1,565 Join Date: Jun 2006 Location: Gurgaon Groans: 100
Groaned at 51 Times in 31 Posts
Thanks: 3,796
Thanked 5,323 Times in 997 Posts
| Title: Medicine -
23-03-2007, 06:22 PM
Robert Steinbrook, M.D.
On April 1, 2007, India will launch a new phase of its National AIDS Control Program (NACP). Its goals include reducing the number of new human immunodeficiency virus (HIV) infections — currently, an estimated 98.5 to 99.5% of India's 1.1 billion people remain uninfected — improving treatment, and providing therapy to more people. The 5-year program, known as NACP-III, has a budget of about $2.6 billion, two thirds of which is earmarked for prevention and one sixth for treatment (with the remainder primarily for management), and represents a substantial increase in the attention to and spending on HIV–AIDS. More than 80% of the funds will come from outside India — from the World Bank and other international organizations, governments, and philanthropies. Most of the funding has already been committed.
When I visited India earlier this year, it was evident that the HIV epidemic was only one of the country's many pressing health problems. 1 India must decide whether to commit more of the resources that are fueling its rapid economic growth — and the growth of its private health care industry — to improvements in public health and basic health care. 2 In 2003, public expenditure on health represented only 1.2% of India's gross domestic product. 3 There are 60 physicians per 100,000 population (as compared with 230 in Britain and 256 in the United States). With regard to HIV, challenges include increasing the number of patients receiving treatment, making additional antiretroviral medications available, improving the monitoring of therapy, training physicians and other health care workers, caring for patients with tuberculosis coinfection (see pages 1198–1199), and reducing stigma and discrimination.
Although prevention will account for a smaller percentage of the total NACP resources than at present, it will remain the focus of India's AIDS control strategy. The components of the strategy are similar to those in other South Asian countries and include intensive prevention efforts directed at the high-risk groups of commercial sex workers, injection-drug users, and men who have sex with men, as well as "bridge populations" such as truckers and migrant workers. 4 Avahan (Sanskrit for "a call to action"), the India AIDS initiative of the Bill and Melinda Gates Foundation, addresses gaps in India's national response and aims "to prove that prevention can be done at scale," according to Ashok Alexander, the program's director. The components of India's strategy also include expanded HIV counseling and testing and treatment for sexually transmitted diseases, broad communication of information on prevention, promotion of condom use, an increase in the proportion of blood donation that is voluntary (since payment for donation attracts high-risk donors), improved access to safe blood, and expansion of programs for preventing mother-to-child transmission.
Each year, about 28 million children are born in India. Skilled health care personnel attend less than half of all births; infant mortality is about 55 per 1000 live births. In 2004, only an estimated 4% of all pregnant women received HIV counseling and testing, and only about 2% of HIV-positive pregnant women received antiretroviral prophylaxis, usually consisting of a single peripartum dose of nevirapine. Moreover, HIV-positive pregnant women may benefit from antepartum combination antiretroviral treatment for their own health. Under NACP-III, more pregnant women should receive monitoring of their CD4 cell counts, antiretroviral treatment, regimens designed to prevent HIV transmission (including combinations of antiretroviral drugs), and other services.
In scaling up treatment, India's domestic pharmaceutical industry has a critical role. A paradox is that Indian companies have become major suppliers of low-cost generic antiretroviral medications to low- and middle-income countries in Africa and elsewhere at a time when there are still major unmet needs for HIV treatment in India. Cipla, a company based in Mumbai, manufactures the largest range of HIV drugs and has the largest market share. Cipla exports 18 times as much antiretroviral medication as it sells domestically, according to Amar Lulla, its joint managing director. Retail drug prices are higher in India than in Africa, in part because of taxes. Eventually, enhanced patent protection for pharmaceuticals in India, which took effect in January 2005, may lead to higher prices. So far, however, no relevant patents have been issued. Initially, "government activities were not [proceeding] at the speed at which the virus was spreading," according to Suniti Solomon, director of Y.R.G. CARE, a nongovernmental treatment, research, and education facility in Chennai. In April 2004, India launched its public-sector antiretroviral treatment program at eight centers. As of January 31, 2007, about 56,500 patients were receiving treatment at 103 centers (see graph); about 62% were men, 32% women, and 6% children. Perhaps 10,000 to 20,000 additional patients were receiving treatment in the private and nongovernmental sectors. The goal is to have 250 public centers open within 5 years, providing free antiretroviral treatment to 300,000 adults and 40,000 children. However, there is no way to know whether this response will be sufficient.
Patients with HIV infection in India can receive care in the private sector that is indistinguishable from that provided in leading treatment centers around the world. All the relevant medications and laboratory tests are available. In fact, HIV medications, like other drugs, are sold over the counter. Some doctors and pharmacists, however, provide treatments that make no sense — Solomon says she knows of instances in which a patient was told to take ineffective regimens, such as one zidovudine tablet twice a day for 21 days. The provision of ineffective regimens and the development of drug resistance are major concerns.
The national program provides laboratory tests, such as CD4 cell counts, and medications at no charge to the patient. At present, five first-line antiretroviral medications are provided: the nucleoside analogues lamivudine, stavudine, and zidovudine and the nonnucleoside reverse-transcriptase inhibitors efavirenz and nevirapine. More expensive first-line medications (i.e., tenofovir and emtricitabine) are not provided, nor are second-line medications and more expensive laboratory tests, such as measurement of plasma HIV RNA levels. The immediate priorities are to start patients on first-line regimens, to achieve high rates of compliance through supervised therapy and intensive counseling, to build infrastructure, and to ensure that people are not "dying for lack of access to drugs that are available and affordable," according to Sujatha Rao, the director general of India's National AIDS Control Organization.
It seems inevitable that the national program will have to cover additional first-line treatments, second-line treatments, and measurement of plasma HIV RNA levels and that its protocols will eventually reflect the updated recommendations of the World Health Organization. 5 Yet the costs of such tests and second-line medications — which, at about $2,000 a year, are about 10 times those of some first-line regimens — remain formidable. According to Rao, a policy of covering additional drugs is "a big responsibility. Once the government says it will provide you with these drugs, it is a commitment forever."
The largest AIDS care center in India is the Government Hospital of Thoracic Medicine, Tambaram Sanatorium, Chennai. Established in 1928 as a 12-bed private tuberculosis sanatorium, it now has extensive outpatient and laboratory facilities as well as 32 inpatient wards, with a total of 776 beds; 8 of the wards are devoted to patients with HIV. Between April 2004 and February 2007, more than 5000 patients began antiretroviral therapy at the hospital. "Every other government and private hospital would just throw the patient out as soon as they found they were HIV-positive," says Soumya Swaminathan, deputy director of the Tuberculosis Research Center in Chennai. "At Tambaram, anyone could walk in at any time. They would be taken care of."
In India, as in much of the world, stigma and discrimination present major barriers to controlling AIDS. In 2005, the HIV–AIDS unit of the Mumbai-based Lawyers Collective, which provides free legal aid, drafted comprehensive antidiscrimination legislation. India's parliament has yet to consider the bill. There are other antidiscrimination efforts, such as a campaign to persuade the courts to overturn, or the parliament to rewrite, Section 377 of the Indian Penal Code, which makes homosexuality illegal and punishable by imprisonment. 1 Within the next several months, a more accurate estimate of the number of HIV-infected people in India should be released. Although the estimate is eagerly awaited, its effect, if any, on India's resolve is a matter of conjecture. Regardless of the number, the new phase of the AIDS control program is just beginning, and the challenges remain immense. | | | | | The Following 15 Users Say Thank You to writetotanveer For This Useful Post: | abhichin (03-08-2007), anubhav_1986 (22-06-2007), archiserrao (05-07-2007), CATcherintherye (24-03-2007), Ch!Nk (01-04-2007), huzefa bala (30-04-2007), in210223 (27-05-2007), mbain2007 (06-09-2007), midhun murali (18-07-2007), popoye (28-09-2007), rani_das (03-04-2007), satwik_204 (01-05-2007), saurabh20_manit (14-04-2008), savomaniac (28-06-2007), shivakanthm (18-05-2007) | | |